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Submitted by Jim Moore, Malaria Partners International Vice Board Chair

The purpose of the trip to Senegal and the Gambia was to follow up with Gambian Rotary members on the Malaria Public Education/Awareness project implemented in support of the Senegambia national LLITN distribution campaign and to explore opportunities for follow-on projects—perhaps even a Global Grant.  October 14-15 were spent in Dakar to meet with key anti-malaria organizations and two Rotary clubs, including Senegal’s largest and oldest club:  RC Dakar Doyen.  Thanks to groundwork for the visit laid by Dr. Emma Bruce and AG Fatou Bah of the Gambia, I was met at the airport and escorted to all meetings by AG Massaer Ndiaye.

My meeting schedule in Dakar and Banjul did not allow for air travel between the two as there are not daily flights.  So, on Wednesday, October 16, I traveled by road and ferry to Banjul, arriving in the early evening, in time for RC Banjul’s welcome meeting.  The next three days involved meetings with NGO, Gambian Government, U.S. Embassy and Rotary members with the highlights being an hour long meeting with the President of the Gambia, Adama Barrow, a half-hour interview on National TV, and a grand Rotarian gathering to celebrate their campaign against malaria.

SENEGAL

October 13: arrived at Dakar at 08:00 and was met at the airport by Senegal AG Dr. Masseur Ndiaye, a primary care physician who also supplies pharmaceutical products to doctors and pharmacies in Senegal.  Dr. Ndiaye brought me to my hotel, the International Dakar TVN. The rest of the day was spent recovering from jet lag and making arrangement for Monday and Tuesday’s meetings.  I spoke with Emma Bruce and Gambia AG Fatou Bah.  Massaerndiaye6819@gmail.com  massaermed@hotmail.com                                                                                                                                                                                                              October 14:  Picked up by Dr. Ndiaye at noon and taken on brief sightseeing tour of Dakar on the way to lunch.  We discussed the malaria elimination opportunities in which Senegalese Rotary members might be interested as well as the possibilities for a collaborative relationship in an elimination project between Gambian and Senegalese Rotary members.

At 2:15 PM, we met with Dr. Katherine (Kathy) Sturm-Ramirez, CDC Resident Advisor for PMI.  Dr. Sturm-Ramirez was giving us extra dispensation by meeting on the Columbus Day holiday.  After explaining Rotary and Malaria Partners International as well as the Malaria Partners International history with malaria elimination projects in Uganda and Zambia, we turned the conversation to PMI’s changing perspective on malaria—from control to elimination.  Dr. Ramirez outlined PMI’s role in providing commodities to the national malaria program and indicated that moving to “elimination” as the objective gave the PMI program a new, more satisfying mission.  The Senegal team of PMI is in the process of preparing their annual program and, although they do not work in the Gambia, might consider funding “Senegambia” collaboration meetings in Senegal by Rotary clubs in both countries. At my request, she said she would float the idea, although resources available were limited.   ksturm@usaid.gov

By chance, the Coordinator of Senegal’s Programme Nationale pour la Lutte contre le Paludisme (PNLP), Dr. Doudou Sene, was a medical school classmate of Dr. Ndiaye.  Thus, even on short notice, we were able to secure an appointment to meet with him and did so for about 30 minutes.  In this introductory meeting, Dr. Sene described the progress that had been made in Senegal against malaria emphasizing the challenges that remained in more remote rural regions, along the border with Guinea and in areas bordering the Gambia.  He leafed through an evaluation report of the Senegambia bednet distribution campaign and expressed an interest in the possibilities for Rotarian assistance on both sides.  I explained the roles that Rotary members were playing in Zambia and Uganda, as well as the scale of activities that they were undertaking.  drdocsene@yahoo.fr

Dr. Ndiaye and I then proceeded toward downtown where we met up with PDG Aristide Tino Adediran.  The three of us traveled to the nearby location where the Rotary Club of Dakar Alizes held its meetings.  The hour long meeting was devoted to a brief presentation by me in halting French, followed by a longer Q & A in which Dr. Ndaiye explained the cycle of malaria parasites and we discussed the actions that were being taken, in the absence of a vaccine, to reach zero malaria.  The meeting ended at 8 PM and, given the heavy traffic in Dakar, I was able to reach my hotel an hour later.  Aristidetino@yahoo.fr

October 15:

Tuesday morning, for one hour, we met with the PATH/MACEPA team, led by Dr. Aminatou Sar.  PATH has implemented the same data collection and graphical presentation tools as they developed for Zambia.  The CHW component is on the PEDACOM++ model, with CHWs visiting every village household once per week.  The problem has been turnover among CHWs because of the lack of income earning alternatives.  A proposal that is going to be tried is to give the CHW a plot of land in exchange for his/her health services in the village.  Creating other forms of agribusiness opportunities have also been proposed—e.g., heifer project support for animal husbandry.

The PATH team with other collaborators also has an interest in the delivery of nutrition through fortified rice or millet as part of the CHW formula.  We have often discussed among ourselves what additional roles CHWs can play, like nutrition assistance, and how they might be compensated for it.

Dr. Sar indicated that PATH/MACEPA was very interested in extending their data collection program to both sides of the border area.  Thus, working with the Gambia NMCP.  The Senegambia cooperation agreement facilitates a partnership via CHW activities and data collection as well as other aspects of “getting to zero.”  Drs. Sar and Diouf thought that Rotary members could undertake a continuous program of public education and/or the provision of training and material inputs for income-earning activities for the CHWs.  asar@path.org

Dr. Ndiaye was kind to take me to the seaside monument/museum to independent African leadership (Malcolm X, MLK, and Barack Obama were included) and then to the National Museum where a young docent led us through the evolution of humans.

Rotary Club of Dakar Doyen: this 80 year old club has a membership of about 50.  30 or so attended the meeting.  PDG Tino (see RC Dakar Alizes, above) attended—it’s his home club.  The membership was mostly dressed in suits and the meeting was run in a more formal manner than RC Alizes the night before.  I made a brief presentation before the club’s main program: what Rotary members can do to combat climate change.

October 16:

Picked up at 7 AM for the drive to Banjul.  It took 2 hours to get out of Dakar as far as the airport exit on a 4-lane toll road.  An impressive number of breakdowns helped slow what little progress we might have had.  I am left with a better feeling about Seattle traffic after Dakar.  The rest of the trip was on 2-lane roads to the border, which we reached at around 1 PM.  Exiting Senegal is all electronic, with passport and finger print scans and no hassles.  Getting into the Gambia is another matter.  Every official had his hand out for a little “acknowledgement” of the help he was providing.  Everything needed to be noted down in ledgers—nothing electronic in the process.  Between the border and the ferry terminal, there were several checkpoints.  Although my driver was from the area and largely avoided any problems, a couple of surreptitious payments had to be made.  We then waited for about an hour for the ferry to arrive.  In her inimitable fashion, Emma Bruce had arranged with the director of the ferry terminal for our vehicle to be at the front of the line.  She came over on the ferry to meet us.  The passage across the River Gambia took about an hour and after the traffic coming into Banjul, I got to the hotel by around 5 PM (long day).

The Rotary Club of Banjul had invited members of the other clubs and Rotaractors to join in a welcome meeting at the resort hotel next door to mine.  It was a nice turnout and my presentation about Malaria Partners International and what we might be able to help Rotary members in the Gambia accomplish was the main program.  Dr. Bruce thought that it hit the mark very well, but she tends to be generous in her praise of everything that Malaria Partners International has done for Gambian Rotary members.

October 17:

Meetings were held today with, CRS’s Ousman Ndie & team, NMCP’s Balla Kandeh & team, and U.S. Peace Corps.

Catholic Relief Services (CRS):  Emma, I and two other Malaria Committee members met with Ouman Ndie, Director of CRS/the Gambia.  Ousman described the CRS partnership with Rotary members as relatively new and it was becoming part of the significant progress that was being made in the Senegambia initiative.  CRS volunteers helped distribute bednets in two regions of the Gambia and they have been training volunteers for seasonal malaria chemoprevention (SMC) – mass preventative treatment programs for children.  They annually train about 400 volunteers.  During the August – December period, they check on kids 0 – 9 months in 4 cycles and treat them with a malaria preventative using drops.

CRS has also initiated a two-year pilot project as part of the Sene-Gambia cooperative effort.  They have recruited and trained 35 village health workers, supervised by 7 community health workers.  They are now adding 26 more VHWs in a 2nd location.  In addition, CRS has trained 72 volunteer students to talk to their peers in secondary schools about malaria prevention.   Data derived from diagnosis and treatment by CRS VHWs and related programs are shared with the Ministry of Health and Social Welfare and eventually will be integrated into one health information system.   Interesting to note that the CRS staff included one RPCV and one current PCV.

National Malaria Control Programme (NMCP): the NMCP coordinator, Balla Kandeh provided an overview of the country program and was most effusive about the key role that Rotary members and Rotaractors played in sensitizing the public about malaria and the proper use of mosquito nets that were being distributed as part of the Senegambia national bednet distribution program in April-May.  He and some members of his staff participated in the launch of the Rotary project, the March for Zero Malaria and World Malaria Day events.  This new partnership has been gratifying for both parties.  NMCP’s goal is to extend SMC to all children 10 years of age and under.  Already, the prevalence of the disease in kids under 5 has shrunk to fractions of a percent.  They are also planning IRS in the most endemic areas.  The goal with SMC coverage is 1,400 villages, so far 52 have been covered.

Dr. Bruce and I discussed priority gap areas in the getting to  zero program to which Rotary might contribute.  Balla proposed financing 4 urban spray units for densely populated areas around the capital at a cost of about E7,000 each.  This would do much to encourage the private sector to support NMCP.  Next was the training, equipping and deploying of CHWs to implement iCCM or PEDACOM++.  He said that he would work with Dr. Bruce to define the components, costs and timelines of priority collaborative projects that could fill the gaps. ballakandeh@yahoo.co.uk

U.S. Peace Corps:  Emma and I met with Kelleagh Young, the PC’s Director of Training and Programs.  A new group of 44 volunteers had just arrived in-country and were beginning their training.  Following a description of Rotary members’ roles in the campaign against malaria in the Gambia and elsewhere, we discussed the possibility of collaborating with PCVs in rural villages in planning and implementing Rotary-supported malaria elimination actions.  This type of collaboration would fit right in with PCV health workers’ mission and objectives.  Once we have a concrete proposal drafted, we will have the basis for working out a cooperative MOU.

October 18:

Meetings were held today with the U.S. Embassy, the President of the Republic, and the Permanent Secretary of the Ministry of Health.  Then we visited the Banjul Rotary Club’s work at the Maternal and Child Care Hospital.  In the evening, Rotarian Emma and I attended the meeting of RC Fajara and followed that with a late, working dinner.

U.S. Embassy (Charge d’Affaires, Shelly A Seaver & Economic and Commercial Specialist Samuel Sarre):  SeaverSA@state.gov

The purpose of this visit was to inform the relevant Embassy staff of Rotary members’ activities in fighting malaria in the Gambia.  In particular, we mentioned the possible collaboration with PCVs in rural village programs and made plea for embassy support in requesting that PMI extend its work into the Gambia again.  See  https://gm.usembassy.gov/rotary-malaria-partners-combat-malaria-in-the-gambia/  for the Embassy’s photo of our group and description of the meeting.

President of the Republic of the Gambia, (HE Adama Barrow):

The Rotary District 9101 Malaria Committee the Gambia, Balla Kandeh of NMCP and I were fortunate to spend an hour meeting with the President of the Republic of the Gambia at the Statehouse.  After brief introductions, Emma Bruce described the work that Rotary members had been doing, thanked the President for his and the First Lady’s support for the Zero Malaria efforts of Rotary members and outlined the public education work that had been carried out concomitant with the national bednet distribution campaign.  She then introduced me an the purpose of my trip.   I summarized the purposes of Malaria Partners International and how impressed we were with the response and commitment of Gambian Rotary members to the Zero Malaria challenge.  I outlined how we were working in Uganda and Zambia as well as how we raised funds and brought partners to facilitate Rotary members’ projects that bolstered the resource gaps of the countries’ own national malaria programs, saved the government money and brought us closer to zero malaria.  Balla Kandeh followed with a summary of the status of malaria in the Gambia, the cross border initiatives with Senegal and the possibilities of getting to zero.

President Barrow welcomed us all and gave an overview of the actions of his government to eliminate corruption at the top, provide essential public services, expand infrastructure and advance education.  He demonstrated a good grasp of the malaria situation.  Asked several questions that Rotary members and Mr. Kandeh answered, and again thanked Malaria Partners International for its timely assistance.

Permanent Secretary of MoH (Mr. Dawda Ceesay):

Mr. Ceesay met with Emma Bruce and me for ½ hour after hours on Friday.  He has a broad public health background, including field work, policy development and planning.  He worked for a time with the Global Fund in the Gambia and also served on consulting assignments for WHO and Save the Children.  Dr. Bruce contacted him for a referral to Bella Kandeh.  I briefly outlined what Malaria Partners International was doing to support national malaria programs and Rotary members work to eliminate malaria in other countries and what we hoped to do as a follow on to our initial project in the Gambia.

Rotarian Emma and I had dinner at my hotel and worked until midnight on the plan to utilize the remaining balance of the funds from the original Malaria Partners International grant project.

October 19:

Live TV interview on national station: Dr. Bruce and I were interviewed from 10:30 – 11:00 on Gambian national television.  An effort is being made to get a copy of the interview.  I don’t think that I embarrassed anyone, but won’t know until I see the tape of the program.

https://drive.google.com/file/d/19dIqQXrhBBmXcMtJHTO2HzHHn5YnP-qV/view

Lunch with Rotary District 9101 Malaria Committee Gambia: The Committee sponsored a lunch with Rotary members and Rotaractors at their meeting place.  Key players were asked to give speeches – it was a nice informal affair.

Visit to Bundung Hospital: This maternal and pediatric care hospital serves one of the poorest and most densely populated sections of Banjul.  During the week, the hospital sees about 1,000 patients per day.  Not surprisingly, it has many needs, from equipment to medical supplies.

Celebration of Rotary – GoG partnership to eliminate malaria: Saturday night featured a gathering of about 60 Rotary members, spouses, and representatives of CRS, the MoH and NMCP.  (see attached invitation).  I was honored with a seat at the head table next to Dr. Bruce and the Assistant Governor, Fatou Bah.  A sign of the strength of the Rotary partnership with the Government of the Gambia was attendance by Balla Kandeh and his wife as well as by the Assistant Principal Secretary of MoH.  There was music, an excellent buffet meal and an official master of ceremonies.  Dr. Bruce indicated that that my presence allowed them to arrange this celebration of what Rotary members had accomplished so far and what they hoped to accomplish going forward.

Rotary District 9101 Malaria Committee the Gambia plus JRM and AG Fatou Bah

October 20:

After spending 2 hours with Dr. Bruce in the late morning, I departed at noon for the ferry across the River Gambia and the 7 hour drive to Dakar International Airport.