Activity Report 2009
DA M I E N FO U N DAT I O N *jaarverslag2009_cover_eng.indd 2
An association with many faces For Belgium, 2009 will forever remain the year in which Damien was finally canonised. For the vast majority of the population, it was a given for years, however it was only on October 11th 2009 that Pope Benedict XVI officially declared the canonisation during a big ceremony in Rome. We should all be proud. At the same time, we continue to feel the pressing call launched by this unique person. His example continues to make an impression. And he is so close and so recognisable that even many young people today admire this 19th century missionary. In our society, where everything goes so quickly, this is truly saying something. For the Damien Foundation, Damien has always been and will always be a unique anchor around which the association, since its creation in 1964, has gathered many people to work towards an extraordinary goal. This objective has gone through some evolution, notably in terms of the fight against leprosy, and is currently worded as follows: “The association aims to follow the example of Father Damien and his work and to contribute to fighting leprosy and other medical-social issues in the world on the one hand, and to help develop all kinds of campaigns to inform and raise the awareness of the Belgian people on the other hand.” With the strength of his Christian faith, Damien shook up society. Turning away from the norms of his era, he made the radical choice to side with the down-and-outs, with the people in whom nobody was interested. This is why our association throws all of its energy into trying to inspire people today to continue to fight for these down-and-outs. And the association has strived, from the outset, to cross all borders and to break down any barriers in bringing together those who support the association's objectives. It is clear that outside Belgium, the Damien Foundation relies on people of all different faiths and beliefs. Some may be surprised to learn that the example of Father Damien inspires almost universal respect. As Mahatma Gandhi wrote in 1945: “The political and journalistic world can boast of very few heroes who compare with Father Damien of Molokai. It is worthwhile to look for the sources of such heroism.” Here in Belgium, many people are also clearly inspired by this commitment towards the down-and-outs. Almost every day, through our contacts with our donors and many volunteers, we sense the great importance of Damien's example. For at the end of the day, these donors and volunteers are what make our association strong. In a nutshell, suffice it to say that the spirit of Damien lives on! As the Damien Foundation, we are proud to have his name as part of our association's name. As an association, we are increasingly hearing this call to walk humbly, yet with an ever greater commitment, in the steps of our illustrious predecessor. Throughout 2009, this commitment bore much fruit, both in Belgium and in our projects. Thousands of people worked for the cause. They gave a real face to the association around the world. And they helped tens of thousands of sick people. In this 2009 activity report, you can read some selected examples of this vast range of activities. Before you get reading, we want to thank you from the bottom of our hearts for your support of our association. Rigo Peeters Secretary General
Paul Jolie Chairman
4 | Activity Report 2009
Short Introduction The Damien Foundation is a Belgian pluralist and apolitical NGO. Established in 1964, on the heels of the “World Days of Leprosy” started by Raoul Follereau (“the lepers’ lawyer”), the Damien Foundation draws daily inspiration from the work of two other key figures: Dr Frans Hemerijckx (“the lepers’ doctor”, to whom we owe “clinics under trees”) and, of course, Father Damien (“the lepers’ apostle”), who was canonized on 11 October, 2009.
The mission of the Damien Foundation is threefold: to fight against diseases of poverty overseas, to raise the Belgian people’s awareness of the issue and to create a network of volunteers at home.
The Damien Foundation was established to fight leprosy. But as the needs in this area dwindled and the foundation's financial means continued to grow, the Damien Foundation soon extended its scope of action to include the fight against tuberculosis. While tuberculosis is the disease it fights the most today (the figures tell the tale), the Foundation will always continue on its quest to eradicate leprosy. What's more, the Foundation is also fighting against leishmaniasis in Nicaragua. In 2010, this program will be extended to Guatemala.
By late 2009, the Damien Foundation was working in fifteen countries in Africa, Asia and Latin America. There are four key elements to the Damien Foundation’s work: it only works at the request of local governments, on long-term projects, in cooperation with partners like the WHO, ILEP (International Federation of Anti-Leprosy Associations) and the UIATLD (International Union Against Tuberculosis and Lung Disease), and almost exclusively with local personnel.
The Damien Foundation works mainly through national leprosy and/or tuberculosis programs, some of which it helped to establish. However, as national programs cannot meet all the specific needs of patients or former patients, the Damien Foundation has been running “basic projects” since 2007. These small-scale projects target limited populations. For now, they are mainly socio-economic by nature, but they can be medical too. They coexist alongside the national programs, which remain the best way to provide access to health care to the greatest number of people, as well as being the Damien Foundation’s top priority in its work overseas.
Solid support in Belgium
To earn the "N" in its designation as an "NGO", the Damien Foundation relies on two solid pillars of support in Belgium: enthusiastic colleagues and faithful donors who contribute over half its needs every year. It's enough to keep the Foundation independent, no matter what happens.
| 5 345.257 patients diagnosed and treated in 2009 Country
LEprosY Number of patients
tuBErcuLosis Population Number covered of patients
N.B.: Nicaragua: also 4.116 cases of leishmaniasis detected in 2009. Total population covered: 378.844.196
Number of patients: evolution
Tuberculosis 300.000 250.000 200.000 150.000 100.000
50.000 08 09 05 06 07 02 03 04 01 00 97 98 99 94 95 96 93 92 91
6 | Activity Report 2009
Financial Report Balance assEts Fixed assets Intangible assets Tangible assets Financial ﬁ xed assets Current assets Amounts falling due after more than 1 year Inventory Amounts falling due within one year Investments Cash balance Deferred charges and accrued income t o t a L a s s E t s
LiaBiLitiEs Equity Own funds Permanent funding Reserves Provisions (Pensions) Debts Short term debts Accrued charges and deferred income t o ta L L i a B i L i t i E s
2009 506.430 € 31.284 € 471.397 € 3.749 € 20.903.135 € 500.530 € 671.552 € 6.606.355 € 10.819.196 € 1.769.995 € 535.507 €
2008 622.216 € 58.292 € 560.192 € 3.732 € 25.741.330 € 6.438.571 € 729.814 € 7.098.272 € 10.029.456 € 930.848 € 514.369 €
26.363. 546 €
2009 16.108.436 € 61.974 € 5.429.546 € 10.616.916 € 74.661 € 5.226.468 € 539.248 € 4.687.220 €
2008 16.646.218 € 61.974 € 5.429.546 € 11.154.698 € 88.230 € 9.629.098 € 439.751 € 9.189.347 €
26.363. 546 €
These ﬁgures require some explanation: Assets: Amounts falling due after more than one year: includes the legacies that the Damien Foundation will receive from 2011 onwards. Amounts falling due within one year: includes the legacies and grants from the DGDC that the Damien Foundation will receive in 2010. Liabilities: Accrued charges and deferred income: these are DGDC grants that will be received for 2010.
Profit and loss account Operating income (page 8) Operating charges (page 9) Operating proﬁts Financial income Financial charges (including reassessment of the amounts written oﬀ ) Current proﬁ ts Exceptional charges Proﬁ ts of the year
2009 15.211.223 € -16.523.536 € -1.312.313 € 221.981 € 552.550 € -537.782 € 0 € -537.782 €
2008 17.113.778 € -16.599.208 € 514.570 € 386.588 € -2.135.278 € -1.234.120 € 0 € -1.234.120 €
NB: The detailed accounts of the 2009 tax year are available on the website of the National Bank of Belgium (www. bnb.be).
8 | Activity Report 2009
Operating income own rEvEnuEs Belgian people Direct gifts and local group initiatives (from 1.1. to 31.12.2009) Bequests Total own Revenues
suBsiDiEs anD co -FinancinG Belgian government (DGDC) European Union ILEP members Municipalities, Districts and States
8.560.247 € 1.283.522 € 9.843.769 €
4.503.710 € 0 € 589.330 € 164.240 € 5.257.281 € 110.173 €
t o ta L o p E r at i n G i n c o m E
Direct gifts and local group initiatives
Belgian government 29,6% ILEP 3,9% Municipalities, Districts and States 1,1% Miscellaneous revenue 0,7%
Operating charges FiELD ac tions Projects supervised directly by the Damien Foundation Asia Africa America Contribution to ILEP member’s projects Scientiﬁ c support Training Project management Basic Projects Damien workshops
6.106.917 € 3.982.833 € 509.322 € 135.566 € 438.293 € 161.914 € 819.312 € 294.124 € 147.938 € 12.596.217 €
i n F o r m at i o n , F u n D - r a i s i n G a n D a D m i n i s t r at i o n Information and development education 1.170.500 € Fund-raising 2.147.287 € National Secretariat 609.533 € Total Information, Fund-raising and Administration 3.927.318 € 0 €
Provisions t o ta L o p E r at i n G c h a r G E s
Field actions 76,2%
Information and development education
National Secretariat 3,7%
s i t u at i o n at B E G i n n i n G 2 0 0 9 leprosy and tb tuberculosis
Niger Guinea Nigeria Congo Rwanda Burundi
"More for Africa". These three simple words, born in the chaos of the tsunami that ravaged... Asia at Christmas-time 2004, describe the Damien Foundation's credo perfectly. While many places around the world are in bad shape, the situation in Africa is even worse, and the continent tends to be forgotten. As a result, 8 of the 15 countries in which the Foundation is active are African, with the biggest share of its efforts going to Congo. The Foundation's two latest projects are in Niger and Guinea.
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The situation in which the Damien Foundation works is often rather difficult. This stands to reason as, if all was going well, the local authorities would not be asking for help in the fight against leprosy or tuberculosis. This being said, the Foundation's work in Africa is even more complicated because alongside poverty issues, there are occasionally highly delicate situations at the political or security level. Just think of Congo, where Kivu and the Eastern Province as well as Haut and Bas-Uélé were once again home to a series of dramatic events in 2009. Nor was it a quiet year for Burundi, which is preparing for elections in 2010. In Guinea-Conakry, where the military junta had taken power after the passing of President Lansana Conté in late 2008, the year started out well before chaos broke out when the junta announced they were running for the 2010 elections. Naturally these types of situations make the work of the Damien Foundation's teams all the more difficult.
Tuberculosis is truly a plague in Africa, or at least in certain regions. To realize the extent of the problem, all you have to do is visit one of the many health centres in Kinshasa on any given morning. You will see dozens, even hundreds of patients waiting to take their medication every morning, under the close and direct supervision of a nurse. It is an impressive sight. Especially when these patients starts to sing the tuberculosis song along with volunteers from the "Club des Amis Damien" (the Damien Friends' Club), an association of former patients who help in screening and encouraging treatment. Tuberculosis is a serious problem that needs to be taken seriously. However, there is no use letting the disease destroy all happiness either. This type of scenario is common in Kinshasa. However, apart from the presence of the Damien Friends' Club, it is a scenario that occurs all the time across Congo and in all the African countries in which the Damien Foundation is active. In total, well over 100,000 patients have been screened and signed up for treatment by the medical teams supported by the Damien Foundation. A status quo compared to 2008, a year in which the number of screenings had risen considerably.
One of the great challenges of tuberculosis is the fight against multi-resistance. If the proper dosage of treatment is not given or if treatment is terminated too early, the patient can become resistant to one or several of the medications. This patient can in turn contaminate his or her surroundings with a resistant strain of tuberculosis. The treatment for such cases becomes considerably more expensive and more difficult for the "MDR" (multi-drug resistant) or "XDR" (extensively drug-resistant) patient. The scenario described above is designed to avoid such resistance. It is part of the "DOTS" strategy (directly observed treatment short course) in which a patient, for the first months of his or her treatment, takes the medication under the supervision of a paramedic or of a trained volunteer. The latter case falls in the category of "community DOTS", which is particularly popular in Rwanda right now, with 80% coverage nationally. This approach is very much appreciated, as it reduces the need for the patients to travel. The community DOTS strategy is also being rolled out in Mozambique, Burundi and Guinea.
As long as AIDS is around...
Another major problem related to tuberculosis is AIDS, and more specifically tuberculosis/HIV coinfection (in some countries, over half the tuberculosis patients are co-infected!). HIV/AIDS is a major factor for tuberculosis. It is worth noting that a person infected by tuberculosis as is the case of an estimated third of the world's population - statistically has very little risk of developing the disease, unless he or she is HIV-positive. What's more, tuberculosis is the number one HIV/AIDS-related “opportunistic” disease and the number one cause of death amongst AIDS patients. The Damien Foundation does not fight against AIDS as such (many others are leading this battle and given the Foundation's relatively limited means at international level, its support would be only minimal). However, the Foundation does work on co-infection and has helped to implement a series of strategies. One such strategy has been to introduce HIV testing for tuberculosis patients: this has been done systematically in Comoros for several years (although co-infection is not an issue there), it is very common in Rwanda and is strongly encouraged in many other countries too. The aim is to be able to provide preventive treatment for co-infected patients. We can only hope that someday soon, AIDS will be curable. Otherwise, tuberculosis continues to have a "bright" future ahead of it...
Whatever the challenges faced in the fight against tuberculosis, the ultimate goal is to detect the disease, to provide proper care and to help patients recover. The Damien Foundation's African projects generally have good treatment success. While the WHO recommends a treatment success rate of 85%, some countries are doing even better, such as Congo, Rwanda, Burundi or Comoros (which has considerably less patients). Others are not faring as well, although there are encouraging signs of improvement. In Mozambique, for example, for the first time in years, thanks to a huge boost in synergy between the tuberculosis and AIDS programs, the death rate of tuberculosis patients under treatment has fallen below 10%…
Let's not forget leprosy
While tuberculosis is a terrible plague in Africa, six of eight of the Damien Foundation's African projects are combined leprosy/tuberculosis programs, with only the two most recent programs in Niger and Guinea-Conakry - focused solely on tuberculosis. Other than in Congo, the number of detected cases is quite low. In fact, in 2008, the WHO even officially declared that leprosy had been eliminated in Mozambique, with under 1 patient for every 10,000 inhabitants. However, there are still two major points of concern. Firstly, there is the often high proportion of multibacillary leprosy patients amongst newly detected cases (over 93% in Burundi for example). Multibacillary leprosy is the most serious form of the disease: patients have many (Hansen's) bacilli in their bodies and are contagious. Full treatment takes 1 to 2 years. Paucibacillary leprosy, on the other hand, is characterized by a relatively limited number of bacilli in the patient's body, which means he or she is not very contagious or not contagious at all. Treatment takes 6 months. The second point of concern is that, in some countries, a rather high percentage of cases detected are already second-degree (vision problems or visible lesions on the hands or feet), which proves that people are getting diagnosed far too late. This may be partially due to an additional difficulty: with the number of patients dwindling, health care providers in some countries may
14 | Activity Report 2009
find it increasingly difficult to diagnose correctly. And this lets leprosy sufferers slip through the net.
Working on "La Rive"
It is principally with a view to helping patients or former patients of leprosy that the Damien Foundation implements basic projects. With a few exceptions (such as financing a pineapple plantation in Rwanda or reconstruction surgery operations in Burundi), all the African basic projects are located in Congo. The biggest project is the "La Rive" Hospital, Kinshasa's old leprosarium, on the banks of the Congo River. Some long-term leprosy patients and their families continue to live in a camp beside the hospital, which is still operational. The living conditions were simply inhumane, probably somewhat akin to the living conditions experienced by Damien back on Molokaï. The Damien Foundation could not leave things in this state. It is a three-year project aiming to completely rehabilitate the site and the hospital. Major progress was made in 2009: the living spaces of longer-term patients were rehabilitated (with the addition of water and electricity), an operating theatre for leprosy surgery was built and equipped in the hospital (with operations being carried out by the end of the year), critical medication was provided to the hospital that could also be used for the longer-term leprosy patients, financing was arranged for schooling the children of the longer-term patients and a community plantation project was kicked off. Their biggest crop is vegetables (with courgettes so big that our Belgian producers would be green with envy): the idea is to feed the inhabitants of the camp and to sell off the rest.
As you can clearly see, the teams the Damien Foundation supports in Africa are keeping busy. And the results are reflecting this. However, the work is far from done, and much more work lays ahead. Firstly we have to hope that the political situation stabilises and the health care services in the countries in question can continue to work in good, safe conditions. Otherwise it is impossible to expect efficient work. As regards tuberculosis, it is important to try to increase the detection rate along with the treatment success rate to reach 85%. In some countries, much more synergy is needed between the tuberculosis and AIDS programs, as this balance has not yet been achieved. As regards leprosy, even in regions where it seems less prevalent, such as Mozambique, it is important to stay vigilant and make sure that the health care staff still know how to diagnose new cases. To this end, in Mozambique, every new leprosy diagnosis must now be confirmed by a team of supervisors. Consequently, this should reinforce prevention of disabilities among patients, which is another challenge for the future. Finally, other than the "La Rive" Hospital, which is still one of the Damien Foundation's priorities for 2010, we need to multiply and especially diversify basic projects on the African continent.
Support to the National Leprosy and Tuberculosis Programs (PNLT)
2009 Expenses Local partner Damien Foundation representative Personnel under local contract Presence of the Damien Foundation
143.266 € Ministry of Public Health Dr Michel Sawadogo 4 people since 1964
Support to the National Leprosy and Tuberculosis Programs
2009 Expenses Local partner Damien Foundation representative Personnel under local contract Presence of the Damien Foundation
100.123 € Ministry of Public Health Dr Younoussa Assoumani 7 people since 1979
Support to the National Leprosy Elimination Program in DRC (PNEL) Support to the National Tuberculosis Program in DRC (PNT) Activity development in 14 leprosy and tuberculosis Provincial Coordinations Support for primary health care in three health zones in North Kivu. 2009 Expenses Local partners
4.651.086 € Ministry of Public Health, provincial medical inspectorates, health zones, locally-based NGOs Damien Foundation representative Dr Pamphile Lubamba-Ngimbi Personnel under local contract 292 people Presence of the Damien Foundation since 1964
Support to the National Tuberculosis Program (PNLAT)
2009 Expenses Local partner Damien Foundation representative Presence of the Damien Foundation
269.045 € Ministry of Public Health Dr Etienne Bahati since 2007
Support to the National Leprosy and Tuberculosis Programs in the provinces of Tete and Sofala
2009 Expenses Local partner Damien Foundation representative Personnel under local contract Presence of the Damien Foundation
240.196 € Ministry of Public Health Dr Serge Bertschy 11 people since 2004
Support to the National Tuberculosis Program at central level and in the Tillabéri Region
224.390 € Ministry of Public Health Dr Alberto Piubello 3 people since 2007
Support to the National Tuberculosis and Leprosy Program 2009 Expenses Local partner
273.969 € Ministry of Public Health at federal level and in two states: Oyo and Osun Damien Foundation representative Dr Osman El Tayeb Personnel under local contract 9 people Presence of the Damien Foundation since 1991
Support to the National Integrated Leprosy and Tuberculosis Program (PNILT)
2009 Expenses Local partner Damien Foundation representative Presence of the Damien Foundation
204.843 € Ministry of Health Dr Martine Toussaint since 1964
s i t u at i o n at B E G i n n i n G 2 0 0 9 leprosy and tb tuberculosis
China India Bangladesh Laos
Asia is the second most active continent for the Damien Foundation. The Foundation works in four Asian countries, three of which are truly "heavyweights". Indeed India, Bangladesh and China all have an operating budget that surpasses a million euros. Then there is Laos, the only "small" country in Asia, where the Damien Foundation is active solely in the fight against tuberculosis.
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Nowadays not a week goes by without hearing about Asia on the television, the radio or in the papers. Some countries are discussed more than others, with China and India heading that list. Why these two countries? Economists often talk about the "BRIC countries" or "emerging countries" with their amazing booming economies. Old Europe seems to pale by comparison. And yet, in spite of the economic crisis we have been going through, a crisis which hit some areas more worse than others, the Damien Foundation continues to be active in Asia. And not only in Bangladesh, one of the poorest countries in the world, despite its ever growing textiles industry, but also in India and China. It seems that the "economic miracle" that these countries are experiencing (and especially China) is leaving a lot of people behind...
The continent of leprosy
WHO figures bear witness to the fact that Asia is still the continent of leprosy today. According to 2008 data (the most recent data available internationally at the time of writing), two thirds of the new 249,000 patients screened in the world live in South-East Asia. While this proportion was even higher until the early 2000s, the figure has stabilized in recent years, clearly showing that the issue is far from solved.
This is why Asia is the continent where the Damien Foundation deploys the greatest efforts in the fight against leprosy, as the Foundation is leading a combined fight against leprosy and tuberculosis in its three big Asian countries. There are varying degrees of effort deployed however, as Hansen's Disease represents but a small part of its work in China (where several dozens of new patients are screened every year in the independent region of Guangxi), whereas it is a huge component in Bangladesh and especially in India, where several thousands of new patients are screened every year and where former patients continue to need aid or care. Another noteworthy distinction is the percentage of type 2 patients at the time of screening. While the figure is very low in India, the percentage is 15 in Bangladesh and 20 in China (one patient out of five, which is a huge number…). This shows that patients are being screened much later (and for some, much too late) in China and in Bangladesh. And that means all kinds of problems for the patients in question.
One way of helping these patients is to provide surgery. It may seem a bit paradoxical, but India is where reconstructive surgery (or plastic surgery) is the most common (this being said, it is not really a paradox given that, for example, 1% of 10,000 represents considerably more people than 20% of 100). Surgery has been provided within the framework of three of the projects there and about 100 of former patients were able to benefit from surgery in 2009. These operations are generally performed by a very experienced surgeon, Dr Jacob, who has also trained a Congolese colleague and sometimes travels there to assist with surgeries. This mechanism has also been put in place in Bangladesh, but on a smaller scale, as only some thirty people were operated in 2009. No surgery is available at all in China, where leprosy patients sadly garner very little attention. However, an "assessment" of incapacity preven-
tion was carried out in 2009, at the initiative of the Damien Foundation. This should be followed up in the near future with training and targeted activities.
... and basic projects
The Damien Foundation has also made another very valuable contribution for leprosy patients in China. After having renovated several leprosy hospitals, the Foundation has implemented a basic project that consists in building houses for people affected by leprosy. This project, which aims to fight against poverty and exclusion, has been extended into 2010. It goes without saying that there are also basic projects in Bangladesh and in India. Their main objective is to allow former leprosy patients to carry out activities that allow them to earn a living and to support their families. To this end, the Foundation teaches them a trade and provides them with cows, goats, rickshaws or materials to run a small business. Other projects aim to finance the education of leprosy patients' children, so they can escape the stigmatisation to which their parents are subjected and, at a later time, in these countries that do not have pensions, to help support their parents.
Tuberculosis, of course
Alongside leprosy, the Damien Foundation is also very active in the fight against tuberculosis: indeed this represents the bulk of the Foundation's work in Asia. The greatest number of patients screened and treated by the Damien Foundation are located in China (where not everyone has access to health care yet, even if the situation has improved considerably) and in India. The therapy success rate (proportion of patients declared cured) is good all around. Even Tibet has surpassed the 85% mark recommended by the WHO for the first time. There has been great improvement in recent years. This being said, the therapy success rate is far less impressive for re-treatment patients (sometimes barely reaching 60%, like in Tibet... versus 90% in Laos), occasionally dropping considerably in a year, like Qinghai (by 7%!). Such results probably indicate the emergence of resistant strains.
The problem of resistance is very serious in Asia, and it is taken seriously too. This is why, in India, the Damien Foundation has created a tuberculosis research centre in Nellore. This fullyequipped laboratory started drug sensitivity testing in the last quarter of 2009. China started its fight against multi-resistance in 2006 with a pilot project in Inner Mongolia. In 2008 and again in 2009, steps were taken to launch similar projects in Guizhou, Ningxia and Qinghai. It took until the very end of 2009 for the very first beginnings of a similar pilot project to emerge in Tibet. We are hoping the project will be operational by 2011. Finally, in Bangladesh, it has been a year since the 31 districts in Rajshahi started treating multiresistant tuberculosis, in cooperation with NGO partners.
As mentioned earlier, the Damien Foundation works almost exclusively with local personnel. And this personnel sometimes requires training. While training is important in every country in which the Damien Foundation is active, it is especially so in Asia.
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This is why the Damien Foundation has its own training centre in Jalchatra, in Bangladesh. Note that Jalchatra is one of three hospitals run by the Damien Foundation, with a total of 234 beds, for leprosy and tuberculosis patients with complications, as well as for multi-resistant tuberculosis patients in the initial phase of their treatment. Bangladesh is currently the only country in which the Damien Foundation runs its own hospitals. In 2009, some thirty paramedics were trained in Jalchatra, or did retraining, while over 200 volunteers took retraining on leprosy and tuberculosis. Village doctors continue to be integrated in controlling tuberculosis and leprosy in Bangladesh. Since 1997, over 25,000 of them have been trained in the zones covered by the Damien Foundation, with a quarter of them serving as fixed DOTS providers. When you add the many former patients who are also active in the fight against leprosy and tuberculosis to these village doctors, it becomes clear that the community approach makes it possible to detect and treat several thousand new patients every year. It is clearly a successful method. It is also worth noting that the Damien Foundation organises seminars for medical students and for doctors in India.
Alongside training, there is another way of maintaining and even improving the quality of care provided to patients: research. As you will read later (page 27), the Damien Foundation supports several scientific research projects. But two countries are specifically home to a great deal of research, for many years in some cases. In Bangladesh, research is being undertaken on the treatment of multiresistant tuberculosis (with an excellent cure rate to boot), the improvement of laboratory services (including cultures and drug sensitivity testing), follow-up on resistance to medication and uniform polychemotherapy for multibacillary leprosy. In India, the Damien Foundation is also involved in research on uniform polychemotherapy for all types of leprosy, as part of a WHO-implemented program. As one of the participating research centres, it has recruited over a thousand patients in the two districts between 2005 and 2008. Its work now consists in following up on patients to find any complications.
Challenges and the future
There is clearly no lack of work to be done in Asia either (including in Laos, where the Damien Foundation focuses mainly on providing tuberculosis program personnel with supervision, training and management assistance to help them adapt to new developments and changes). There are several major challenges that lie ahead for the Damien Foundation, especially in China. All inhabitants of the regions covered need real access to health care for fast and accurate diagnosis. All diagnosed patients also need regular and direct follow-up of their treatment. We need to pay closer attention to multiresistance in all the projects. And finally, as for leprosy, it is important to ensure efficient control of the disease (which requires early detection and the presence of health care personnel that are capable of screening patients), as well as to allow those severely disabled by the disease to live with dignity through the bias of the basic projects.
Support to the National Leprosy and Tuberculosis Program
1.116.588 € Ministry of Public Health and local NGOs Dr Md. Abdul Hamid Salim 629 people since 1972
Support to the National Leprosy Program in the autonomous region of Guangxi Support to the National Tuberculosis Program in the autonomous regions of Tibet, Inner Mongolia and Ningxia, and in the provinces of Qinghai and Guizhou Representative Office of the Damien Foundation in Beijing
2009 Expenses Local partners
1.111.241 € Ministry of Health in Beijing Dermatology Institute of Guangxi, Tuberculosis Institutes of Tibet, of Inner Mongolia, of Qinghai, of Guizhou and of Ningxia Damien Foundation representative Alex Jaucot Personnel under local contract 5 people Presence of the Damien Foundation since 1982
Support to the National Leprosy and Tuberculosis Programs via district programs (Bihar, Jharkhand, Delhi, Andhra Pradesh, Karnataka and Kerala), projects managed by local NGOs and own programs
2009 Expenses Local partners
1.714.031 € Ministry of Health (Delhi), Ministry of Health in the states of Bihar, Andhra Pradesh, Karnataka and Kerala, 10 local NGOs Damien Foundation representative Dr P. Krishnamurthy Personnel under local contract 377 people (including NGO personnel) Presence of the Damien Foundation since 1955
Support to the National Tuberculosis Program
2009 Expenses Local partners Damien Foundation representative Personnel under contract with the Damien Foundation Brussels Presence of the Damien Foundation
40.972 € Ministry of Health, National Tuberculosis Centre Alex Jaucot (office in Beijing) Vatthana Nanthana (manager) since 1994
s i t u at i o n at B E G i n n i n G 2 0 0 9 leprosy and tb tuberculosis tb and leishmaniasis
As a continent, America represents the Damien Foundation's smallest endeavour in terms of both personnel and budget, as well as in detected and treated cases. However, there are two unique things about this continent: it is the only continent where the Damien Foundation has a local representation office and, most importantly, it is the home ground of its battle against its "third" disease: leishmaniasis. *jaarverslag2009_binnen_eng.indd 23
24â€‰â€‰â€‰| Activity Report 2009
The number one vocation of the Damien Foundation is to fight against diseases of poverty. This clearly explains its presence in Africa and certain Asian countries. America does not immediately come to mind when you think of diseases of poverty, however they have needs too. And some countries have called for the Foundation's help...
A regional office
America is the only continent where the Damien Foundation has a regional coordination office. This office, which is based in Nicaragua, has three main purposes: to provide a connection between the different countries and the Secretariat in Brussels, to provide local teams in each country with counselling as well as ongoing technical and administrative follow-up, and to organise visits in each country at least twice a year. This makes everyone's work a lot easier.
A twofold approach
The three American countries in which the Damien Foundation is active all have one thing in common: the fight against tuberculosis (alone or combined with another disease). And in each country, the Foundation's approach is twofold. There is technical and structural support for tuberculosis programs (at a national or more regional level), notably in the form of training and supervision. The goal is of course to strengthen local capacity. It is to this end that the "Global Fund" (Global Fund to Fight AIDS, Tuberculosis and Malaria - a public/private partnership that strives to find and provide additional means for preventing and treating these three diseases, under the umbrella of the United Nations) put the Damien Foundation in charge of training health care personnel in Nicaragua for the next three years. What's more, the Damien Foundation does more in-depth work in several specifically-targeted areas. These regions have a particularly vulnerable population (such as the homeless in Salvador de Bahia), a high level of endemicity (like in a few mountainous regions of Nicaragua) or difficult access (as is the case of several health areas in Guatemala, which are populated mainly by native peoples). The ultimate goal is to give all patients better access to care.
Food and transport
Food plays an important role in treating tuberculosis. Firstly, it is not easy to take medicine on an empty stomach and secondly, as soon as a patient starts to feel better, they regain their appetite. Various projects have been implemented with this in mind. In Guatemala, in a very remote region, several hundred patients were sent food rations that helped them to make it through their treatment. In Nicaragua, a basic project allowed some fifty very poor patients and their families to receive basic food rations for six months, as well as pigs and poultry to help them in their daily lives. It is worth noting that at the end of their treatment, the patients "returned" a newborn piglet so that others could benefit from the same assistance in the future. In a similar vein, some hundred homeless people from Salvador de Bahia were also given monthly food supplements. However, this project went one step further, as it also aimed to provide these patients with round-trip tickets to the hospital to get treated. There is no way a homeless person could afford such a trip without external help...
Leprosy is not out of the picture yet
The Damien Foundation used to have several leprosy projects ongoing in Latin America. In fact, it was the fight against leprosy that first brought the Foundation to Nicaragua, although things have turned around completely now. Nowadays the Damien Foundation is only fighting leprosy in Brazil, and more specifically in the Federal District around Brasilia. Every year, several hundred new cases are detected and treatment is commenced. The Damien Foundation actually provides very concrete aid to patients with plantar ulcers by providing them with suitable footwear and other materials needed to take care of themselves at home.
While the Damien Foundation is no longer fighting leprosy in Nicaragua, it is fighting a third disease: leishmaniasis. This disease is caused by a parasite, the "leishmania", which is found in the blood of small mammals like foxes, rodents and sometimes even dogs. The parasite is transmitted to people by the bite of an insect: the sandfly. There are a number of different types of leishmaniasis: cutaneous leishmaniasis (which causes chronic ulcers that are reminiscent of leprosy, earning it the name of "mountain leprosy"), mucocutaneous leishmaniasis (which also affects the mucous membranes in the nose and throat), visceral leishmaniasis (or kala-azar, which kills 90% of cases in under two years if they do not receive treatment) and finally atypical leishmaniasis (which causes nodules on the face). The Damien Foundation is the only partner of Nicaragua's national leishmaniasis program. As happens every year, alongside its regular activities, the Foundation had to deal with a shortage of glucantime, the only existing medication that can fight this disease. An additional purchase order was placed, making it possible to cure another thousand patients.
The Damien Foundation has several tasks in the coming years. The three main ones are as follows: The current basic food projects are going to continue and increase in scope in Guatemala, where families will be encouraged to tend their own vegetable gardens with a view to improving their daily lives. In Nicaragua, with the support of the "Global Fund", the Damien Foundation will continue to take care of training health care personnel across the country. Finally, at the request of the local authorities in Guatemala, the Damien Foundation will become, in early 2010, a partner in the national leishmaniasis program. In Guatemala, or at least in certain regions of the country, leishmaniasis is rampant, with at least a thousand new cases every year. Until now, very little attention has been paid to these cases. However, the experience and efficiency that the Damien Foundation demonstrated in Nicaragua will undoubtedly help it to provide good technical support for the Guatemalan leishmaniasis program. The Foundation will also be providing financial support and additional supplies.
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Regional Coordination Office 2009 Expenses Damien Foundation representative Personnel under local contract
103.301 € Dr Toon Bongaerts 1 person
Support to the National Tuberculosis Program in the Federal District, in the state of Goiás, in the city of Salvador, as well as in four municipalities near the state of Bahia. Support to the National Leprosy Program in the Federal District
Support to the National Tuberculosis Program
182.644 € Ministry of Public Health Dr José-Luis Portero 3 people since 2000
111.304 € Ministry of Public Health Zoila Bailon 6 people since 1993
Support to the National Tuberculosis and Leishmaniasis Program
112.073 € Ministry of Public Health et one local NGO (Prosalud) Dr Toon Bongaerts 6 people since 1990
With the ITM As mentioned, the Damien Foundation undertakes or takes part in research for several of its projects. The Foundation also supports two research projects by the Institute of Tropical Medicine in Antwerp.
Mycobacteria are behind three major diseases: tuberculosis, leprosy and the Buruli ulcer. The ITM’s mycobacteriology laboratory has focused its research mainly on tuberculosis (for which the Damien Foundation partners with the IMT) and the Buruli ulcer. The main problem with tuberculosis, as explained earlier, is the development of germs that are resistant to the main anti-tuberculosis medications. This is why the ITM laboratory continued in 2009 to keep an eye on the resistance situation in Bangladesh (which saw a slight increase) and in Congo (which remained the same as in 2008), trying to ascertain what factors in the treatment scheme could play a role. What’s more, the treatment scheme for multi-resistant tuberculosis that was successfully applied in Bangladesh has been put forward to the WHO for application around the world. There has also been a focus on sharing technical know-how with local laboratories, so that they can do more analyses on their own and get the results back faster. With this in mind, quick tests (for screening and confirming multiresistant tuberculosis) have been successfully implemented in local projects, notably in Bangladesh and Burundi. The idea is to ensure that these techniques can be used in low-income countries, allowing caregivers to use a microscope instead of costly new equipment for example.
Tuberculosis mainly affects the lungs. However, in 20% of cases (or more for AIDS patients), tuberculosis affects other organs too. This extrapulmonary tuberculosis is very hard to diagnose, so we need better diagnostic strategies. This is why the ITM launched research in Peru this year, in cooperation with two Peruvian hospitals, in order to study the efficiency of a protocol involving a series of diagnostic steps to be undertaken in a specific order. The study focused on two forms of extrapulmonary tuberculosis: tuberculous pleurisy (the pleura is the double "envelopes" covering the lungs) and tuberculous meningitis (the meninges are the "envelopes" that cover the central nervous system - the brain and the spinal marrow).
Finally, alongside research, another crucial factor in patient care is personnel training. Training not only improves the quality of services, it also motivates staff and keeps projects going for longer. In addition to all the training offered at local level, a series of key staff members (Congolese, Indian and Chinese) were also given international training.
The Damien Foundation is known for its work overseas, which is its primary mission. However, the Foundation also has two other missions, which are anchored in Belgium: to raise the Belgian population's awareness of the diseases of poverty and to create a network of volunteers. It is to this end that the Foundation organises a whole series of activities across Belgium every year. What set 2009 apart, however, was the fact that the year had not just one cornerstone event, but two.
The traditional cornerstone event takes place on the last weekend of January every year, on the occasion of the annual awareness and fundraising campaign. This campaign is spearheaded by a documentary, which is broadcast by the RTBF, but serves mainly as a common thread for sessions organised in schools. "The white mask", which introduced viewers to the Pygmies in the rain forest of Ituri, was seen by some 110,000 students in 822 primary and secondary schools, across the country, during sessions animated by some fifty people, almost all of whom were volunteers. Nearly 8500 copies of the film were also distributed to schools and individuals. Despite the sponsorship of Jean-Louis Lahaye (who had discovered the Damien Foundation's work in Bangladesh a few months earlier), an excellent commercial with Eddy Merckx and strong media support, the campaign did not get off to a great start. But after all, the drop in numbers, caused by the economic crisis that had really just started to rear its head, was quite limited, which proves once again that the Belgian population continues to stand firmly behind the Damien Foundation.
A role in the canonisation
The second big cornerstone event was the canonisation of Damien on October 11th. This occasion put the Damien Foundation in a potentially awkward situation: taking its rightful place as one of Damien's followers, while staying outside the church and the religious circle. To mediate this situation, the Foundation came out with a DVD, "Damien at the heart of the action", which explores Damien's life and the four values that the Damien Foundation took away from Damien's experience and has integrated in its own work. Respect, determination, cooperation and inspiration are illustrated by the accounts of several key figures who have discovered the work of the Damien Foundation overseas. What's more, three books were co-written or supported by the Damien Foundation: "Damien hier et aujourd'hui", the first part of which is about Damien and was written by Father Brion (a Picpus like Damien); "Damien, le miracle continue", which explores the four values and provides accounts by Eddy Merckx, Adrien Joveneau, Jean-Louis Lahaye and Saule; and finally, "Junior, une histoire d'espoir", which covers the life and extraordinary story of Junior, formerly a child
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of the streets of Kinshasa, who became the central figure of the Damien Foundation's campaign in January 2007. The Damien Foundation also worked with television stations to share their work in fighting leprosy today in Congo and in leprosy hospitals in China. Eddy Merckx even went to Molokaï, in the steps of Damien, to get (some) idea of what life might have been like back then. Finally, many volunteers helped out at or took part in the countless festivities in Belgium, while others, including an official delegation, headed to Rome to attend the canonisation ceremony.
All ages abroad
Other people went abroad too. Every year, the Damien Foundation sends students and teachers, accompanied by journalists, to visit one of its projects. In the second half of 2009, five groups went to Congo, India and Bangladesh. They were from the region of Verviers, from the Germanspeaking Community, from Flemish Brabant, and from East Flanders. Every year, the Damien Foundation also organises “Damien Workshops”. The objective? After preparing in Belgium, participants spend three weeks helping local workers at a site and then spend a fourth week discovering the country. In 2009, some sixty volunteers (including representatives from the St-Pierre College in Jette) set off for India, Bangladesh, Nicaragua and Congo. The participants in the 100th workshop were given a real celebration upon their return to Zaventem airport. What's more, with the support of the “Follereau Abuzaabal Project”, some twenty people helped to improve the living conditions of leprosy patients in Cairo, Egypt, by renovating health centres and caring for the sick. Another noteworthy event took place at Easter, when regional supervisors and school organisers visited a part of our projects in Bangladesh. Two groups from a series of schools (from Torhout, Mol and Herentals) also cycled around Bangladesh during the spring and Christmas holidays.
Cycling for and with the Damien Foundation
It was a big year for cycling. Like every year, the Damien Foundation ran a stand at Adrien Joveneau's “Beau Vélo de RAVeL”. The Eddy Merckx car was once again on display at several major events: the Flèche Wallonne, Liège-Bastogne-Liège, the Tour of Wallonia, the Wallonia Grand-Prix and the Franco-Belgian Circuit. Eddy himself cycled for the Damien Foundation with 300 cycling tourists in late May in Temse, and in October with Unizo. He was also a frequent guest on the VRT station, as part of the show "Vive le Vélo" (evenings during each stage of the Tour de France), to auction off a table signed by many cycling stars to benefit the Damien Foundation. And again thanks to Eddy, the Damien Foundation had a very visible presence at the Belgian championship on the road to Aywaille and the Six Days of Ghent. Finally, as an opener to Liège-Bastogne-Liège, a "race-against-the-clock-for-the-heart" event was organised on Place Saint-Lambert for the benefit of the Damien Foundation, amongst others.
Two days a year
One of the two "special" Damien Foundation days also took place in the province of Liège. The association has many volunteers across the country; volunteers who have the opportunity to get together twice a year at national level for family day and launch day.
The first day marks an end to the summer holidays. On the first Sunday in September, over 700 people got together at Plopsa Coo. On the menu: sun, friendship, rides and fun times. The second day took place in November. Over 500 supporters got together in Brussels on November 21st for the launch of the next campaign. It was an opportunity to discover the campaign materials and the new film, in the presence of Marc Herman, the sponsor of the 2010 campaign, en route for a "mini-trip" to Kinshasa.
This is also the time of year when the gospel concerts take place. While Flanders had not taken part in 2008, "Gospels voor Damiaanactie" did take place in four Flemish cities, starring Lea Gilmore. On the French side, some 13,000 people attended “Gospels for Life” with Beverley Trotman and 2,600 backup singers on the occasion of 15 concerts in Wallonia and in Brussels.
A bit of everything
And we must not fail to mention the initiatives taken by the network throughout the year. There are traditions like the “Damien Walk” in Tremelo in May, the Festival of Impersonators for the benefit of the Damien Foundation in November in Tournai and the “Kamiano monologue” performed throughout the year. There were also fairs (like the education fair in Namur), festivals (like the Francofolies in Spa and "Saga Africa" in Hannut) and the Christmas market. The Foundation also helped organise events like the "Nuit des Chœurs" in Bois-Seigneur-Isaac and open-air operas in Liège, Namur and La Hulpe. Finally, there were a number of unique initiatives, such as "Happy X Mass", a show that featured a choir of 200 young people, a big band and Brahim singing Christmas carols in Torhout for the Damien Foundation.
Campagne 2009: the figures Private gifts Number
Private gifts Total
Sale of felt pens and collections
Euro per inhabitant
* Inclusive german-speaking community These figures were established on the basis of the annual solidarity campaign, fixed from 1st September 2008 to 31st August 2009. The other financial data that you will find in the report pertain to the calendar year, from 1st of January to 31st December 2009.
Ja lc h at r a [ BAN G L AD E SH 03/11/ 20 0 9 ] Pi c t u r e : T H O M A S d e g r ae v e
Tuberculosis is a highly contagious disease, to the point that some patients, who are generally multiresistant, have to take precautions to protect those around them.
M y m e n s i n g h [ BA N G L A D E SH 20 0 9 ]
| P i c t u r e : Thomas D e G r a e v e
Even if they are cured, many former leprosy patients have to learn to live with disfigurement
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Leishmaniasis is disabling by nature. But it can also be fatal. The Damien Foundation is the only partner of the program that fights this disease in Nicaragua.
[ N I C A R AG UA 20 0 9 ] P i c t u r e s: T i m D i r v e n [ N I C A R AG UA 20 0 4 ] P i c t u r e : J E A N P L ATTE AU
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| 37 Reconstructive surgery is sometimes the only option to allow former leprosy patients who have been paralysed or disfigured to regain their dignity.
Lu b u m b a s h i [ Co ng o 11/ 20 07 ] P i c t u r e : T i m D i r v e n
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Eddy Merckx revisiting his career with an inhabitant of Molokaï... A break during a poignant trip.
[ M O LO K a ï 15/0 9/ 20 0 9] P i c t u r e s:T i m D i r v e n
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The Pygmies in the rain forest of Ituri were not only the central figures in the Damien Foundation's 2009 campaign. They have also proved that when the disease calls for it, the association is willing to go to the most isolated corners of the earth to care for the least accessible populations.
[ Co ng o j uly 20 0 8 ] P i c t u r e s: j e a n plat t e au
Young or old, parent or child, man or woman: whatever the conditions in which they live, every human being has the right to health.
D e l h i [ I ndia januari 2010 ] P i c t u r e s: j e a n plat t e au
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[ co ng o 20/12 / 20 0 6 ] P i c t u r e : t i m d i r v e n
| 45 If not detected on time, leprosy can have major after-effects. On the hands and feet, but also on the eyes!
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D e l h i [ I N D ia januari 2010 ] P i c t u r e s: j e a n plat t e au
The living conditions, hygiene and nutrition play an important role in the spread of diseases of poverty such as leprosy and tuberculosis.
Annual report Damien Foundation