Traduzione en 20110512 - Project Malawi

8/3/2019 Traduzione en 20110512 - Project Malawi

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Rome, 12 May 2011.

Press conference presenting Project Malawi

Corrado Passera: It is truly a pleasure for me to present a project that involved both

Fondazione CariploandIntesa San Paoloin an important promotional role, which theycontinue to guarantee, not only through financing but also through coordination.

However, concrete contributions were made by organisations which have already been

partially mentioned: firstly the SantEgidio Community, Save the Children, the local

Scouts and CISP, which is with us here today. We have also been joined, over time, by

Italian paediatricians and neonatal doctors; this is a strong and committed team,

which for a long time has been involved in important works. For this reason we are

pleased to accept this invitation by the SantEgidio Community, which will host a

convention over the next few days with the participation of many important Africanexponents who will examine the Project to date. We are pleased to do so in the

presence of a representative of the Malawi Government, because these projects, if

they are to be vital and sustainable over time, require strong integration with national

structures. We cannot limit ourselves to taking skills and installing structures; we need

to create internal strength, train people on-site, create structures capable of

collaborating with central structures. Mary Shawa, who has worked with this project for

more than six years, has acted as its sponsor in Malawi. The cover that will now

appear on the screen is a sort of summary of all of this: strong contribution by the four

non-governmental organisations, an equally strong contribution by the Malawi

Government and the two sponsors and principal coordinators, Intesa Sanpaolo and

Fondazione Cariplo of course. All of this leads to a project that we have simply called

Project Malawi. It is a project that appeared to be somewhat impossible a few years

ago, primarily for the reasons mentioned earlier by Marazziti: no-one believed that a

country in such a bad situation could recover positive trends such as the ones we are

witnessing today. Today, six years later, we are reporting to you and not because the

project has concluded: it must continue and will continue with our firm support.

However after six years and after real and proven results that have been achieved, it

appeared to us to be a good occasion to benefit from the event organised over the

next few days in Rome by the Sant'Egidio Community to share with you some of the

work done.

Two points must be underscored. Primarily, the issue of AIDS has not been resolved,

although little is spoken about this in Italy, because we have learned to live with it and

people are not dying in the way they did before. AIDS still represents - for the world in

general and certainly for Africa - an enormous problem that has not been eliminated

and must be dealt with. Project Malawi and the Dream programme in particular,


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most specifically dedicated to treating AIDS, has proved to be effective so this is not

just a promise, not just a commitment in dealing with AIDS using an integrated

approach, which I would like to try and illustrate with regard to health and

development.

Clearly the maximum priority and emphasis have to date been given to health, the

starting point to create hope for a future. However if we did not act on prevention,

education, micro-financing, support for this endless population of orphans, there would

be no hope of resolving problems with a merely medical approach. So lets look at

some concrete data both on the first and second point. The first table shows that in

certain countries, in the sub-Saharan part of Africa in particular, AIDS is still a problem

of enormous scope: we are talking about more than 33 million infected persons with

two thirds of them concentrated in this region. So it is absolutely and dramatically true

that in some parts of the world it continues to represent the foremost problem. Atpage 4 you can see that AIDS is the main cause of death, far outweighing any other

cause; we are therefore talking about an epidemic that is still important and this is the

reason why we are not giving up, and in fact we are going to increase our action. At

page 5 you will see the same type of message: AIDS is still the principal cause of

death in Africa, and if we look at various parts of the world, where obviously there are

many different causes of death, both in terms of mix and overall effect, you will see

the difference between wealthy countries and the African continent. If we should

investigate further and look specifically at the sub-Saharan area of Africa, the terrible

string of illnesses and percentage of deaths from AIDS would be even higher, but even

by this we know just how serious the problem is, and it is therefore essential to pay

attention to this problem. This is not just a health issue, its a social issue, because

AIDS destroys families, and when the fundamental structure of society is destroyed

that same society is destroyed. AIDS has produced 16 million orphaned children and

90 per cent of them are concentrated in the countries we are talking about. We are

talking about 16 million children. The extent of the problem is endless and triggers

further exceptional problems: since orphans do not have access to education and are

not cared for, desperate generations are created, generations without hope who are

open to social and economic risks, which are far greater than the medical issue itself.

According to the various countries involved, the cost of AIDS is enormous in terms of

lost development and amounts to 1-2 per cent of GDP, a figure which makes a

difference in many of these countries. Since the few doctors, nurses and teachers in

these countries also die, society itself becomes weaker, destructured and incapable of

coping with the extent of the problem.

I have merely summarised some aspects, not to highlight the weaknesses of the

country, but to justify the need for intervention and the commitment we have made


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thanks to this information, which we evaluate periodically with Mary Shawa and the

people who manage the project in Africa. AIDS remains the number 1 cause of death

and this is easy to state: more than 12 per cent of the population is infected and 17

per cent of mothers are HIV positive. If project Dream did not exist, many of them

would have to give birth to sick children, and when you are born sick this means that

there is no hope. The aim of Project Malawi, if we want to summarise it, is to raise a

barrier against the disease in order for healthy generations to be born, who can hope

for a better future. It is extremely difficult to construct a life from an economic, social

and democratic viewpoint, but if we dont protect the right to be born healthy there is

no chance of achieving something positive in life. We are talking about transmission

through deliveries of tens of thousands of possible newly infected persons each year;

we are talking about an illness which, as stated in the remarkable film, is not only

critical and leads to death, but marginalises, hides, ghettoises people and facilitates orworsens economic and social degradation, making it even more terrible. I mentioned

the fact that the first victims are those who can contribute to the solution, such as

doctors, teachers, nurses and persons who generously treat this illness. When you

think of Malawi, a country with little more than 10 million inhabitants, and more than 1

million orphans, imagine what that would mean proportionally in Italy, adding levels of

poverty that we have certainly not experienced for many decades: these are problems

that appear to be irresolvable. Since hope was almost lost, we wanted to concentrate

our efforts together with Fondazione Cariplo in an area where it appeared that

everyone had given up but where the possibility to take action still existed. The

numbers, above all six years ago, showed that Malawi was reacting to these

characteristics.

Lets now look at some of the results. I will quickly recall some of the characteristics of

Project Malawi: the first objective is to improve the living conditions, health and overall

development for the population. A second specific objective is to create a barrier

against AIDS which we spoke of earlier, through preventing the transmission of AIDS

from mother to child, i.e. contributing to creating healthy generations. We must then

contain the economic and social impact of the AIDS epidemic. The approach adopted

is fundamental: we are talking about an integrated project including cooperation with

the locals, because woe betide if each person deals with their own little piece

autonomously and the interventions made from the outside are not linked to local

structures so that they can be developed over the long term. A second aspect: the

fight against AIDS is the main objective, but health education, prevention, aid to

orphans, local development and micro-finance must also be developed. It is a fairly

unusual model, there are not many cooperation projects of this kind and this is one of

the reasons why the UN recognised us and awarded us for our work. We were talking


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about financing, because these works cannot be carried out in the absence of

important resources which in our case are guaranteed by Fondazione Cariplo and by

Intesa Sanpaolo. We have already earmarked 18 million over the last six years, and

then we found other contributors: for example, employees of Intesa Sanpaolo made

part of their resources available. We reached a total of 20 million, a figure which

makes this one of the biggest private projects in this field globally. We belong to the

Business Coalition Association, which involves all those private persons committed to

the fight against AIDS throughout the world. We have received confirmation that there

are really very few projects of this scale, duration and scope. The quality of therapy is

another important feature, as our experts will explain later. This was not the case in

the past: Africa was given leftovers, whatever we had; today the results that we have

achieved originate from the application of the best global standards. The care that you

receive in Italy or in the US is the same that we guarantee there. The quality of thelaboratories, the type of analyses and prevention that we now guarantee to parts of

the population and hopefully to an ever increasing number in the future, are just as

good as the care that has allowed us to start to isolate AIDS in our countries. The most

important thing is that we collaborate with the Government, because the project must

be implemented within the structures and life-style of the country, it must involve

local communities, which are of utmost importance, villages, local provinces, which

are in part responsible for applying some of the changes that we introduce.

Investment in training: we are talking about hundreds of trained locals, who then

continue on their own, with better organisation and coordination in various parts of the

country. We involve non-governmental organisations with territorial offices and whose

members are predominantly Malawi. What does that mean? Take the scouts for

example, the girl-guides, one of the most vital organisations in Malawi: they spread

the message of training, education and hope throughout the country. They do this

through theatre, establishing small pre-schools, or pre-schools for local children. Only

with large local structures can we achieve results that will make a difference.

One last word on the role of the sponsors, Fondazione and Intesa Sanpaolo. They do

not just write a cheque, they are directly involved, they feel part of this, they feel

responsible, they travel to Malawi, they ensure coordination, which does not occur

naturally. This is truly a long-term commitment, because often as many governments

tell us, also in other parts of the world - these projects start, they have an initial boom,

they make spot announcements, but then they fade away, whilst the commitment that

we have made is to go through to the end. A great deal of rigour is required on

monitoring and controlling costs and investments; in this regard, I believe this is one of

those cases that can lead by example. Clearly this is also due to Fondazione Cariplos

extensive experience in managing humanitarian and social projects, with its tried and


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tested mechanism for reporting back on the results of the projects. I repeat, the four

big areas are health and the treatment of AIDS, which is obviously the biggest in scale

and is managed by the SantEgidio Community, followed by the integrated activities of

education and prevention, carried out by Malawi scouts and by the project Dream.

Save the Children is mainly involved in the care of orphans, while the International

Committee for the development of people (or CISP) carries out economic policies on

micro-credit and micro-entrepreneurship.

Let us take a look at the main results for each sector. Since scientific matters must be

explained in a comprehensible manner, Dr. Palombi will be much better than me at

this, but some things make a difference and I would like to concentrate on them. Africa

before and after Dream Project are two different realities, because Africa has now been

given protocols of global excellence. As Marazziti mentioned at the beginning, initially

at the very most we provided some prevention with the excuse that there was nomoney nor viable solutions to carry out therapies. No, Dream has shown that by

combining prevention and therapeutic treatment we can achieve results. Initially the

therapies adopted were extremely simple, mono-therapies, bi-therapies and therefore

they had scarce results in the prevention of mother-to-child transmission. However it is

clear that only through the application of tri-therapies to all pregnant women the

results are extremely important. Third point, when do we start? At birth? No, we need

to start much earlier: when the conditions are this bad that is too late and so it is

necessary to start earlier, monitor and invest in terms of preventive care. According to

the Dream model, only if mother and child are accompanied throughout breast-feeding

is it possible to eliminate and lower the probability of an early death for young babies.

This has become the Procedure. Last but not least, we have progressed from purely

clinical diagnosis in the field to thorough and rigorous diagnosis based on laboratories

and techniques which represent the frontier of knowledge in this field, as you would

confirm if you could see them in person. Results: this blue line represents the

percentage of mother-to-child transmission of AIDS for mothers under care as part of

project Dream: the other lines show the results in the absence of care, or obtained

following different and much more simpler care plans. So these are numbers that

speak loudly in terms of effectiveness. This is the maternal death rate. Many mothers

died after giving birth; now, as you can see, with the application of the Dream protocol

as part of the project Malawi death rate is reduced by three quarters: this is a different

life expectation and result expectation. Dr. Palombi will provide more details on this,

however these numbers demonstrate that the viral load, i.e. the strength of the illness

in communities in which the Dream protocols have been adopted, drops significantly:

we are talking about numbers that drop from 91 to 5. These are concrete

demonstrated results: thanks to them the WHO and the Malawi Government have


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taken some important steps. Let us look at the strength of the virus in communities

where mothers have been treated during pregnancy: in addition to higher rates of

recovery, the entire community produces persons who are less vulnerable and less

open to infection. So, these are world championship numbers, which led to important

changes both with regard to WHO (in the first chapter the results of the Dream

programmes are cited as being of significance in relation to the WHO decision to

introduce this type of protocol in place of earlier ones) and at a local Government

level, which set up the early use of these protocols for a large part of the population.

Since these results are not based on good intentions alone, investments are only

possible if local structures are built. We have financed and sponsored the construction

of nine hospitals that provide this type of assistance, which in a small country makes a

difference; seven maternity structures the majority of which are connected to local

structures, and four laboratories built from scratch, progressing from nothing to thepossibility of thoroughly following the trend in the viral load and increase the

effectiveness of care timing. Seven hundred trained operators, including educators

and extremely specialised health operators. We are talking about numbers that start

to be noticed within the entire country thanks to great communication activities and

connections between the country, the continent and the rest of the world. This is the

small country where our health centres and laboratories have been recognised

together with communities in which Project Malawis activities have concentrated.

These are just a few numbers, because the numbers provide proof of whether we have

achieved success in our project or not, both in relation to our initial choices and in our

operations. Clearly, these numbers will now grow much more quickly, because the

structures have only been created over the past few years; we are however talking

about three thousand children born healthy, we are talking about ten thousand people

in care: these are significant quotas in the communities in which we are working,

which lead to people who can hope for an acceptable life, rather than certain death.

We are talking about significant activities by laboratories, but in this case too there

has been an additional spurt, since all four of them are now operating perfectly;

finally, consider the number of medical check-ups and samples: we are talking about

large numbers which, in a country of this size, certainly make a difference. Aside from

the fundamental activities carried out by Project Malawi, i.e. Project Dream, local

scouts are doing their work wonderfully. I mentioned the enormity of this matter: we

are talking about thousands of young people who made themselves available to help

thanks to permanent initiatives in 158 schools, and tens of thousands of kids who have

been trained. You have no idea of the scale of cultural retardation the film shows this

to some extent because some things which make your skin crawl are not known. We

not only have to fight against ignorance but also against convictions that appear to be


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insane, such as if you rape a healthy girl you can recover from AIDS, so think what can

happen within families. So informing families and kids that these are absurd things or

about the right things to do can really make a difference. Now I dont want to give you

all the details, but as you can see we are talking about tens of thousands of boys and

girls. Everyone knows what Save the Children is: 104 centres have been created in the

country, almost 600 educators have been trained, a Childrens Club has been created

in many countries together with places where the hardship is dealt with and resolved.

This is no mean feat: hundreds or thousands of works are ongoing and will not stop.

Micro-finance and micro-credit, together with education regarding micro-

entrepreneurship are difficult to put into practice and take a long time, the foundations

are to be laid to transform a henhouse into a small economic venture, a business for

the repair of buckets into something that can represent a source of income for the

village. This is what the CISP deals with. A large working structure with local ruralbodies, 300 business-men assisted on setting up their business plans and 77 revenue

producing activities which proved to be successful with an impact that cannot be

forever monitored, because when you understand that you can escape from absolute

poverty by doing something relatively simple, the avalanche effect starts. We are

also incredibly grateful to the Italian society of neonatology and paediatrics who,

taking turns, are always present in a certain number of paediatric and neonatology

departments of the area, providing a direct service and training local personnel.

The next moves stem naturally from what I have been telling you. We must carry on:

the original project has proved to be right, a second three-year period is concluding

and a third one will commence soon. We must obviously continue to rethink protocols

used to date. How to adapt them, how to develop them, whether or not to concentrate

them in certain areas only, or to ensure that they are more widespread; in all

probability we will concentrate them in order to defeat all sources of AIDS in a

particular area, which is what we are evaluating at present. However we will speak of

this another time, when we will specifically deal with activities planned for the next

three years. Certainly, these commitments only make sense if they are long-term

commitments. 3,300 children born healthy and their mothers still alive is a result that

appeared to be impossible to achieve: we think that this is living proof that our efforts

were worth it and that, as Marazziti said, this was a small contribution to real hope

that is being created in Africa. So once again I would like to thank the organisations,

firstly the Sant'Egidio Community; thanks to the support of the Malawi Government.

Thanks to so many of you for following us, we hope you will continue to. I think I must

now pass the floor to Mrs. Enoch, then to Palombi, a technical expert who will talk to

you and provide more detail than I have. We must be convinced, because often all we

do is write a cheque and we are not part of the decision and of the risk of starting a


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new journey because Dream was revolutionary compared to other projects so, if we

dont try and understand things a little, we wont have the same enthusiasm. And then

Mary Shawa will speak to you and give you an idea of Malawis viewpoint.

Documents

Traduzione en 20110512 - Project Malawi