Why MSF determined to lift lives of refugees at Nduta Camp

Kigoma. "I am happy to see mothers come to hospital for delivery alone but leave with happy faces, embracing their newborns," shares Elda Kyando, the MSF Medical Team Leader at Nduta Camp in Kibondo, Kigoma Region.

Ms Elda’s expression is a testament to the beginning of a new life filled with hope and joy to women, newborns and mothers at Nduta Refugee Camp. Put differently, it is a dream come true for those who were hardly praying for having one great family thousand miles away from home.

To Sabina Kwezi, who is a midwife supervisor at Nduta Camp, this is more than a wonderful story; it’s a life-lifting journey. She is at the heart of the fight against rising maternal and neonatal deaths like a sergeant at the battlefield defending territories of his country from external invasions.

There’s more unfolded details of human interest that are worth reading in this narrative. Just flow with it. “As a midwife supervisor at Nduta Camp, I oversee a dedicated team providing comprehensive secondary healthcare services to women, newborns, and mothers.

Our services include normal labours and delivery, emergency obstetric care, and pathological care for pregnant and postpartum mothers. "We manage high-risk pregnancies and obstructed labour by referring to a Comprehensive Emergency Obstetric and Newborn Care facility for specialized care as needed," explains Sabina and added that: "Additionally, we offer essential newborn care, including neonatal intensive care for sick newborns and those born with complications.”

There’s a well-established referral system to Kibondo District Hospital which is part of the MSF’s commitment to quality care and has significantly enhanced maternal and neonatal outcomes in the camp and surrounding host communities, she adds further.

On projected reduction in maternal and newborn deaths, Sabina believes that the goal will be achieved by improving access to comprehensive maternal and neonatal healthcare services, including skilled delivery attendance and timely referral for high-risk pregnancies.

On another note, she mentions postpartum hemorrhage (PPH), eclampsia, sepsis, obstructed labour, and unsafe abortions among the leading common medical conditions that significantly increase the risk of maternal and neonatal mortality.

However, Ms Sabina states that the community health promotion programs have fostered trust and increased awareness about maternal and neonatal health, including encouraging women to seek timely health care.

Collaboration with other health International NGOS such as Medical Teams International, International Rescue Committee, and Kibondo District Hospital and ensuring that especially those at the high-risk of cases receive the necessary specialized care.

“Despite the challenges, these supportive elements create a more conducive environment for secondary healthcare services, allowing them to make a significant impact on the health outcomes of pregnant women and newborns.” “On average, we facilitate about 40 referrals each month, primarily to Kibondo District Hospital. We offer adaptability and resourcefulness in providing quality healthcare.

We have also seen the profound impact of community health promotion programs in empowering individuals to take charge of their health, leading to improved health outcomes."

According to her, Nduta Hospital has 15 beds dedicated to maternal health out of a total of 74. With adequate resources, including drugs, medical devices, and qualified human resources, it provides services following well-defined, evidence-based guidelines from both the Ministry of Health (MOH) and MSF.

It has also a well-established referral pathway to ensure timely referrals to the district hospital when Comprehensive Emergency Obstetric and Newborn Care is needed, particularly for high-risk pregnancies requiring surgical intervention.

The facility maintains a stable blood bank, which has been crucial in saving lives, especially those at high risk of death due to hemorrhage during or post-delivery.

The midwife leader recalls, "One night, I received a call from Kibondo District Hospital about the patient we had referred to, who was severely bleeding. The hospital had no matching blood, and it was difficult to find a donor. I managed to organize with our blood bank, and three units of blood were sent to save the woman's life."

This year, we have referred 191 maternal cases to Kibondo District Hospital, with full support from MSF in terms of medical bills and social support. Since January, MSF has supported a total of 624 referrals to Kibondo hospital.

Indelible success stories

Lilian Fabian from the neighboring village of Malolongwa in Kumgondo Ward, Kibondo District is among the recipients of maternity services at Nduta Hospital who have enjoyed good and free services provided. "I have three children, all of whom I gave birth to at the hospital in Nduta.

When we come from the village to the camp, we are given a permit and accommodation close to our residence. The services are good, and the staff are friendly. You are listened to and very well cared for.

We are grateful to the government and the stakeholders in this camp because it is a great help to us," she recounts. Establishing a medical facility at Nduta Camp has led to numerous impactful success stories.

One such story involved a complicated twin delivery that our team successfully managed and provided immediate neonatal intensive care, resulting in healthy outcomes for both babies and the mother.

Another case to remember was a high-risk pregnancy with the history of four previous cesarean sections. Timely intervention and referral to a CEmONC facility saved the lives of both the mother and her newborn.

MSF at the wheel

Despite the Government's sincere desire to continue cutting down death cases for mothers and children under the age of five, the health docket belongs to the whole community, and therefore the private sector also has a role to play.

In Kigoma, the Médecins Sans Frontières (MSF) - Doctors Without Borders – lives on one purpose of providing emergency and comprehensive secondary healthcare services to refugees from the Democratic Republic of Congo, Burundi and Rwanda and the local communities surrounding the Nduta Refugee Camp.

In 1993, emergency programs were initiated in Kigoma to aid refugees from Burundi, Rwanda, and the DRC. From 1995 to 2001, various health interventions were implemented, including malaria control, water provision, and primary healthcare in Kasulu, Mtwara, and Kigoma.

Additionally, an emergency preparedness project for cholera epidemics was launched in several regions, including Dar es Salaam, Lindi, Dodoma, Mtwara, Arusha, Pemba, and Tanga. Between 2001 and 2004, efforts to combat malaria and HIV/AIDS were focused on Unguja, Pemba (Zanzibar), and Makete, Njombe.

From 2004 to 2007, medical responses were directed towards urban and Burundian refugees in Kagunga, Kigoma. In 2015, cholera treatment and vaccination, along with malaria and primary healthcare services, were provided in the Nyarugusu refugee camp.

Water provision and community health surveillance in Mtendeli followed in 2016. Between 2016 and 2018, a 175-bed hospital offering primary healthcare and health promotion was established in the Nduta refugee camp.

During 2017-2018, technical support was given to the Ministry of Health's cholera response in Zanzibar. Subsequent years saw various initiatives, including rehabilitation of Kibondo District Hospital’s surgical services (2018), Ebola and cholera response (2019), and a new project in Liwale district focusing on maternal and child health (2022).

The MSF continued to respond to cholera outbreaks and other health emergencies, including a Marburg fever, malaria control program and mass vaccination efforts in 2023, cholera in Mara, Kalya-Uvinza. However, in 2024, MSF responded to a cholera outbreak in Nanjilinji, Lindi.

In the Southern part of Tanzania, Lindi Region, Liwale District hospital targeted the deprived community to improve access to primary and secondary health care for pregnant women and children.

It is an integrated approach with the Ministry of Health to ensure the sustainability and continuity of the preferred health services.