All the Interventions MSF Made in the Past and Currently are very Important

All the Interventions MSF Made in the Past and Currently are very Important, Mr. Sylvain Perron (2-2)

MSF-Switzerland Sudan Head Mr. Sylvain Perron visited Sudan Vision premises and discussed with the newspaper staff many issues relating to the organization work and activities in Sudan. This is a report on this visit.
Interview by Alula Berhe Kidani
Photo: Al-Sir Mukhtar

Q: Is MSF involved in addressing the challenges of HIV/AIDS in Sudan?
A: This is something we didn’t work on in Sudan because it requires special resources and expertise that we don’t have here. There are other programs in the world that try to focus on this issue. But is Sudan, we focus on primary and secondary health care.

Q: UNAIDS is more specialized in this area.

A: If we speak of HIV/AIDS worldwide, MSF is involved all over the world and run huge centers for patients in Eastern and Southern Africa and MSF have been a pioneer in the management of HIV/AIDS since 2000. In Sudan the prevalence of HIV/AIDS is much lower than in many other countries that is also a reality. So, we focus on primary health care but that does not mean that HIV/AIDS or TB are not important but our focus is on the main diseases effecting people in Sudan; Malaria at the end of the rainy season and respiratory infections. This are the main diseases we focus now on but when from time to time we identify a patient effected by HIV/AIDS because we are doing tests in all our laboratories ,and when patients effected by AIDS or TB are identified we refer them to the Ministry of Health hospitals.

Q: Let us go back to the question of maternal mortality. There is a general consensus that the main challenge for maternal wellbeing is the lack of well-trained midwives in the rural areas. Are you training midwives or raising the capacity of the existing cadres?
A: Indeed, we are assisting a lot and that is one of our main objectives in South Kordofan in particular as it is purely a reproductive health project.

The government and the Ministry of Health have made a lot of efforts in the past years in training midwives or what is called village/communities midwives and we experienced in many primary health centers that midwives are available. The constraint for these women is the access to the hospitals in the centers in case of need for more specialized assistance. And there are many reasons behind this including social norms.
So, what we try to focus on in our project in South Kordofan is pass the message that services are available and free because this is a sort of constraint. If services are not free it may be very difficult for some in the villages to pay the fees. Also, try to pass a message that some deliveries could be performed at home safely but pregnancies at risk should be seen by a professional midwife and preferably the women to deliver in a facility. So, this is the messages that we try to pass to the communities.

Also, we try to understand what are the different challenges because off-course we are a medical organization but cannot ignore the social factors. So, we try to engage with sociologists, with communities, women group and communities leaders to understand what are the challenges and the barriers to address the risks.

Let us go back to your question in bridging the gap in the capacity and knowledge of professionals.
In South Kordofan part of our agreement with the Ministry of Health is to provide support to the Midwives Academy in Deleng, so MSF team assist by providing lectures, it is not that we consider these midwives are not well trained but we also have some expertise which can help in bridging the knowledge gap for these professionals.

Q: What about the IDPs camps in the rural areas around Khartoum State?
A: At the moment our organization is not present in Khartoum State to provide services for people from wherever they come from. As you say it is true that are some Sudanese IDPs in Khartoum and also refugees and migrants from neighboring countries. And I am sure that there are Sudanese people in need around Khartoum.
But that is always the difficult part with my job, where we set the priorities. You can be in a country and you could see that you could intervene in the East, West or South or the Centre. But unfortunately, and also we are a big organization worldwide, we still have limited means and resources. So, unfortunately, we cannot provide services everywhere. Despite that we wish and hope to work not only in Khartoum but all over Sudan.
So, we discuss with the Ministry of Health and HAC (Humanitarian Aid Commission) where the needs are and in the case that we are informed of a specific situation somewhere then depending on our resources we see how we can assist and set a project.
MSF in the past was very much involved in Khartoum with many projects. I remember in 2004, when I came to Sudan MSF was supporting Maygouma Orphanage and our colleagues where supporting centers in Omdurman and Jebel Aulia.

So, there may be needs in Khartoum as well but at the moment our organization is not working in Khartoum. But there other organizations that are present.
Personally, I would like to say that sometimes I would like to do more but we have to make choices. And at the moment been present in South Kordofan, North Darfur, White Nile and Gedarif is quite a lot.

Q: In your projects how do you guarantee sustainability?
A: This is a very good and an important question. In Sudan we always work with a national organization which means that in all the technical agreements that we sign with the government, Ministry of Health and HAC, national organizations are part of these agreements and sign the technical agreement with us. Then, we have a MoU (Memorandum of Understanding) with the national organization. So, in every project we have a partnership with a national organization and we work together on daily bases but our wish is to be able at the end of our intervention to hand over the project to a national organization or back to the Ministry of Health.
I will take the example of Gedarif where MSF have been present since 2009, supporting this hospital in Tabarkalla and since 2016 in Basoha. The work we provide there is not MSF work, it is really in cooperation with the Ministry of Health. This means that the care delivered to the patients’ every day is done jointly by MSF and the Ministry of Health (MOH). And our wish is that at some point MSF will be able to pull out and the MOH staff will continue to provide the care.

We believe in building the capacity of all MOH staff as much as we can.
We guarantee sustainability and I wish we could and we are trying to do our best by having these capacity building actions and supporting the Midwives Academy in Deleng , working together in MOH hospitals.
I will again take the example of Gedarif for the last one year ,the hospital we support in Tabarkal is also a training center and we have medical doctors coming from all over Sudan to be familiar with the management of Kalazar and I believe this also contribute to sustainability.

Q: MSF had a wide world experience, so do you have any relation or interaction with medical institutions in Sudan?
A: Yes, we have specially in Kalazar,I speak a lot about Kalazar because it is the oldest project since 2009 . So for example, we have partnership with the Kalazar Research centers and that is very search Centre of the University of Gedarif a partnership that we have for more than one year. We are also coordinating with the medical institutions here in the University of Khartoum engaging with research centers and that is very important. We are trying to do more and have more ambitions for the coming years and always try to involve national professionals, so that is very important so that we don’t work alone.

Q: Are you engaged in public awareness rising campaigns?
A: Yes and this is what we call prevention. Off course without the involvement of the communities and without raising awareness then your hospital or facility became an isolated island. So, it is very important to link the work inside the hospital with the communities. So, in all our projects and whatever we do, we have a health promotion and education component and very often with the help of our national partner. So, we have an active community awareness program in all our projects.
In East Darfur, we have a team of community workers who everyday deliver health messages to encourage people to come to the facility whenever they are sick ,try to make them understand what is water-diarrhea. Try to understand why people don’t come. Some times in the refugee camps the women are alone with many children and have to take care of an extended family. So, we try to understand that and provide some support for those women. So, what we call community awareness is very important and part of all our projects everywhere.

Q: What are the criteria for the selection of certain areas for your interventions?
A: This is about first discussing with partners in the Ministry of Health and HAC and also the other actors present here in Sudan (international and national NGOs and the UN Agencies). Off course, we are also part of the forms that follow the situation in Sudan or anywhere in the world. Also we discuss directly with the communities trying to understand what are the dynamics and the problems and where our organization could help with the most added value.

And as a health emergency organization we follow the public health situation in the country and we hear of cases of epidemic disease, this is something we follow up and engage in discussions with the Ministry of Health to see if there is something we could do. We try to focus always where we could have the most added values, where we could save lives. It is true that in case of influx of people, displaced people or refugees, the first few days could be very critical. This is our experience from all over the world for the last 40 years. We will try to focus on emergencies and where other organizations are not present or less present.

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