Photo: Andrey V. Pirogov, Assistant Director-General - Executive Director of the WHO Office at the UN (third from left) is presented with the report of Dr. Giorgio Giovannoni, Chair of the Health Educational Programs Committee of the International Service Division of the Rotary Club of New York. The report outlines the need for the construction of the Saint Bakhita Dispensery in Atacora, Benin. Also in the photo are (from left) John German, Giorgio Balestrieri, Rotary Ambassadorial Scholar Celine H.L. Tsai from the Taipei Millenium Rotaract Club in Tiawan, Rotarian Bill Delong and Sister Marie Adele of the Fraternite Notredame.
Editor's Notes:
This report was originall written in Italian and traslatted into English. Some minor changes have been made by the Newsletter Editor.
Editor's Notes:
This report was originall written in Italian and traslatted into English. Some minor changes have been made by the Newsletter Editor.
Saint Bakhita is The Catholic Saint of Africa. She was born to a wealthy Sudanese family, and was kidnapped by slave-traders at age 9, and given the name Bakhita by them. Sold and resold in the markets at El Obeid and Khartoum, finally purchased in 1883 by Callisto Legnani, Italian consul who planned to free her. She accompanied Legnani to Italy in 1885 and worked for the family of Augusto Michieli as nanny. She was treated well in Italy, and grew to love the country. An adult convert, joining the Church on 9 January 1890, she took the name of Josephine as a symbol of her new life. She entered the Institute of Canossian Daughters of Charity in Venice, Italyin 1893 taking her vows on 8 December 1896 in Verona, and serving as a Canossian Sister for the next fifty years. Her gentle presence, her warm, amiable voice, and her willingness to help with any menial task were a comfort to the poor and suffering people who came to the door of the Institute. After a biography of her was published in 1930, she became a noted and sought after speaker, raising funds to support missions.
Tom McConnon provided Doctor Giovannoni, that is the project cooordinator (www.puntomedico.it/benin), the contacts with the District Governor in Benin for this important project that besides the NY Rotary and other rotarians in Italy and Benin has as supporting members the Veneto Region, the Health Unit No. 15 of Padova District, Guerrato Spa of Rovigo, the Savings Bank of Padova and Rovigo, the C.I.S.L. of Padova, the Association of the Rural Families of the Piave and Giuseppe Olivotti s.c.s. a non-for profit organization.
GENERAL SITUATION OF THE REGION
Economy:
Natitingou Diocese is situated in Atacora, the only region in the whole Benin characterized
by the presence of mountains. Seasons sequence is marked by a rainy period, which lasts
from May to October, and by a dry one dominated by Harmattan, with dry winds coming
from the Sahara.
Inhabitants mainly live in houses made up of mud and straw, although in few cases it’s
possible to have building with iron-plated roofs, which are often further less unfit than the
straw one, because of the high temperatures. Jobs mainly consists on cultivations and animals breeding. The instruments used to work the fields are very rudimentary such as the hatchet, while oxen are rarely used. The main products are: millet, beans, potatoes and yams.
All of them are produced for a subsistence economy, and are often damaged by acts of
nature, like: drought, overflows, and parasitical epidemics.
Only growing cotton, although limited in some areas, permits a very modest income from
abroad.
Agriculture is obfuscated by the presence of uneven ground, rains which are often
insufficient and concentrated in short periods of the year. Another negative factor for
economy of this area is the complete absence of other industries, apart from agriculture,
such as handicraft.
Population:
The population of Natitingou diocese counts up over 40.000 inhabitants who chiefly live in
rural areas and it is divided in more than 20 different ethnic groups; however, only 5 of
these are acknowledged on the cultural side and officially recognized and they are: the
Ditamari, who live in the Tatas Somba; the Wamas, who occupy the middle area of the
region; the Baribas at the east; the Berbas in the north-west; while the Gourmantchés are
nomadic.
These ethnic groups, although maintaining their ethic and traditions, are able to keep a
relation of agreement among them; share the same difficulty in every sort of communication,
even if the population feels to be isolated and left alone, both by local politics and by
international organizations.
School-attendance index:
School attendance is limited, less than the 30% of young boys and girls being in school
age attends it regularly. This phenomenon is further more diffused among young females.
School is often interrupted because of the pressing necessity of job for the families.
Children’s labor is often required for fields growing.
Another difficulty consists on the poverty of the families who haven’t got sufficient money
neither to permit their children to enter school nor to buy goods of bare necessities.
In addition to poverty, there’s a lack of sensibility towards the importance of school
education.
In many cases, relatives themselves have never attended school, and, so, they hardly
understand the importance of giving a school education to their sons.
Health:
Having a bad nutrition affects especially children and young persons, and, among young
people, almost the 50% suffers from it and haven’t got sufficient food, and often this is due
to ignorance and taboos; as consequences of this, we have sickness and damages which
obstructs the children’s natural growth. The principal sicknesses affecting this area are:
malarial fever, anemia, diarrhea due to the use of undrinkable water.
Other sicknesses, although less frequent than the formers, are diffused in spite of
vaccination campaigns carried out, and they are: meningitis, cholera and jungle fever.
There are still many big villages which can’t take advantage of a Health Center to take
care of themselves and this because of various reasons.
Land and economy characteristics in the area of the intervention:
The area interested by their project comprehends 23 villages, which are Natitingou diocese
parishes and is situated in a mountain region of Benin.
The ground is poor, although, with appropriated techniques, it is possible to improve the
production with new growing techniques, fertilizing, irrigation, although this last one has to
be limited to the richest horticultural crops because of the lack of water, especially
during the drought.
The area is crossed by a river with a flow that may change during the year worth a
maximum reached in the rains period, that is to say from May to October, and a minimum
in the dryness from November to April.
To increase water availability for human uses, for animals and crops and making the
period of utilization last for longer, it is possible to project the creation of some
along the course of the brook, and some wells thanks to the presence of a deep stratum
rich of water.
These resources would make water available to the population during the whole year and
to all the components of the family, furthermore even to those sites where will take place
the attendances expected by the actuation of the project.
It is known that water is a strategic factor for a productive, economic and social
development of a community and, without it, it is hard to accomplish an improvement on
the present situation of poverty. Other positive aspects in this area concern the presence of a road to Natitingou, which is only 22km far away are the availability of 30 hectares of already settled and good quality ground;
The possibility of having other adjacent 30 hectares of ground at disposal and the
prospective of a market place where to collocate agriculture and animal-breeding products.
Population’s attitude towards this project is another considerable factor, thanks to
the activity of the dioceses development committee. In fact, expectations on this project are a factor essential for the promotion and the participation of the community in the realization of any development initiative.
SITUATIONS OF MEDICAL STRUCTURES PRESENT IN NATITINGOU DIOCESES
After being invited by Natitingou bishop, Pascal N’koue, who had previously
been our guest in Italy, we went to Benin and visited the dioceses in order to rate the social
and hygienic conditions and check the level both of medical structures and organization of
the region. We examined two clinics, one situated in Nattitingou city and another one which are about 100 kilometers distant among them, I’d like to remember that there are only 7 clinics in the dioceses and that they are many kilometers far away one from another.
Natitingou clinic appeared absolutely insufficient for what concerns the structure, the
spaces reserved to the medical assistance, the equipment and, furthermore, for the small
number of the equipped members. We were impresses especially by the delivery room,
which was insufficient for dimensions, equipment and hygiene.
Spaces set for recovering and visiting the patients( the obstetric room is furnished with 5
beds; while general cases are managed in a room furnished with 6 beds) seemed
unavailable to receive people both because of the bad ambient conditions and the
hygienic ones.
There’s even a surgery applied for check up and a lab where any microbiological and
parasitical exam could be done; however they are very hampered by a bad equipment.
In this medical structure work a doctor, an obstetric assistant and a lab expert.
The doctor appeared very motivated and well-prepared; he and his colleagues complained
about the situation in which they have to operate in the hospital delivery room.
We visited even the clinic 100 km far away from Natitingou. This structure was in better
condition than the former. The delivery room, the spaces used for recovering women who
have just given birth to a baby and the ward (2 rooms with 5 beds each) looked clean
enough and quiet comfortable; however, it was shocking to discover that this clinic suffers
from the absence of a doctor who is neither available. This clinic is managed by a nun who
operates there as a nurse, with the help of an assistant who had experience of obstetric.
Patients attending this clinic are managed both for the diagnosis and the cures by the
equipment previously described, but in case of necessity and not without troubles, they are
moved to clinics more furnished (don’t forget that the only hospital is many kilometers
distant from the clinic). As a consequence, patients may run into serious risks, especially those women whose labor and childbirth present complications.
In spite of all these aspects, what impressed me in a greatly positive way, is the motivation
and the strength of these persons who daily give themselves to the assistance of poor and
needy people 100 km far away from Natitingou.
Furthermore, we visited a clinic in the north of Tanguieta, close to Porga, which has not
been operative yet, but will soon start working. This clinic is applied with an ambulatory for
check-up, a lab, an obstetric ward, a pediatric one and one for first aid, although offering
few beds, it looked very functional and clean.
Very close to this clinic, it has been built a hostel for hosting the religious members of the
equipped who will handle the clinic. This type of building should be taken as a model for the
reorganization of Natitingou clinics.
Clinic of Porga
Finally we went to Tanguieta’s hospital in the north of Natitingou dioceses.
For what concerns the medical equipped, the hospital counts up: a medical director, who
manages every aspect relating to surgery (from general surgery to orthopedic surgery);
furthermore, the medical equipped is formed by 7 doctors, while there are about 100 people
joining the paramedical personnel as nurses.
The hospital has a well furnished surgery room where can take place any kind of
emergency operations and specialized ones. There are even 3 beds used for intensive
therapy, in addiction to the surgery one, a ward which is very important and worthwhile for the
hospital is the pediatrics one with 120 beds, although is some period of the year there
might be recovered more than 180 children.
It’s obviously present an obstetric ward and one where are recovered even many patients
dying for AIDS virus.
This hospital is remarkably managed by the FATEBENEFRATELLI foundation, which
operates in a very wide territory going from Benin up to Togo and Burkina Faso. In fact,
there are many patients coming to this hospital even from 1000 kilometers of distance.
URGENT SANITARY NEEDS AND PROPOSAL FOR THE FUTURE
After the on-the-spot investigation and after the exchange of opinions we had with the
doctors and the religious members who work in the clinics previously described, and in
particular with the doctor at the head of Natitingou’s clinic and the medical director of
Tanguieta’s hospital, it has been brought out the exigence of pursuing the following tasks:
1. Finding a doctor to be responsible for all the clinics in Natitingou dioceses (at the
moment, there’s only one doctor who operates in Natitingou city), who will
periodically visit all the clinics in order to control the work of the paramedical
personnel; check the furniture and visit those patients considered in need of a more
specialized visit by the paramedical personnel and that only the doctor can carry
out. The presence of a doctor might be important even because the doctor could
become a reference for the population in those places and so create a relationship
based on faith towards the medical clinics and the cures practiced.
2. Join all the clinics among them by the mean of a radio network in order to make it
possible to them to communicate in case of collaboration and advice. It might be very useful even the availability of a motor ambulance to connect the clinics.
3. Reorganize the clinics for what concerns the necessary furniture and the equipped
members. In particular, Natitingou clinic urges to be reorganized, while waiting for a
new building, and to be improved. In case it would be impossible or inconvenient to
make it wider, it would be better to optimize the use of the spaces available (such
as the delivery room); to apply it with the minimum furniture and the instruments
necessary for medical activity.
4. The building of a new clinic in Natitingou results fundamental first of all because the
present one is absolutely insufficient for the medical cures required by Natitingou
population; furthermore it could be an important reference for Tanguieta’s hospital.
At the moment the hospital of Tanguieta hosts many patients who might be
recovered in other local buildings at the same fine way as in Tanguieta’s hospital. If
only there were local clinics well functioning, the hospital of Tanguieta could
become a reference only for cases of extreme emergency, so saving means and
cures to patients who really need them.
5. To spread among the population a sentiment of sensibility towards the use of the
medical buildings of their area, making them comprehend the usefulness and the
benefits they can obtain for their health in those structures, without revolutionizing
their beliefs and habits.
6. To activate a clinic at the farm of Pam Pam in order to give medical assistance to
people who work there and to all the population living in the surroundings. Such an
employment and the sanitary buildings might help, as time passes by, the formation
and development of a village close to the farm.
7. Promote collaborations among the clinics.
Submitted by Dr. Giorgio Giovannoni
Rotary Club of New York
Economy:
Natitingou Diocese is situated in Atacora, the only region in the whole Benin characterized
by the presence of mountains. Seasons sequence is marked by a rainy period, which lasts
from May to October, and by a dry one dominated by Harmattan, with dry winds coming
from the Sahara.
Inhabitants mainly live in houses made up of mud and straw, although in few cases it’s
possible to have building with iron-plated roofs, which are often further less unfit than the
straw one, because of the high temperatures. Jobs mainly consists on cultivations and animals breeding. The instruments used to work the fields are very rudimentary such as the hatchet, while oxen are rarely used. The main products are: millet, beans, potatoes and yams.
All of them are produced for a subsistence economy, and are often damaged by acts of
nature, like: drought, overflows, and parasitical epidemics.
Only growing cotton, although limited in some areas, permits a very modest income from
abroad.
Agriculture is obfuscated by the presence of uneven ground, rains which are often
insufficient and concentrated in short periods of the year. Another negative factor for
economy of this area is the complete absence of other industries, apart from agriculture,
such as handicraft.
Population:
The population of Natitingou diocese counts up over 40.000 inhabitants who chiefly live in
rural areas and it is divided in more than 20 different ethnic groups; however, only 5 of
these are acknowledged on the cultural side and officially recognized and they are: the
Ditamari, who live in the Tatas Somba; the Wamas, who occupy the middle area of the
region; the Baribas at the east; the Berbas in the north-west; while the Gourmantchés are
nomadic.
These ethnic groups, although maintaining their ethic and traditions, are able to keep a
relation of agreement among them; share the same difficulty in every sort of communication,
even if the population feels to be isolated and left alone, both by local politics and by
international organizations.
School-attendance index:
School attendance is limited, less than the 30% of young boys and girls being in school
age attends it regularly. This phenomenon is further more diffused among young females.
School is often interrupted because of the pressing necessity of job for the families.
Children’s labor is often required for fields growing.
Another difficulty consists on the poverty of the families who haven’t got sufficient money
neither to permit their children to enter school nor to buy goods of bare necessities.
In addition to poverty, there’s a lack of sensibility towards the importance of school
education.
In many cases, relatives themselves have never attended school, and, so, they hardly
understand the importance of giving a school education to their sons.
Health:
Having a bad nutrition affects especially children and young persons, and, among young
people, almost the 50% suffers from it and haven’t got sufficient food, and often this is due
to ignorance and taboos; as consequences of this, we have sickness and damages which
obstructs the children’s natural growth. The principal sicknesses affecting this area are:
malarial fever, anemia, diarrhea due to the use of undrinkable water.
Other sicknesses, although less frequent than the formers, are diffused in spite of
vaccination campaigns carried out, and they are: meningitis, cholera and jungle fever.
There are still many big villages which can’t take advantage of a Health Center to take
care of themselves and this because of various reasons.
Land and economy characteristics in the area of the intervention:
The area interested by their project comprehends 23 villages, which are Natitingou diocese
parishes and is situated in a mountain region of Benin.
The ground is poor, although, with appropriated techniques, it is possible to improve the
production with new growing techniques, fertilizing, irrigation, although this last one has to
be limited to the richest horticultural crops because of the lack of water, especially
during the drought.
The area is crossed by a river with a flow that may change during the year worth a
maximum reached in the rains period, that is to say from May to October, and a minimum
in the dryness from November to April.
To increase water availability for human uses, for animals and crops and making the
period of utilization last for longer, it is possible to project the creation of some
along the course of the brook, and some wells thanks to the presence of a deep stratum
rich of water.
These resources would make water available to the population during the whole year and
to all the components of the family, furthermore even to those sites where will take place
the attendances expected by the actuation of the project.
It is known that water is a strategic factor for a productive, economic and social
development of a community and, without it, it is hard to accomplish an improvement on
the present situation of poverty. Other positive aspects in this area concern the presence of a road to Natitingou, which is only 22km far away are the availability of 30 hectares of already settled and good quality ground;
The possibility of having other adjacent 30 hectares of ground at disposal and the
prospective of a market place where to collocate agriculture and animal-breeding products.
Population’s attitude towards this project is another considerable factor, thanks to
the activity of the dioceses development committee. In fact, expectations on this project are a factor essential for the promotion and the participation of the community in the realization of any development initiative.
SITUATIONS OF MEDICAL STRUCTURES PRESENT IN NATITINGOU DIOCESES
After being invited by Natitingou bishop, Pascal N’koue, who had previously
been our guest in Italy, we went to Benin and visited the dioceses in order to rate the social
and hygienic conditions and check the level both of medical structures and organization of
the region. We examined two clinics, one situated in Nattitingou city and another one which are about 100 kilometers distant among them, I’d like to remember that there are only 7 clinics in the dioceses and that they are many kilometers far away one from another.
Natitingou clinic appeared absolutely insufficient for what concerns the structure, the
spaces reserved to the medical assistance, the equipment and, furthermore, for the small
number of the equipped members. We were impresses especially by the delivery room,
which was insufficient for dimensions, equipment and hygiene.
Spaces set for recovering and visiting the patients( the obstetric room is furnished with 5
beds; while general cases are managed in a room furnished with 6 beds) seemed
unavailable to receive people both because of the bad ambient conditions and the
hygienic ones.
There’s even a surgery applied for check up and a lab where any microbiological and
parasitical exam could be done; however they are very hampered by a bad equipment.
In this medical structure work a doctor, an obstetric assistant and a lab expert.
The doctor appeared very motivated and well-prepared; he and his colleagues complained
about the situation in which they have to operate in the hospital delivery room.
We visited even the clinic 100 km far away from Natitingou. This structure was in better
condition than the former. The delivery room, the spaces used for recovering women who
have just given birth to a baby and the ward (2 rooms with 5 beds each) looked clean
enough and quiet comfortable; however, it was shocking to discover that this clinic suffers
from the absence of a doctor who is neither available. This clinic is managed by a nun who
operates there as a nurse, with the help of an assistant who had experience of obstetric.
Patients attending this clinic are managed both for the diagnosis and the cures by the
equipment previously described, but in case of necessity and not without troubles, they are
moved to clinics more furnished (don’t forget that the only hospital is many kilometers
distant from the clinic). As a consequence, patients may run into serious risks, especially those women whose labor and childbirth present complications.
In spite of all these aspects, what impressed me in a greatly positive way, is the motivation
and the strength of these persons who daily give themselves to the assistance of poor and
needy people 100 km far away from Natitingou.
Furthermore, we visited a clinic in the north of Tanguieta, close to Porga, which has not
been operative yet, but will soon start working. This clinic is applied with an ambulatory for
check-up, a lab, an obstetric ward, a pediatric one and one for first aid, although offering
few beds, it looked very functional and clean.
Very close to this clinic, it has been built a hostel for hosting the religious members of the
equipped who will handle the clinic. This type of building should be taken as a model for the
reorganization of Natitingou clinics.
Clinic of Porga
Finally we went to Tanguieta’s hospital in the north of Natitingou dioceses.
For what concerns the medical equipped, the hospital counts up: a medical director, who
manages every aspect relating to surgery (from general surgery to orthopedic surgery);
furthermore, the medical equipped is formed by 7 doctors, while there are about 100 people
joining the paramedical personnel as nurses.
The hospital has a well furnished surgery room where can take place any kind of
emergency operations and specialized ones. There are even 3 beds used for intensive
therapy, in addiction to the surgery one, a ward which is very important and worthwhile for the
hospital is the pediatrics one with 120 beds, although is some period of the year there
might be recovered more than 180 children.
It’s obviously present an obstetric ward and one where are recovered even many patients
dying for AIDS virus.
This hospital is remarkably managed by the FATEBENEFRATELLI foundation, which
operates in a very wide territory going from Benin up to Togo and Burkina Faso. In fact,
there are many patients coming to this hospital even from 1000 kilometers of distance.
URGENT SANITARY NEEDS AND PROPOSAL FOR THE FUTURE
After the on-the-spot investigation and after the exchange of opinions we had with the
doctors and the religious members who work in the clinics previously described, and in
particular with the doctor at the head of Natitingou’s clinic and the medical director of
Tanguieta’s hospital, it has been brought out the exigence of pursuing the following tasks:
1. Finding a doctor to be responsible for all the clinics in Natitingou dioceses (at the
moment, there’s only one doctor who operates in Natitingou city), who will
periodically visit all the clinics in order to control the work of the paramedical
personnel; check the furniture and visit those patients considered in need of a more
specialized visit by the paramedical personnel and that only the doctor can carry
out. The presence of a doctor might be important even because the doctor could
become a reference for the population in those places and so create a relationship
based on faith towards the medical clinics and the cures practiced.
2. Join all the clinics among them by the mean of a radio network in order to make it
possible to them to communicate in case of collaboration and advice. It might be very useful even the availability of a motor ambulance to connect the clinics.
3. Reorganize the clinics for what concerns the necessary furniture and the equipped
members. In particular, Natitingou clinic urges to be reorganized, while waiting for a
new building, and to be improved. In case it would be impossible or inconvenient to
make it wider, it would be better to optimize the use of the spaces available (such
as the delivery room); to apply it with the minimum furniture and the instruments
necessary for medical activity.
4. The building of a new clinic in Natitingou results fundamental first of all because the
present one is absolutely insufficient for the medical cures required by Natitingou
population; furthermore it could be an important reference for Tanguieta’s hospital.
At the moment the hospital of Tanguieta hosts many patients who might be
recovered in other local buildings at the same fine way as in Tanguieta’s hospital. If
only there were local clinics well functioning, the hospital of Tanguieta could
become a reference only for cases of extreme emergency, so saving means and
cures to patients who really need them.
5. To spread among the population a sentiment of sensibility towards the use of the
medical buildings of their area, making them comprehend the usefulness and the
benefits they can obtain for their health in those structures, without revolutionizing
their beliefs and habits.
6. To activate a clinic at the farm of Pam Pam in order to give medical assistance to
people who work there and to all the population living in the surroundings. Such an
employment and the sanitary buildings might help, as time passes by, the formation
and development of a village close to the farm.
7. Promote collaborations among the clinics.
Submitted by Dr. Giorgio Giovannoni
Rotary Club of New York
