In 2008 DAHW was active at the hot spots for leprosy: in all of the 33 countries where 90 per cent of the new leprosy cases were found. First of all, the assistance takes the form of direct diagnostic and therapeutic measures. What is more, support of activities in the field of rehabilitation, public education and prevention, training and staff development, supervision, research and logistical support of national control programmes are important for the sustainability of DAHW’s work.
In the fight against leprosy a partial success was achieved. Almost all countries fulfil the criteria for the elimination of leprosy, including India with 137,685 new cases, with the exception of Brazil (39,125 new cases), D R Congo (8,820), Nepal (4,436) and Mozambique (2,510).
These figures show clearly the problem of the purely statistical definition of “elimination” as formulated by the World Health Organization (WHO). Accordingly leprosy is “eliminated” as a severe health problem (for a state) if at a certain fixed date less than 1 case per 10,000 population is registered for treatment. This definition has nothing to do with a real victory over the disease.
Therefore, it is not surprising that the rate of infection has remained relatively constant worldwide. As a consequence it is clear that leprosy obviously cannot be conquered efficiently with drugs alone, especially not in social hot spots. Since there has been no research into this matter up to now, the reasons are not yet known. For this reason, in 2008 DAHW resumed support to research projects. These studies will help improve our understanding of leprosy and how we can fight its transmission. So, for example, one of the research projects is seeking to find out whether leprosy bacilli can survive in amoeba. If they can, we will be considerably closer to clarifying how leprosy is transmitted. The close connection between poverty and leprosy would be more plausible, too.
Tuberculosis
Tuberculosis is still a great hazard for public health. In slum areas where population increases rapidly and where people are living in cramped conditions the infectious disease can spread almost unhampered. DAHW is active in five of the eight most affected countries: India, Pakistan, Nigeria, Ethiopia and China.
In the Indian metropolis of Kolkata and Delhi DAHW has extended its support for provision of the standardised treatment and diagnosis (DOTS – directly observed treatment – short course). In Delhi volunteers are trained in the observation and recording of the drug intake of patients from their vicinity. Thus housewives, students or owners of stalls are helping to reduce infection and to prevent the occurrence of drug resistance.
The treatment of multi drug resistant tuberculosis (MDR-TB) – the pathogen is resistant against at least two antibiotics of the standard therapy – causes severe side effects to the patient concerned and, moreover, it is complex and expensive. In Pakistan in 2008 DAHW has started to treat MDR-TB (see page 18 seq.). No statements about the cure rate can be made from the first reports since most of the patients are still half-way through their 24-month treatment. However, the death rate is very high (5 out of 28 patients) and two cases of extremely resistant tuberculosis (XDR-TB) were found among the group. In this kind of TB the pathogens have developed resistance against alternative drugs.
The World Health Organization (WHO) starts from the assumption that there are some 500,000 patients worldwide who have MDR-TB, and that the trend is rising. Only one to two per cent of those people have got access to treatment that meets with international standards and guidelines.
In combination with HIV/AIDS tuberculosis is killing the patients sometimes even before they are diagnosed. According to WHO figures 1.37 million people are co-infected with TB and HIV. The countries south of the Sahara are especially affected with a co-infection rate of 50 to 70 per cent. DAHW encourages combined TB/HIV activities in all TB projects.
Children for children – TV channel presenter Shary Reeves, collecting donations with students from Bonn on World Leprosy Day.
On the occasion of the World Tuberculosis Day on 24th March DAHW co-financed and participated in an international symposium in Berlin in co-operation with the German Committee for the fight against Tuberculosis (Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose – DZK), the Robert Koch-Institute, the Max Planck Institute for Infection Biology, the Koch-Metschnikow-Forum, the International Union against Tuberculosis and Lung Disease (IUATLD), the Stop TB Partnership (Geneva) and further national and international partners. Our medical advisor Dr. Dinesh Jain from Mumbai contributed his expert knowledge on multi-resistant TB.
Internal Quality Assurance
The “DAHW Handbook” in which processes, administrative standards and ways of communication are described, was finalised by mid-2008 and was distributed to all DAHW offices and important project partners.
However, there is still scope for improvement in the administration and reporting of our partners and DAHW offices. This concerns adherence to deadlines as well as description of the effects and probable side-effects of DAHW’s contribution to a project. For example: last year less than 50 per cent of the project applications reached the headquarters in Wuerzburg by the given closing date – the aim is 80 per cent.
Water for Bisidimo – DAHW founding member Irene Kober and the current President, Gudrun Freifrau von Wiedersperg, at the water pump.
In co-operation with the DAHW offices in all three continents and with our project partners we also developed the so-called “Partner Validation” in 2008. In future it is planned to do a regular “partner test” using a commonly agreed “partnership development tool”. This ought to help to systematically check and identify strengths and weaknesses of partner organisations. The aim is to maintain a basic standard and to better rectify weaknesses. Plans of action indicate the desired effect of our work and make it measurable. Annual reports will indicate how far aims have been reached and, where applicable, will explain reasons for delays or other discrepancies. Where needed, the DAHW offices or the project partners are supported in this task. The ultimate aim is transparency in reporting activities, documenting targets met as planned and proof of efficient use of the financial means according to clearly defined indicators. DAHW is in the middle of developing a process to ensure permanent quality assurance and further quality development at all levels of its work.
Living a self-determined life through work – in the DAHW-supported Hyderabad leprosy project former leprosy patients earn their own living.
Volunteers in DAHW
On the occasion of the 50th anniversary of the first DAHW project in Bisidimo, 19 volunteers from six different supporter groups of DAHW went on a journey to Ethiopia. Among the group were also two builders who had helped construct the leprosy centre as well as Irene Kober, a co-founder of DAHW. They met some of the patients of the centre’s opening days, who had found a new home there free from stigmatisation. The Ethiopian President Girma Wolde-Giorgis and other politicians praised the great support which this former leprosy centre is offering, in particular through the extension of its services by becoming a general hospital, with a school, workshops, agriculture and a self-help group. Ethiopian media also reported on this.
DAHW staff provided information about current developments in the fight against leprosy and tuberculosis to more than 60 DAHW groups of volunteers. The representatives Franz Wiedemann from Togo, Manfred Göbel from Brazil and Jayaraj Devadas from India paid visits to those groups of volunteers which maintain partnerships with specific projects.
The “Pens that work” fundraising campaign was conducted in more than 80 places. School classes, members of parishes and DAHW groups sold more than 7,000 sets of pens in co-operation with Damian-Team Versand. The pens are a reminder that slight pressure of a pen on the skin can be used to detect the first signs of numbness, which can mean leprosy.
The 33rd international children’s festival, which DAHW organised in co-operation with the Bavarian radio channel and the municipality of Wuerzburg was attended by 25,000 people, who came to the Frankonian cathedral city for this event. 898 volunteers, from a total of 84 groups and organisations, contributed to the successful running of this event.
On the occasion of the annual exhibition of educational material named “didacta” in Stuttgart DAHW presented its educational material for 2008. Much interest was shown in DAHW at the first Bavarian exhibition “One World School” in Augsburg. Approximately 1,000 guests, half of them students, visited the exhibition. Educational materials for 2008 were rounded up in co-operation with the BUKO Pharma Campaign for which both DAHW and BUKO produced a package of material for the lesson: “TB – Becoming Motheaten”.
On the occasion of the 97th German Catholic Convention, DAHW and the German Institute for Medical Mission and the Medical Mission Institute Wuerzburg provided information about a “Tropical Clinic”.
Dr. Adolf Diefenhardt | Burkard Kömm
back to the Annual Report 2008
