2009 Operation Report
Mathiwos Wondu -YeEthiopia Cancer Society
A. Introduction
Mathiwos Wondu-YeEthiopia Cancer Society (MWECS) was established by the first General Assembly meeting of the founding members of the Society held on April 17, 2004 (Miazia 9th 1996E.C) and now it is seven years old.
Our Society is non-governmental and non-profit making organization that is dedicated to the national control of cancer and aspires to support all cancer patients in Ethiopia, but due to weak organizational and financial position of our society we are forced to concentrate our efforts on pediatric cancer. There were 15 members when the Society was formed and today the number of members has increased to 350 and it is expected to reach 500 soon. The number of members has to increase even further in order to fight cancer in Ethiopia in a very meaningful way.
Mathiwos Wondu-YeEthiopia Cancer Society (MWECS) is one of the four NGOs working on cancer and the only one giving attention to pediatric cancer. The society is seven years old and actively working in so many cancer related activities particularly in enhancing the awareness of society of cancer, its prevention and treatment possibilities. In addition to these our society has been ardently working to improve treatment condition and helping pediatric cancer patients and their families.
Because of the weak economy and limited financial capability, the Ethiopian government has not able to give proper attention to diseases like Cancer. The Black Lion Hospital, the only cancer treating hospital in Ethiopia, has been trying to give treatment to some of cancer patients but it has no sufficient number of specialists, support staff, equipment, and medicines to fulfill its objectives.
Cancer is the general name for over 100 medical conditions characterized by uncontrolled cell division and the ability of these cells to invade other tissues, either by direct growth into adjacent tissue (invasion) or by migration of cells to distant sites (metastasis). This unregulated growth is caused by a series of acquired or inherited mutations to DNA within cells, damaging genetic formation that defines the cell functions and removing normal control of cell division.
According to UICC (www.uicc.org) each year, almost 8 million people die from cancer and close to 11 million new cases are diagnosed. In today's world, everyone will be touched by cancer - as a patient, a family member or a friend. In 2020, if current trends continue, more than 10 million people will die of cancer and the number of new cases will increase to 16 million per year. If these rising global trends are to be reversed, then present knowledge must be put into effect on a wider scale.
Cancer kills one in eight of those who die worldwide and claims twice as many lives as AIDS or annually cancer kill more people than HIV/AIDS, TB and Malaria combined together. Often it is regarded as a disease of the developed world, but with improved living standards and longer life expectancy, cancer incidence in developing countries is on the rise. According to WHO as of 2010 cancer became the number one cause of death in the developed world, and epidemiological evidence shows that the trend in developing countries is in the same direction. By 2020, three out of every five or 70 % new cancer cases will occur in the developing world.
Despite unreserved efforts made by medical researchers throughout the century, there have only been two vaccines successfully produced for cancer prevention. A vaccine that protects against Hepatitis B Virus (HBV), responsible for 35% of liver cancers worldwide, has been available since 1982, although a national Hepatitis B Immunization program is not in place in many developing countries, particularly in Sub-Saharan Africa. More recently, a vaccine have been developed to prevent against the most common types of human papillomavirus (HPV), the primary cause of cervical cancer. However, population-wide vaccination programs may be cost-prohibitive, at least in the near term.
Cancer is known in Ethiopia as a deadly disease without cure. Because of this, cancer patients and their families are forced to believe that they are doomed and have no future at all. In Ethiopian cancer is one of the major causes of death. The number of cancer patients is getting momentum from time to time; nevertheless, provision of treatment to the patients is not compatible with the demanding situation. It is saddening to admit that for a great country with almost 75 million people one radiotherapy center is available (Egypt, with the same kind of population has more than 40, Kenya and Uganda 2 and The Sudan 4). Above all, it is amazing that the center is delivering medical support by four Oncologists. Because of these; we cannot certainly declare that cancer treatment is being given in the country. Among other things surgery, chemotherapy and radiation therapy are existing, but poorly organized, while hormone therapy and biological therapy are non existent and need to be instituted to improve and enhance the below standard cancer treatment in the country.
Due to the congestion in the Black Lion Hospital, the only cancer treating hospital in Ethiopia, cancer patients are treated as per availability of beds. Parents of in patient children face a particular challenge in between treatments as the lack of beds does not allow them to have their children in hospital for long periods of time. Some of the parents are not able to return to rural areas due to lack of transport and they are forced to endure hardship and some are often homeless for period of “in between” treatments. It is our firm belief and hope that a dedicated cancer ward and National Cancer Institute of Ethiopia should be established in the future to challenge cancer in a more meaningful way.
Our Society being a member of Non-Communicable Diseases Committee formed under the Ministry of Health of Ethiopia and partially supported by World Health Organization(WHO) Country Representative Office, actively working in developing policy and strategy on non-communicable diseases in general and cancer in particular, to be approved and implemented by Ethiopian Government. Thanks to the continuous and concerted efforts of the members of the Working Group, the Strategy developed have been reviewed and appreciated by the management of the Ministry of Health and expected to be included in the fourth Health Service Development Program (HSDP, 2010-2014), which is a huge way forward which can create conducive condition and help to get appropriate attention from government and organizations. This will take some time but it is very big achievement for NCDs in general and cancer in particular.
Based on these factual premises, Mathiwos Wondu- YeEthiopia Cancer Society (MWECS) has declared its commitment to become actively involved in assisting the government in every possible way, to help make a difference in the outcome of a cancer prevention and treatment and to take part in the national effort, by filling the gaps that the government alone is not in a position to handle. But as we have tried to demonstrate mainly due to lack of resource and priority it will take sometime before cancer get proper attention and budget, and these will put cancer in a very bad position. Due to these we are forced to look for every kind of assistance, particularly from abroad to avert the catastrophe we are going to face unless we do something today.
B. Operation Report
Our Society has so far managed to formulate short, medium and long term plans in order to attain its objectives. The following activity report is prepared on the basis of short term plan and action plan of the society.
1. Ethiopian Christmas Party for Pediatric Patients
As per our society’s action plan, we organized an Ethiopian Christmas party for pediatric cancer patients and their families under treatment at pediatric ward of the Black Lion Hospital on January 7, 2009. More than 80 children and their families, invited guests, members and friends of our society actively participated.Mr.Samson Derebew, member of our society and owner of Victory Restaurant and National Café fully covered cost of wonderful food and drinks.
The party took place between 10:30AM and 1PM included moving speeches by the officials of the Society and representatives of the patients’ families highlighting on the importance of the occasion and reflecting concern on the absence of proper medicines and support structure for patients that remain under treatment. Finally, patient families were given Birr 50 each from the Society’s account to show the sympathy and concern the Society has for the pediatric patients our society is formed to serve.
Cancer patients and their families face many challenges that may leave them feeling overwhelmed, afraid and lonely. It is difficult to cope with these challenges or to talk even to the most supportive family members and friends. Often support groups like ours can help people affected by cancer to feel less desolate and this can improve their ability to deal with the uncertainties and challenges that cancer brings. In fact, attention to the emotional burden of cancer is sometimes part of a patient's treatment plan.
II. World Cancer & Childhood Cancer Day Observation
As per the action plan, the "I LOVE MY HEALTHY ACTIVE CHILDHOOD” walk program in support of World Cancer Day and World Childhood Cancer Day was held on Sunday, February 15,2009 at Meskel Square, here in Addis Ababa, Ethiopia. Nearly one thousand people of whom half of them are young students from various schools in Addis Ababa, Ethiopia took part.800 T-shirts were printed for the day along with banners and posters.
Mr.Tsegaye Bedane representing the Ministry of Health of the Federal Democratic Republic of Ethiopia was a Guest of Honor. Representatives from different Government and Non-Government Offices including the WHO, Country Office here in Ethiopia also took part and actively participated in the program. Briefing on cancer in general and Childhood Cancer in particular by Dr.Bogale Solomon, the only Senior Oncologist here in Ethiopia and question and answers program on cancer and childhood cancer that followed afterwards helped to transform the program in to one of the most inspirational and educational event of its kind.
Students from various schools here in Addis Ababa, Ethiopia actively participated in the program and raised more than Birr 50,000 (More than USD 5,000) to be donated to pediatric cancer patients at the Black Lion Hospital). As per our plan and promise together with student representatives we handed over the whole Birr 50,000 in cash and more the Birr 20,000 (USD 2,000) worth of cancer medicines donated by friend of our society to the Black Lion Hospital on March 20, 2009.Unfortunately the hospital has not utilized the donated amount for the intended use. Taking in to account the previous experience in which the hospital failed to utilize Birr 45,000 donated by our partner for the same purpose ,we were forced to develop project proposal and with the collaboration of Hospice Ethiopia Mehaber, we are currently implementing palliative and hospice care to needy pediatric cancer patients and their families .The total cost of the project is Birr 120,000 of which Birr 70,000 was donated by Ambassadors and Heads of Mission Spouses Group (AHMSG) and the rest Birr 50,000 was raised by walk program organized to commemorate World Cancer and World Child Cancer days.
Based on the three fact sheets - on overweight, obesity and cancer; encouraging kids to eat a healthy diet; and encouraging kids to live an active childhood and taking in to account the Ethiopian peculiar condition, particularly culture and way of life, guideline focusing on how to prevent cancer and follow healthy good life was developed. Proper briefing was given on how to use the guideline and finally the guideline was given to each participants of the walk program.
World Child Cancer is dedicated to improving cancer diagnosis, treatment and palliative care for children in the developing world. Over the last 30 years survival rates for childhood cancer have more than doubled to around 80%. However, this success is limited to developed countries and is available to only one in five of the world’s children. In developing countries the survival rate for children with cancer is typically less than 20%.
111. Submission of Operation & Financial Reports
As per the action plan of the society, operation and financial reports of 2008 budget year was presented to Board of Directors on March 15,2009 .Both reports were reviewed and evaluated by the BOD and refereed to the General Assembly and External Auditors respectively.
1V. Develop Project Proposal on Cancer Mitigation
Three major projects were developed to improve the below standard cancer treatment conditions here in Ethiopia. The first one is intended to immensely improve cancer treatment possibilities and enhance the awareness of cancer, its prevention, early diagnosis and treatment possibilities. We are looking for donors to cover the cost of more than 13 million USD. The second project was intended to improve the existing treatment condition and help pediatric cancer patients and their families. Due to some misunderstanding on how to develop and implement the project we were forced to revise the initial draft so as to help the patients while they are on out-patient treatment. The third project is intended to enhance the capacity of our society, presented to International Orthodox Christian Charity (IOCC) and it is under review and evaluation. Other medium size projects on awareness creation and prevention and capacity building were also developed and sent to prospective donors.
V. Eastern party at the Black Lion Hospital
As per action plan, our society organized Easter Party on April 19, 2009 starting from 11:00 A.M to the children under treatment at the pediatric ward of the Black Lion Hospital.
Members and friends of our society actively participated in organizing the party for more than 100 children and their families. As usual, Mr. Samuel Derebew covered all costs of food and soft drinks and Ms.Bosena wife of Mr. Samuel Derebew sent t-shirts and Birr 1,000 from Toronto, Canada. Nas Foods donated biscuits of all kinds to each child and their families and members and friends of our society donated from sugar, soft drinks to money as well.
In addition to well prepared delicious food and drinks well served to each participant, the highlight of the party was the painting contest organized jointly by our member Ms. Cecilia and Ethiopian born and English national by the name of Rupa, among groups of selected children consisting of three each. After serious evaluation the best paintings were selected and prizes were given for best painters accordingly. In addition to these dolls were given to each contestant and various gifts were given to each participant of the party.
Our society also given birr 50 to each pediatric cancer patients. Carefully selected briefing on cancer in general and childhood cancer in particular was given by the general manager of our society, Mr. Wondu Bekele and questions and answers that followed afterwards turned the party to inspirational and educational one.
V1.Moving the Society’s Head Office
Our society is still situated in the Mathiwos parent residence. Several attempts were made to find suitable house to be used as office of the society, hope lodge and cancer center simultaneously. Due to problems associated with the high cost of rent and proximity we were un-able to move the society office according to the action plan. It is high time we move the society’s office to the ideal place so that we serve our members, friends and cancer patients accordingly.
V11.Conduct Anti-Tobacco Campaign
As per our action plan, Anti-Tobacco Campaign was conducted in ten selected schools here in Addis Ababa. The total cost of the campaign was covered by the International Union Against Cancer (UICC). The Grant of the project was released in two separate parts.
This project has been established to accomplish goals such as:
• Adopting methodologies and information tools that reduce risk of young people becoming exposed to cancer causing factors.
• Increasing awareness on how smoking leads to lung cancer and encouraging non-smoking lifestyles among students in 10 schools in Addis Ababa.
• Improving the understanding of risk increasing issues through sport activities and stage plays.
• Decreasing the number of people taking up smoking and limit children’s access to tobacco products.
MWECS believes that most of its objectives set by the proposal if not all are met through the project’s life time. Interview questions for young people who smoke cigarette, have been prepared and given for anti-drug members of each schools to identify students who smoke, disseminate the papers and gather the information needed. The interview consists of 30 through questions such as how students started smoking, how they get the money, how much they smoke per day, about peer pressure, about relationships between family and friends being a smoker and so on.
Club members and teachers found it very difficult to identify students who are smoking because, even if it is known there are a lot of students smoking inside the school, smoking is still a taboo in the students’ world. Therefore, they don’t expose themselves to every body. Other students who know them don’t say anything even if they know. Therefore the interview was held rather systematically, by asking questions orally and filling the papers later, by learning about the students from their friends and so on. For the coming year, all of the schools and MWECS have planned to work hard to identify students’ who smoke, know their family background, learn every situation surrounding them and create better relationship with them.
A wide range of awareness programs were carried out on the relationship between smoking and cancer among students of 11 schools in Addis. Information about the anti tobacco campaign project was distributed through diverse channels including the society’s website, brochures (thousands of brochures were printed), posters were distributed to schools almost throughout the year banners, radio (a number of interviews, 30 minute program on smoking and cancer, a number of announcements mainly on FM stations), TV (panel discussions, news coverage both in Addis Ababa TV, and the national TV).
MWECS has established new anti-drug clubs in the target schools and where there was shortage of individuals to be responsible for new clubs; it developed already existing clubs like Anti-AIDS Club, Civic Club and the like to carry on the anti-tobacco campaign side by side. The clubs have enrolled more than 100 student members each. Members are then split into groups, and each group nominated one or two leaders. Those leaders have participated in two workshops about the on-going project of anti-tobacco campaign along with the teachers. They were also provided with one TOT (training of trainers) based on the life skill guideline prepared by MWECS so that they will train their consecutive groups. The strategy is that each individual will initiate talks with their peers, then with students of the schools, then with their families and at last with the community. Our model schools for such kind of settings are Ayer-Amba and Cathedral schools.
Half day consultative workshop was held on Saturday 26, 2009 at Panorama Hotel, Addis Ababa, Ethiopia, starting 9:00 AM. The workshop was intended to review and evaluate the on-going Anti-Tobacco Campaign and discuss whether to continue the campaign in the future. Representatives from all 11 schools attended the workshop, actively participated and presented their progress report of the campaign so far and action plan to be carried out in the future. The campaign going on for the last one year was found out to be very important and participants of the workshop unanimously agreed to continue the campaign in the future. At the end of the evaluation some schools carried out the campaign program according to the project plan and achieved excellent results while few schools faced various problems and challenges to carry out the program.
Few schools like Tshai Gibat succeeded in declaring smoke free environment and so far they know no one smoking in their school. Other schools reported wide spread smoking among students and teachers alike. Finally, taking in to account the importance of the campaign and magnitude of the problem in many schools it was decided to continue the campaign in the future. In order to look for sponsors and assistance all schools are requested to present their program and action plan as soon as possible.
There is a very strong confirmation of the significance of the project (not only to the students and teachers but for the whole society) from teachers, school administrators, students, education bureau and MWECS that the project is very useful for students in particular and the all members of the school in general. Teachers have been very interested in the anti-tobacco campaign. Students are also interested that they have learned about cancer which they claim that they have never heard before. Some of the schools have held extraordinary and organized campaign, which was very unexpected and motivating one for other schools as well as MWECS.Although many people know that smoking is dangerous, but many don’t know that smoking is the major risk factor not only to lung cancer but to many diseases and due to major contribution of smoking, cancer will overtake heart disease as world’s number one killing disease by 2010.
MWECS strongly believes that the anti-tobacco campaign has strengthened the organization’s capacity in such a way that:
• Detailed problems were learned from the schools and therefore first hand information is gathered.
• Better approaches to address students were learned.
• Students became interested to help the society voluntarily.
• Students are willing to visit cancer patients at the Black Lion Hospital to see the magnitude of the problem (behavioral change).
• All schools have promised to participate in fundraising activities of the society.
• The project helped us to challenge the growing burden of smoking in Ethiopia and helped us to realize one of the major objectives of our society.
• Helped us to familiarize our society and enhance the society’s awareness of cancer, its prevention, and early diagnosis and treatment possibilities.
Problems were faced during the implementation of the project. Some of the major problems include:
Continuous replacement of teachers who are supervising the campaign has been one of the major problems. MWECS has helped clubs to maintain an organized filing system so that when a teacher is leaving, it will be easier to handle the project by the next person.
Although the capacity grant we secured was intended to implement Anti-Tobacco Campaign in 10 schools here in Addis, the implementation program helped us not only to implement all activities planned in the project proposal it also created very conducive atmosphere to enhance the awareness of students, staff and their families of cancer in general and prevention of cancer in particular .Towards these end we have developed a guideline on how to prevent cancer in particular and other non-communicable disease in general, which is developed both in English and Amharic, widely distributed in Addis Ababa and nation wide in limited numbers.
According to some sources, only 2.5% of Ethiopians smoke, but according to study conducted by World Health Organization (WHO) Ethiopia Country Office some 6 years ago in Addis Ababa schools, 9% of students surveyed at one time or another used tobacco and the study conducted showed smoking is rapidly increasing in towns and among students. Although tobacco is widely considered as the major risk factor for lung cancer and many diseases, still many among youth consider it as a sign of cool and modern way of life.
Taking in to account the consensus reached at the consultative meeting held on December 26, 2009 and according to WHO estimate by 2020 70% cancer will occur in developing countries and cancer will be number one killing disease by 2010 mainly due to tobacco, we strongly believe that it is high time we intensify our efforts to combat the growing burden of tobacco in developing world including Ethiopia.
We hope that we will be able to secure additional fund to consolidate and continue the campaign.
VIII, Awareness and Prevention Activities
According to World Cancer Report, over two-third of cancers worldwide are due to known risk factors and potentially avoidable. These modifiable risk factors include infectious agents, tobacco and alcohol use, unhealthy diet, and physical inactivity. Therefore, there is clear scientific evidence that public health actions that promote healthy lifestyles could prevent a large proportion of cancer cases and deaths. However, most people remain unaware of how they can reduce their risk of developing cancer and very little has been done to change this by public health agencies in most developing countries, including Ethiopia.
Taking in to account the peculiar condition of cancer here in Ethiopia, our Society has been following two interrelated approaches to tackle the challenge. The first approach is to enhance the public’s awareness of cancer and its treatment possibilities, creating a conducive condition for prevention, early detection, treatment and care of cancer; provide moral and material support to needy ones.
The other major approach we are pursuing at the present time is advocacy work. This is mainly geared towards Government and donor organizations to convince them that cancer is one of the major diseases in Ethiopia and unless we put things right at this point in time, Ethiopia like most developing countries is going to suffer terrible consequences that will affect future generations. In view of this, our society has become a member of non-communicable disease committee under the auspices of Ministry of Health and supported by World Health Organization (WHO).One of the major objectives of this committee is to propose Policy and Strategy options on non-communicable diseases (including cancer) to be adopted by the Government of Ethiopia. Although progress along this line is gradual, we feel that we are going in the right direction.
Thanks to the financial support of World Health Organization (WHO) Country Representative Office we were able to conduct Situational Analysis. The burden of chronic diseases is growing worldwide, but more rapidly in developing countries. Over 80% of the burden due to cardiovascular diseases (CVD), diabetes and cancers occurs in developing countries. A large fraction of the chronic disease burden in populations is accounted for by a limited number of risk factors. Smoking, hypertension, diabetes, obesity, abnormal lipids, inadequate consumption of fruits and vegetables, and physical inactivity account for most of the risk of CVD, diabetes mellitus and cancers. Conversely, prevention of these risk factors will contribute to a considerable reduction in the burden of CVD, diabetes, cancers and other chronic diseases
The situation analysis was conducted in order to describe the contribution of major chronic diseases as causes of morbidity and mortality at health facilities, and distribution of their risk factors in the population; to illustrate the state of clinical management, prevention and control of chronic diseases, to identify the barriers against implementation of such activities, and to identify resources and potential stakeholders operating in the area of prevention and control of chronic diseases. Findings of the assessment are intended to inform the development of a strategic plan for the prevention and control of chronic diseases.
A number of government hospitals at federal and regional levels, private hospitals and higher clinics in Addis Ababa, regional health bureaus, health professional training institutions, associations of patients or health professionals, were visited for the purpose of the situation analysis. A semi structured interview guide was applied to generate Information on the burden of chronic diseases, the health management information system, strategies and programs relevant for the clinical management, prevention or control of chronic diseases; health human resources, and the challenges and opportunities relevant to implementation of such programs and activities. The assessment was supplemented with a review of the literature on the epidemiology of risk factors for chronic diseases in Ethiopia and other parts of the world.
Quantitative information on the burden of chronic diseases or the epidemiology of risk factors in Ethiopia is scanty. The health management information system (HMIS) lacks completeness and reliability, and few epidemiological studies have been conducted in the area of chronic diseases in the country. Thus, most of the information compiled in this assessment is based on views and opinions of health workers, managers and other experts on the situation in their respective institutions, health facilities or populations. Despite the limitations in the HMIS, chronic diseases such as hypertension and diabetes mellitus appear in the list of leading causes of morbidity and mortality at hospitals and regional health bureaus across the country. However, there are no organized or coordinated activities aimed at the prevention and control or clinical management of chronic diseases at the public or private health system in the country. Risk factors of chronic diseases, such as hypertension, overweight and obesity, and physical inactivity are widely prevalent, particularly in urban populations. Inadequate intake of fruits and vegetables, cigarette smoking, khat chewing and alcohol consumption is common throughout urban and rural populations in the country.
Cardiovascular diseases, diabetes mellitus and cancers may be the leading chronic diseases with marked contributions to morbidity and mortality. Their risk factors are widely prevalent in urban and rural populations of the country.
The burden of chronic diseases, including cancers and chronic kidney diseases might have been obscured due to the lack of complete and reliable HMIS or the lack of disease registration systems such as cancer registry or chronic kidney disease registry.
The economic and social context of the country, related to globalization, urbanization, economic transformation, and population aging, present favorable environment for the spread of chronic disease risk factors, and the ensuing diseases.
The routine health information at various levels, including federal, regional or health facility is constrained by the lack of completeness and accuracy, and consequently it can not reveal the magnitude, pattern or trend of chronic diseases reliably.
There are no strategies or programs at the national, regional or health facility levels that are aimed at the prevention and control of the main chronic diseases in the country. Management of chronic diseases is limited to the routine health care provision at health facilities, without any programs that coordinate prevention or clinical care provision.
The lack of a separate or functional organizational unit responsible for coordinating activities relevant for the prevention and management of chronic diseases cuts across all levels of the health system. Chronic diseases are not sufficiently or systematically covered in pre-service or in-service training programs.
There is a gross shortage of health human resources, particularly general practitioners and medical specialists, across the health facilities throughout the country, which impacts on the quality of care given to patients with chronic diseases.
Equipment and facilities needed for the diagnostic and therapeutic care of patients with chronic diseases are in short supply, and lacking in most hospitals. There is lack of standardized protocols or clinical guidelines, or in-service training programs relevant for the management of chronic diseases in nearly all the hospitals.
The growing burden of chronic non-communicable diseases is gaining increasing attention world wide, including the African continent. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 60% of all deaths. (http://www.who.int/topics/chronic-diseases/en/)
The burden of chronic diseases is increasing in low- and middle-income countries, where it constitutes a double burden along with communicable diseases, maternal and prenatal conditions and nutritional problems.Contrary to common perception, 80% of chronic disease deaths occur in low and middle-income countries, where chronic diseases affect younger populations and lead to premature mortality due to lack of prevention or effective management of the diseases or their risk factors.
The most important risk factors of chronic diseases include high blood pressure, high concentrations of cholesterol in the blood, inadequate intake of fruits and vegetables, overweight or obesity, physical inactivity and tobacco use.
Unhealthy diet and physical inactivity are among the leading causes of the major NCDs, including cardiovascular disease, type 2 diabetes mellitus, certain types of cancer, and contribute to the burden of morbidity, mortality and disability worldwide, but more significantly in developing countries.
In the African region, NCDs are projected to account for more than a quarter of all deaths by 2015. It is estimated that the rate of increase of deaths from chronic diseases in the region will exceed that from infectious diseases, maternal and prenatal conditions, and nutritional deficiencies more than four-fold in the next 10 years. The burden on health care due to chronic diseases will be substantial, given the chronic course and the need for long term and often lifelong treatment. (Fighting NCDs: Africa's New Silent Killers. African Health Monitor. January - June, 2008).
Recent evidence shows that in low and middle income countries NCDs and their risk factors are more and more clustered among poor communities and contribute to social and economic inequalities.
A strategy for the prevention and control of chronic NCDs constitutes the shared commitment and consensus among the government, partners and stakeholders on the strategic direction to prevent and control the main chronic diseases and their risk factors.
A national strategy is essential for effective and efficient coordination of activities and services needed to prevent and control chronic diseases and their risk factors. A strategy is needed to define the relative priority given to the prevention and control of chronic diseases in the background of various causes of the disease burden in the country. It also identifies the approaches and priority actions needed to attaining the intended objectives.
A national strategy on chronic diseases addresses specific goals, objectives, and actions, and the elements needed to implement the plan of action, including identification of necessary resources and key national institutes; collaboration between the health sector and other key sectors, and monitoring and follow-up.
The present strategy sets out the diseases and risk factors, as well as target groups or intervention areas that the government wants to devote its resources on. The national strategy is a foundation for the programs and action plans that are to be implemented subsequently.
The Federal Ministry of Health assumes a central role in the development and implementation of the national strategy framework by coordinating and leading the efforts of various partners and stakeholders. The NCD strategy would provide the framework for partners and stakeholders to contribute towards a common goal.
A strategy for the prevention and control of chronic NCDs constitutes the shared commitment and consensus among the government, partners and stakeholders on the strategic direction to prevent and control the main chronic diseases and their risk factors.
A national strategy is essential for effective and efficient coordination of activities and services needed to prevent and control chronic diseases and their risk factors. A strategy is needed to define the relative priority given to the prevention and control of chronic diseases in the background of various causes of the disease burden in the country. It also identifies the approaches and priority actions needed to attaining the intended objectives.
In many developing countries, such as Ethiopia, a considerable amount of financial and human resources are already spent, mainly in clinical management of chronic diseases, such as diabetes mellitus and hypertension. Thus, there is an apparent need for a reorganization of interventions so as to improve the efficiency of utilization of these scarce resources and subsequently, to promote sustained and equitable access to services. The scarcity of suitably trained human resources at different levels of the health care system, medicines and supplies needed for screening and treating those affected, and meeting the follow up needs of patients are prominent problems encountered in the management of chronic diseases across different levels of health facilities.
Cancer is one of the leading causes of death in the world, particularly in developing countries. More than 70% of all cancer deaths in 2005 occurred in low and middle-income countries.
According to data compiled by WHO, cancer was the cause of death for approximately 45,000 people in Ethiopia in 2005. Cancer accounted for about 4.2% of all deaths in 2005, and the proportion is projected to rise to 7.5% by 2030. In 2005 cervical, breast and ovarian cancers were among the leading causes of cancer deaths in women in Ethiopia. Similarly, liver cancer, lymphoma, multiple myeloma, and colon and rectum cancers were the top three causes of cancer death in men.
Up to one third of the cancer burden could be reduced by implementing cancer preventing strategies which are aimed at reducing the exposure to cancer risk mainly by changes in tobacco and alcohol use, and dietary and physical activity patterns, and immunization against HPV infection. Another third of the cancer burden could be cured if detected early and treated adequately.
Our Society being a member of Non-Communicable Diseases Committee formed under the Ministry of Health of Ethiopia and partially supported by World Health Organization(WHO) Country Representative Office, actively working in developing policy and strategy on non-communicable diseases in general and cancer in particular, to be approved and implemented by Ethiopian Government. Thanks to God, the Strategy we have developed recently been reviewed and appreciated by the management of the Ministry of Health and expected to be included in the fourth Health Service Development Program(HSDP, 2010-2014), which is a huge way forward which can create conducive condition and help to get appropriate attention from government and organizations. This will take some time but it is very big achievement for NCDs in general and cancer in particular.
1X. Recruitment and Placement of some Permanent Employees
As per our action plan we are supposed to recruit and employ one Project Officer, Secretary & Cashier and Accountant each. After several attempts, we managed to recruit and employ Project Officer while the employment of Secretary & Cashier kept pending until the office problem is resolved and we decided the Accountant position to be covered on contractual basis. The General Manager position which has been covered on part time basis became permanent assignment at the end of the budget year. Mr.Wondu Bekele, General Manger, of our society since its inception has been working for the last seven years without any kind of salary and payment, mainly due to weak organizational and financial position of our society and comparatively handsome salary he was getting from his permanent job. Taking in to account the growing operational challenges of cancer and conflicting interests of the two jobs he was holding simultaneously, resigned from his permanent job on his own free will and joined the society on permanent basis as of December 1, 2009. From our last seven years of experience, we came to realize that enhancing the capacity of our society in terms of permanent employees, office, administrative facility etc is very essential to create conducive condition to implement and realize the society’s objectives.
X. Observe World No Tobacco Day
The World No Tobacco Day was observed here in Ethiopia, on May 31, 2009. The following activities were carried out to observe the day.
Our society based on the WHO and UICC proposal and resources produced three kinds of posters in Amharic and English and distributed to various schools here in Addis Ababa, Ethiopia.
Drug Administration & Control Authority sponsored by WHO organized discussion on tobacco particularly on how to increase tobacco control here in Ethiopia. The discussion was presented on Ethiopian Television prime time on May 31, 2009. From the feedback we are receiving many people for the first time came to realize that the devastating health problems the tobacco cause and effect of second hand smoke on the family and particularly children. They recommend that this kind of tobacco health warnings should be continuously presented to enhance the public awareness to challenge the growing impact of tobacco here in Ethiopia.
Based on the recommendation we are receiving we are encouraged to strengthen the on-going Anti-Tobacco Campaign and encourage all stakeholders to coordinate and strengthen the various tobacco control related activities. Despite a recently growing number of young smokers, Ethiopia still has one of the lowest smoking populations in the world. About 2.5% of Ethiopia’s population smoke, on the average, one individual smokes 6 to 14 cigarettes a day.
Though Ethiopia is a signatory of the Framework Convention on Tobacco Control (FCTC), it has not yet ratified the convention. Hence, rampant smoking in most public places is a common practice and most passive smokers do not react to it. There have never been any vocal activists for the designation of smoking and non smoking zones so far. Passive smoking has played a central role in the debate over the harms and regulation of tobacco products. Perhaps prompted by the impact of second hand smoke, about 75 countries around the world have banned smoking in public areas by creating smoking zones.
Ethiopian Public Health Association with the collaboration and support of its partners conducted one day workshop in December, 2009, on how to ratify the Framework Convention on Tobacco Control (FCTC) by the House of Representative of the Federal Democratic Republic of Ethiopia, the highest law making body in Ethiopia. After intense discussion from participants they have agreed to develop working paper and send to House of Representative and encourage the house to ratify within six months time. Ethiopia being one of the few African countries failed to ratify the convention, expected to do so as soon as possible.
X1.UICC Membership Renewal
After several attempts we have finally managed to renew our society’s membership of UICC for 2009 and 2010 budget years respectively, but failed to renew membership of International Confederation of Childhood Cancer Parent Organization (ICCCPO).We are trying to send membership fee as soon as we get the necessary foreign exchange and renew our membership.
X1I. German Church Fundraiser
As per the action plan, our Society actively took part in a Bazaar that was held at the German Speakers Evangelical Church, here in Addis Ababa, Ethiopia on May 17, 2009.The program was intended to raise money to buy medicines for paediatric cancer patients under treatment at the Paediatric ward of the Black Lion Hospital. Due to all round involvement and participation of the Fund Raising and Promotion Committee and their families, the program achieved its set objectives and it was found out to be very successful. This is the second promising experience, which should make us proud and happy.
On behalf of the fund raising committee and our Society, we would like to extend our heartfelt gratitude to our respective members, families and friends for their contribution to the bazaar, without whose support this result would not have been achieved. Above all our thanks should go to the German Speakers Church for allowing us to participate in the bazaar and keep the proceeds from the sale of food and drinks, for our society.
Moreover, we would like to thank and congratulate the following organizations who have given us their services and products free of charge for sale at the bazaar.
• Shi Solomon Supermarket - 100 pieces of spiced hamburgers.
• BGI Ethiopia - 3 barrels of St George Draft Beer.
• MOHA Soft Drinks Industry =5 cases of Mirnda and 2 tents.
• W/o Sophie Ali =100 pcs of Burger Bread.
• W/o Emebet Tesfaye = Birr 200 for preparing Ethiopian food.
• Zur Canteen Restaurant = food item and person to grill the Burger.
Total revenue raised from the Bazaar was Birr 9,600.
XII. Ethiopia New Year & Id Al Feter Party to Cancer Patients
As per our Society’s action plan we celebrated the Ethiopian New Year and Id Al Feter holidays September 11 and 20, 2009( Meskerem 1 and 20, 2002 Ethiopian calendar) respectively at the Black Lion Hospital, Pediatric Ward with more than 100 pediatric patients and their families.
In addition to the party our Society gave Birr 50 to each cancer patient under treatment at the hospital. The party took place between 10:00AM and 02:00 PM and included moving speeches by the officials of the Society and representatives of the patients’ families highlighting on the importance of the occasion and reflecting concern on the absence of proper medicines and support structure for patients that remain under treatment.
XIII. Walk for Life (October International Breast Cancer month)
A walk program organized by our society with the collaboration of YeEthiopia Cancer Association to commemorate the October International Breast Cancer month was held on October 25, 2009 here in Addis Ababa, Ethiopia. Thousand of participants including Ministers, celebrities, Head and Representatives of International Organizations, Government & NGOs, and students from Various Schools of Addis Ababa took part in the program.
H.E Muferihat Kamil, the Federal Democratic Republic Ethiopia, Minister of Women’s Affairs Ministry was Guest of Honor. Her Excellency in her speech elaborated the need to forming united front to challenge the growing cancer burden in Ethiopia. She also appreciated concerted efforts being made by Government and Cancer organizations in their efforts to enhance the awareness of society of cancer, its prevention and treatment possibilities. And reaffirmed the readiness of the Ministry to join and help the on-going efforts in what ever way possible to make a difference in Ethiopia.
Head and representatives of various international organizations like World Health Organization, Ethiopia Office, United Nations Women Association, Ambassadors Wife Group, Mr. Haile Gebereselassie widely considered being the greatest long distance runner of all time in the world, students from various Schools of Addis Ababa, members of Scouts actively participated.
Ambassadors’ wife group representative, Mrs. Sherry Sewall explained why her group selected Mathiwos Wondu-YeEthiopia Cancer Society’s project proposal intended to help paediatric cancer patients and earlier donated Birr 70,000 (USD 5,385). On behalf of the group she reaffirmed their readiness to closely work with the society.
Representative of the United Nations Women Association Mrs. Amelia on her part thanked the organizers of the program and presented Birr 25,000 (USD 1,923) to Mr. Wondu Bekele, General Manger of MWECS.
Dr. Kunuz Abdella representing WHO, Country office, outlined the ongoing efforts to challenge the growing burden of non-communicable diseases in general and cancer in particular and thanked the organizers of the event and reaffirmed the readiness of his organization to continue helping the society’s efforts.
The greatest long distance runner of all time Athlete Haile Gebreselassie on his part thanked the organizers for inviting him and acknowledged that he himself lost his Mother due to cancer. He noted that in today’s world, everyone will be touched by Cancer-as a patient, a family member or a friend. Taking in to account the absence of proper treatment options, high cost of treatment and low level of curing rate associated with the below standard treatment condition in Ethiopia, he strongly underlined the need to focus on awareness creation and prevention possibilities.
Finally the Guest of Honor initiated the walk program and together with the participants covered the whole three kilometres starting from Meskel Square, covering areas around the Grand Palace, Filweha, Red Cross and then back to Meskel Square.
Thanks to the involvement and active participation of various organizations and people from all over Addis; all expenses of the program were covered by sponsorship money. On behalf of the Society and the beneficiaries of their help, we would like to extend our sincere thanks and appreciation for taking part in our walk program.
Various kinds of activities were carried out to commemorate the breast cancer month. Panel discussions were held on television and radio while several interviews were given to local newspapers and FM radio stations. More than 1,200 T-shirts, posters, banners, different kinds of brochures were printed and widely distributed. From the feed back we are getting the program conducted for third time here in Ethiopia found out to be the best ever held.
XIV. Others
A. Working Visit to Rio
Mr.Wondu Bekele, General Manager of Mathiwos Wondu-YeEthiopia Cancer Society made four days working visit to Rio de Janeiro,Brazil.The working visit was made possible and full travel and accommodation cost was covered by London based Love for Children,NGO. During his stay, Mr.Wondu Bekele was able to present paper on the Society and cancer in Ethiopia which included his own personal experience and how cancer affected his family emotionally, physically and financially. During his stay in Rio he managed to visit some of the landmarks of the city which is widely considered to be the most beautiful city in the whole world, including the statue of Jesus Christ.
Mr.Wondu also participated in the congress of Children's Fund and had friendly discussion with Mr. Humberto Silva, Director of World Children's Fund and Marketing Manager of Love for Children, on various issues including on how to coordinate their activities and how to strengthen MWECS organizationally and financially. We would like to thank all members of the Love for Children staff specially Mr. Humberto Silva, Mr.Alexander, Mr.Henrique, Ms Paula A. Francisco and Natalia for their all round support and making the working visit successful.
B.Diplomatic Bazaar in Addis Ababa
Diplomatic bazaar organized by members of diplomatic mission was held on November 28, 2009 in the African Union compound here in Addis Ababa, Ethiopia. Almost all embassies situated in Addis actively participated. Some embassies organized bazaar in which they managed to familiarize their costumes and tradition. Food and drinks of different verities were sold to the visitors.
Our society was one the invited NGOs to the Bazaar and the society’s General Manager, Mr.Wondu Bekele gave more than one hour live interview to the popular English FM radio situated here in Addis Ababa. We tried to familiarize our society and cancer to the visitors which include people from several countries, including the first lady of Ethiopia HE Ms.Azeb Mesfin, wife of Prime Minister, Mr.Meles Zenawi. The interview which was presented just four days to the bazaar attracted a huge attention, according to the feedback we received from the listeners.
C.Busy Saturday
December 26, 2009 was one of the busiest days of our Society. Four important events took place in one day alone. These are the followings
C-1.Anti-Tobacco Campaign Workshop
The first program of the day was half day consultative workshop was held at Panorama Hotel, Addis Ababa, Ethiopia, starting 9:00 AM. The workshop was intended to review and evaluate the on-going Anti-Tobacco Campaign and discuss whether to continue the campaign in the future.
C-2.Peace and Justice Club
The second program of the day was Peace and Justice Club (with members from seven Addis Ababa schools) program at Cathedral School. Club members promote culture of peace and non violence among students of Addis Ababa, Ethiopia. As per their program, the Club members invited two prominent NGO Managing Directors to attend as a Guest of Honours and present speech on their organization activities and personal experience. Accordingly, Mr.Wondu Bekele, General Manager of MWECS, and Managing Director of Environmental Protection Organization attended the program.Mr.Wondu managed to set aside some time from his very busy schedule of the day and together with the other Guest of Honour made moving and inspirational speech on their respective topics. According to the feedback we got widely appreciated by the club members and invited students and their families. Finally Mr.Wondu was given a gift of t-shirt printed for the day.
C-3.Attend Hayat Medical School College Program
The third program attended by Mr.Wondu the same day was organized by students of the renowned Hayat Medical School College. The program was held at the Medical School College compound starting 3:00PM.Mr.Wondu was one of the two people invited from NGOS working on health related activities.Mr.Wondu presented briefing on the MWECS in particular and cancer in general.
Group of six students from the medical school recently began preparing research paper on cancer in general and activities of MWECS in particular. Taking in to account the absence of such paper in Ethiopia and the significance of the research in our future work, the students were give utmost attention and cooperation and furnished with all information and documents at our disposal. The students were given a chance to visit the paediatric ward of the Black Lion Hospital to see the existing condition there and witness the various problems the patients and their families are facing which including acute shortage of medicines, isolated ward, cancer specialists and treatment options.
C-4.Attend Memorial Program
The fourth and the last program attended on December 26, 2009 was to take part in one year memorial program of the late Ms Alayush Tefera, who lost her life due to breast cancer last year. She was the only breast cancer patient who readily participated in the awareness program and shared her personal experience on how cancer affected her physically, emotionally and financially. She was survived by three sons of whom the oldest is attending Geology class at the Addis Ababa University. Although the kids are supported by their father working as driver, but due to their meagre income they are desperately looking for every kind of support to complete their education.
C. Financial Statement
Mathiwos Wondu -YeEthiopia Cancer Society
Notes to the Accounts
For the Year Ended 31 December 2009.
1. Introduction
Mathiwos Wondu-Ye Ethiopia Cancer Society is Non-profit making organization
established for the purpose of supporting cancer patients in Ethiopia.
Its main objectives are the following,
• Create the societies awareness of cancer its detection, prevention and
treatment possibilities.
• Provide moral and material support to cancer patients;
• Encourages the establishment of National Cancer Institutes where research
and development will be conducted and treatment will be given to cancer
patients.
2. Accounting Policy:
The principal accounting policies adapted by the society are the following:-
a) The society used cash basis of accounting, where by income is recognized
when cash is collected and expense when cash is paid.
b) Fixed assets and consumable items are expensed at the time of purchase.
Mathiows Wondu -YeEthiopia Cancer Society
Statement of Cash Receipts and Payments
For the Period Ended 31 December 2009.
Fund Balance Brought Forward 166,123.82
Add: Receipts
Registration & monthly contribution 11,999.74
Donation 226,736.06
Capacity Building Contribution (CRDA) 13,800.00
Fund Raising 77,398.00
329,933.80
Total Receipts 496,057.62
Less: Payments
Salary Expense 40,337.50
Donation to Cancer patients 17,350.00
Membership fee - CRDA 3,750.00
Telephone & postage 4,017.31
Printing & stationary 27,857.65
Rentals 7,200.00
Traveling Expense 7,721.28
Professional Service 4,800.00
Medicine for cancer patients 5,000.00
Publicity 2,371.00
Audio visual expense 8,191.74
Incentive 10,750.00
Tea, Coffee, Luncheon etc..... 8,129.28
Miscellaneous 824.89
Total Payments 148,300.65
Excess of Receipts over payment 347,756.97
Represented By:
Cash on Hand 2,670.41
Cash at Bank 345,086.56
347,756.97
D. Conclusion.
Our Society is seven years young. Taking into account, the peculiar condition we have been forced to operate in, without proper office facilities and permanently assigned personnel, we believe that we have achieved remarkable results so far, but still we have a lot of work to do in the future. We know that we cannot change all cancer related problems in a short period of time, but still we can start to change something today.
Although we are still experiencing various kinds of problems, thanks to the capacity building we are getting from CRDA, UICC and others we are more than ever before convinced that we have a bright future ahead of us. We are encouraged by the support we are getting from the Society’s first permanent employee, Project Officer and our volunteers who are untiringly supporting our Society’s activities to realize its objectives.
2009 budget year was very special year in our society’s seven years existence. Thanks to the generous support we received from UICC we managed to conduct Anti-Tobacco Campaign, the first of its kind in Ethiopia. The implementation program helped us not only to implement all activities planned in the project proposal it also created very conducive atmosphere to enhance the awareness of students, staff and their families of cancer in general and prevention of cancer in particular.
We have also started to implement palliative and hospice care to support pediatric cancer patients. The project is intended to decrease the suffering of pediatric cancer patients and their families and increase their survival rate. Although the project implementation is underway, we strongly believe that it will give us first hand experience on how to mitigate cancer impact and support pediatric cancer patients and their families.
Our Society being a member of Non-Communicable Diseases Committee formed under the Ministry of Health of Ethiopia and partially supported by World Health Organization(WHO) Country Representative Office, actively working in developing policy and strategy on non-communicable diseases in general and cancer in particular, to be approved and implemented by Ethiopian Government. Thanks to our continuous and concerted efforts, the Strategy we have developed recently been reviewed and appreciated by the management of the Ministry of Health and expected to be included in the fourth Health Service Development Program(HSDP, 2010-2014), which is a huge way forward which can create conducive condition and help to get appropriate attention from government and organizations. This will take some time but it is very big achievement for NCDs in general and cancer in particular.
Unlike our previous reports, this year report particularly in some topics and activities is elaborated and presented in detail intentionally to give readers the chance to see peculiar condition of cancer here in Ethiopia, what we have achieved so far and trying to achieve in the future.
Finally, we are very grateful for all who supported our activities in what ever way they can. Life seemingly long, but it is very short and expensive to waste. We know that no one is allowed to live in this world forever or gets out of this world alive; few people come through life without at least one serious illness. Therefore, members of our Society and friends more than ever before should be committed and involved to create a world where cancer is eliminated as a major life- threatening disease for future generations. As you all know cancer is not a battle that one can fight and win in isolation, we look forward to all round support and involvement in order to make a difference!