AS.ME.V. Calabria: Partnering for Health – Eritrea’s Dialysis Centers

A strong healthcare system can be considered as one of the basic pillars of a comprehensive development program of a given country. Indeed, access to healthcare can be justifiably set atop all other social services. Even in cultural belief, we say ‘te’ena tray yehalu’, literally translated as ‘only health matters’. As such, the question of healthcare access is a key priority in Eritrea and the Ministry of Health in partnership with other government bodies and international partners and other stakeholders is continuously striving to deliver on this basic social need, equitably, throughout the country.

One of its partners, the Italian association called AS.ME.V. Calabria whose members are medical doctors from the city of Calabria were visiting the country this week and I took the liberty to meet them and discuss the work of the association in Eritrea. In today’s issue, my piece will spotlight the question of partnership and collaboration as a key for development progress by featuring the establishment of dialysis centers in Eritrea by the Eritrean Ministry of Health in close collaboration with AS.ME.V Calabria. [...]

Indeed, the question of nephrology, the branch of medicine, which deals with the physiology, and diseases of kidneys, is gaining more acknowledgment and many African states are underway to catch up with western countries in giving access to dialysis centers. As a matter of fact, more than 30 African states have developed their dialysis services with the first one opened in 1957 during the apartheid in South Africa. As the population in Africa continues to grow, the changes in lifestyles and also an increasing number of kidney-related diseases and as kidney transplantation is almost impossible to operate and its interminable waiting list, the best solution in place for both acute and chronic kidney failures are the opening of dialysis centers.

Eritrea is also facing an increase in kidney failures among its population. Henceforth, the clinical purification of blood by this technique, as a substitute for the normal function of the kidney becomes primordial for Eritrean policy makers. Accordingly, with an international average of 1 out of 1000 affected by kidney failure, number of affected in Eritrea is also important. In fact, due to dehydration, diabetes but also genetic blueprint, numerous Eritreans suffer from acute kidney failure with smaller amount of chronic one. As I was wondering how and when it started in the country, Francesco Zappone, dialysis technician, gave me an insight to the context of this project. In fact, the Minister of Health at that time, the late Dr. Saleh Mekki, firstly expressed the need for dialysis center in 2005 over a discussion with Dr. Roberto Pittito, specialized in nephrology and president of the association AS.ME.V Calabria. The main point was how could we tackle the issue of kidney failure in Eritrea, and the best agreed solution was the opening of dialysis center.

After three years of planning, fundraising and support, the Ministry of Health in partnership with the Association opened the first center in the capital city, Asmara, at Orotta Hospital, on the 21st January 2008.

The partnership allowed the initial opening thanks to the funding and material donations by Kosmos Hospital in Calabria among others.

The center began its operation with two beds and four machines (two were put in reserve) and the first patient was an 11 years old child who suffered from acute kidney failure and the center was officially opened after this successful first dialysis.

Seven years later, Francesco Zappone and his comrades are very satisfied of the progress made in such a short period of time. To strengthen this, the center, which started with only 2 beds, expanded to two dialysis centers.

Each center, one in Orotta and one in Sembel Hospitals, have respectively 8 and 7 beds available with 14 machines each. The dialysis centers are opened 6 mornings a week with a possibility to open in the afternoon in the future. A patient affected by kidney failure can now come and have his/ her dialysis in four hours, twice a week. Yet, the standard in Europe and other western countries is three times a week, I asked Francesco if twice a week would be enough in Eritrea. Accordingly, as the food intake is lower and more organic, the number of dialysis responds perfectly to the living standards of the majority of Eritreans.

Further to this, as Eritreans, we always wish to ideally be self-reliant; the opening of these centers is, thus, not enough. Indeed, monitoring and keeping the momentum can only be achieved by sharing knowledge or the socalled ‘know-how’ idea. In practice, members of the association come about three times a year to train nurses, medical doctors but also technicians who are able to work effectively all year-long. As Francesco said, “I hope in the future I will come to Eritrea just as a tourist as local staff would be able to sustain themselves”.

As the establishment of these dialysis centers has significant positive impact to Eritrean citizens, the challenges remain the access for those in remote areas and other cities such as Keren or Massawa. In the coming years, the expansion of centers to other areas would need to be further examined to respond to the growing demand. Nonetheless, the members of the association are satisfied of the current development as they said, “in Italy, 60 years ago, dialysis centers started only in the city of Pisa and slowly expanded throughout the country, Eritrea will surely follow the same steps”. The positive spirits, commitment and personal motivation I witnessed by the members of the association cannot be ignored. Their dedication comes a long way. Of course, with my economic background, I had to ask about the question of funding. Certainly, the association which in size is smaller than the UN agencies among others organizations currently operating in Eritrea, it still manages to aim big by implementing this long-term project. Currently, the Ministry of Health is financially in charge of the center. The association, on its part, manages to get private funding and donations by the association Consulcesi Onlus, thanks to its president, Mr. Massimo Tortorella, who is very enthusiastic about the project. Despite this, an important amount of the work of the association is made all year long through fund raising events; specifically concert, as some members are also musicians during their spare time. Accordingly, the short visit two to three times a year is only a small percentage of the yearlong program for funding and planning.

The partnership with the Ministry of Health shows the positive impact for better health care services to the population. Another positive development is that anyone living abroad can now come and visit the country while doing his/her dialysis at Sembel Hospital. This is an important achievement primarily for Eritrean living in Diaspora suffering from kidney failure.

The questions of sharing knowledge and expertise under the vision of ‘know-how’ but also the importance of working in partnership with different organizations and government bodies can be beneficial in terms of development prospects. Hence, the work of AS.ME.V Calabria is surely going to be a long collaboration for further health-related projects.

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