Fausto Ciccacci has been directing the Community of Sant’Egidio’s health projects in Mozambique for over 10 years. He was involved in the creation of the NCD project, funded by the Italian Agency for Development Cooperation against chronic diseases in Mozambique, and which was started by CUAMM in collaboration with AIFO, among others. As a doctor he deals with the clinical aspect of the project.
This project aims to improve the Mozambican health system’s capacity to respond to emerging chronic diseases, in particular diabetes, hypertension and cervical cancer. The initiative began with a generous loan allocated by the Italian Agency for Development Cooperation in Maputo. The Community of Sant’Egidio, together with CUAMM and AIFO decided to accept the challenge. The project involves 13 health centres in three of the country’s provinces (south, centre, north). The aim is to turn them into centres for screening, diagnosing and treating these three diseases, and to raise the awareness of the community of the importance of actively looking for these diseases.
As with the other projects in Africa, Sant’Egidio counts on local staff. This project is run by Mozambican nurses, medical technicians, pharmacists, biologists and administrators, who work on the project every day with great professionalism, and who Ciccacci is in touch with every day.
What is the situation regarding chronic diseases in the country?
In Mozambique, as in other African countries, there is now a situation in which there are both diseases related to poverty and diseases related to wealth. This is the phenomenon of the double burden of diseases. Mozambique still has a high number of deaths from infectious diseases (especially the three main diseases, HIV/AIDS, tuberculosis and malaria), maternal mortality and infant malnutrition. As the same time however, there has been an increase in non-communicable diseases, mainly hypertension, diabetes and cancer. Hypertension alone is estimated to have a 30% prevalence in Mozambique. This is just an estimate because the country is not yet very good at diagnosing and therefore then treating these patients. There are hidden non-communicable diseases that we are trying to find. In any case, the spread of Western lifestyles, the increase in life expectancy of the general population and the increased survival of patients with HIV are all factors that will lead to a rapid increase of these diseases.
What is the most urgent need?
One of the first aspects to improve is screening. One of the first ways we are doing this is by measuring the blood pressure and blood glucose levels in all the patients, in order to see the real number of people with hypertension and diabetes. The problem though, is the lack of instruments, which need to be provided so the diagnosis can be carried out properly. This is one of the key points of the project, together with therapy and follow-up.
How long will it take for the approach to these diseases to reach a good level in the country?
Unfortunately Mozambique is a country that still has a lot of problems, not only in terms of health. It is one of the poorest countries in the world, 180th out of 189. The life expectancy is still around 60 years and on average the Mozambicans only go to school for three years. For these and for other reasons, it will take a long time. We are working on this project and other initiatives to promote simple and cost-effective solutions to respond to new health challenges, but it will take time. Above all, renewed international involvement in these countries will be necessary, also in non-communicable diseases.
The local personnel’s response, their participation.
During our field work, what impressed us most was the enthusiasm of the local personnel. We started three training courses for doctors, nurses and medical technicians who work in the centres with the project. They are all enthusiastic about learning but above all about receiving the instruments they need in order to put into practice what they have learnt. Many Mozambican healthcare professionals are frustrated because they are not able to help the patients. For us doctors, being able to help a patients get better, or when possible, cure them, is the most rewarding aspect of our work. Imagine what it means to have a patient in front of you, to understand that you could save their life with an antihypertensive therapy, for example, because otherwise they risk a stroke or a heart attack, but you don’t have the medication you need. When the staff realised we were going to help them get the drugs so they could treat the patients, it was as if we had told them the best thing in the whole world, and when we brought the electrocardiograms their eyes lit up. It is ridiculous considering this is an ordinary routine test for us. Altogether we found that the local personnel are very enthusiastic and willing.
How is the project carried out?
The part of the project that we are involved with, as the Community of Sant’Egidio, is first of all based on the everyday work of local staff who communicate with us in Rome. Some missions with experienced international personnel are also planned. The purpose of these missions is to carry out training during the first year, and to supervise and possibly provide more training in the following two years. The missions we have carried out so far were aimed at providing the cultural instruments necessary to treat the pathologies included in the project. Every mission provides classroom taught lessons and training on the job. We have given more and more space to practical work because it has made it possible for us to better understand the situation in each centre and for them to understand how to integrate the indications in the everyday work they carry out in the centre.
What is your relationship with the Mozambican Ministry of Health?
Sant’Egidio has had an excellent relationship with Mozambican healthcare institutions for many years, both centrally and locally. The MISAU (Ministry of Health) is one of the project’s main partners, it has been involved since the planning stages of the initiative, and assisted us in choosing the sites and what was needed. In the current phases of the implementation of the project, both the MISAU and the local health authorities are playing a prominent role. This is an essential point. Involving the local institutions is fundamental, it aims to make sure there will be the continuity that is necessary to deal with these diseases.