Faraja Centre Community-based Health Care (CBHC) in Singida has carried out HIV-related interventions since 2002, beginning as an outreach of the Medical Missionaries of Mary, Makiungu Hospital to mitigate the effects of the HIV epidemic. Faraja was officially registered in Dar es Salaam in September 2005 under the Ministry of Home Affairs as an FBO working with the Catholic diocese of Singida. Later in 2017 we were recognized by the Ministry of Health, Community development, Gender, Elderly and children as the programme had expanded from voluntary counseling and testing (VCT) activities to a comprehensive programme with social, developmental and outreach components of awareness raising and home based Palliative care.
More recently, in July 2016 the staff of Faraja Centre became aware of another reality deeply affecting the lives of the local people. As we went on our outreach visits to the villages and “house to house” counseling and testing, there were “rumblings” that all was not well. The village elders and some government leaders expressed concerns that teenage girls had gone to a few cities and were never heard of again. They could not understand how girls were offered “clean work” in boutiques, hotels, restaurants and some private houses but had never called their parents to say how they had settled into their new jobs. Our work now includes awareness raising on Human Trafficking using Standard Radio and 33 Community Health workers. We have a staff of 14 including nurses, doctor, social worker, accountant, secretary, security and counselors.
Faraja Centre CBHC is a non-profit faith based organization (FBO) located in Singida town, within Singida Municipality in North Central Tanzania. It is administered by the Medical Missionaries of Mary (MMM), an International Missionary Congregation of Catholic of women religious, founded to bring the love of God to others through a service of healing. Their charism (special gift) as Medical Missionaries places them in the world of health and medicine, for the service of the universal Church. They were founded by Marie Martin in Nigeria in 1937 to bring the love of God to others through a service of healing. They follow Christ, who “went about doing good,” healing the sick and proclaiming the Good News of the kingdom. They serve preferentially in missionary situations where the need for human development is great and the people are awaiting the liberating and healing power of the Gospel. Their motto is: “Rooted and Founded in Love” (Ephesians 3:17).
The Medical Missionaries of Mary:
The Medical Missionaries of Mary (MMM) are an international congregation of women religious, founded by Mother Mary Martin in Nigeria, in 1937. Desiring to share Christ’s healing love, the sisters form 20 different countries are educated in a variety of health related and other professions, bringing health services to people of different cultures where human needs are greatest. MMMs are serving in 13 countries around the world – Nigeria, Tanzania, Ireland, Angola, Republic of Benin, Honduras, Malawi, USA, England, Kenya, Uganda, south Sudan and Brazil. With Mother Mary as our model, our special concern is the care of mother and child and the fostering of family life.
Faraja Centre CBHC is a non-profit Faith Based Organization (FBO) located in Singida town, within Singida Municipality in North Central Tanzania. It is administered by the Medical Missionaries of Mary (MMM), an International Missionary congregation of Catholic women religious, founded to bring the love of God to others through a service of healing. Our charism (special gift) as Medical Missionaries places us in the world of health and medicine, for the service of the universal Church.
In the last 10 years Tanzania has seen a significant increase in Non-communicable Diseases affecting children, youth, adults and the elderly which has resulted in an increased burden for the Health Sector and families/community at large. A large percent of these patients need palliative care or/and hospice. FHPCP was started in 2012 to address this situation as there were no palliative services in Singida Municipality. Until this Programme was initiated, there was no treatment for this target group in Singida Municipality; patients were discharged home to die with no treatment, even for control of their pain. Faraja Hospice and Palliative Care Programme (FHPCP) provides home based treatment and care, including morphine for severe pain, for these people. According to the National Policy Guideline on Palliative Care Services (December2012) palliative care is a human right and Tanzania wishes to address it even though the resources of the government for doing so are poor and scarce.
Having discovered that patients with terminal illness had no care, especially of their pain, more investigation was done by us. It was found that there is a definite need for hospice and palliative care in Singida. Faraja Centre CBHC saw that this population could be served and cared for from the Centre. It had a Doctor with 35 years of medical experience in Tanzania who was very interested in helping to solve this problem. FHPCP began as a Pilot Programme in 2012. Very soon the number of patients increased to the point of convincing the Programme that palliative care, especially End of Life Care, was needed in Singida.
Firstly, the Medical Officer in Charge, and Nursing Officer in Charge of Singida Regional Referral Hospital were contacted to get their opinion as to whether there was a real need. They were very enthusiastic and encouraging. The Municipal Manager was contacted and gave us permission to contact the Local Government Leaders in the various Wards. Ocean Road Cancer Institute (ORCI) Dar es Salaam was visited. It was found that they had no arrangement for follow-up and care in the patients’ local areas, but the Palliative Care Department agreed to communicate and to facilitate ongoing care locally for Singida patients. Also at this time the Tanzania government issued a National Policy Guideline for Palliative Care Services (Dec2012). Palliative Care was a totally new concept to the patients needing it but, when it was explained to the patients and their families, it was readily accepted and welcomed.
FHPCP contacted and took the advice of Hospice Africa Uganda (HAU), which pioneered Palliative Care in Africa, and decided on a Home Based Programme model instead of an institution. It was decided to follow on the 20 years experience of HAU and to adapt it to our local situation. FHPCP began as a Pilot Programme in Singida with one medical doctor, one nurse and a part-time driver. The plan has been to start small, build on our experience and to expand when and if possible. From its beginning in August 2012 until the end of 2017 the Programme has enrolled 303 patients out of which 176 have died. At any one time there are between 85-95 patients currently being cared for by FHPCP.
In our five years of experience we have found that almost all of our patients (303) have been poor. A number would have been considered middle-class before their illness, but their finances were totally depleted travelling to various health facilities looking for a cure or to obtain cancer treatment in Dar es Salaam. Most have been too poor to even think of travelling to get treatment; thus they have needed palliative care since diagnosis.
The Tanzania government exempts patients with chronic diseases and the elderly over 60 years from paying for their health care services. But in reality this isn’t happening due to scarce resources: patients pay to open a file, for lab services and for medicines prescribed as they are told that what they need is not in stock.
All people, rich and poor, with life-threatening and incurable illnesses are very vulnerable! We treat all people needing hospice or palliative care. However, we have encountered a good number of patients, usually women or single women with children, who have cancer and other life-limiting ailments (strokes, paralysis from various causes, neurological conditions) and have no one to turn to and are extremely vulnerable. We especially reach out to these people offering a compassionate and professional service embracing the medical psychological, spiritual and social components of hospice and palliative care.
Sr. Dr. Marian Scena, MMM, Coordinator and Physician
Ms. Amina Kimashalo, PC Nurse
Ms. Matilda Saul, PC Nurse
Mr. Shabani Miloho, Driver
And 14 Palliative Care Volunteers from the community.