The goal of this matching grants project will be to help the "Yendube" (God is There) Children’s Hospital (Hopital d’Enfants) of Dapaong to obtain the equipment necessary to set up a serology laboratory to allow for the proper diagnosis of Hepatitis A, B, C as well as HIV/AIDS and other illnesses. The city of Dapaong (population approximately 40,000) is the administrative center for the 800,000 people of the Savannah Region of northern Togo. The city is the home to a number of administrative and governmental offices. There are also several non-governmental organizations (NGOs), which are operating regional projects based in Dapaong. The city of Dapaong ("new market" in the local language: Moba) has running water and electricity, and was first effectively linked into the rest of Togo in the early 1980s, when Togo’s north-south National Highway reached the city on its way north to Ouagadougou, the capital of the neighboring nation of Burkina Faso. No longer "off the beaten track", the past twenty years have been a period of rapid growth, as small businesses, administrative offices, and a number of new primary and secondary schools have been built in Dapaong.

One of the results of this growth has been that the health-care facilities at the Regional Hospital Center in Dapaong and the nearby Children’s Hospital have been upgraded and expanded to meet the increasing needs. However, the health care facilities at the regional hospital, which depend almost entirely on government funds, have suffered during the past twelve years of political instability. At this point in time, the Children’s Hospital is in a much stronger position to serve as a partner, since they receive consistent support from the local Catholic mission, and already have staff and an existing laboratory that can be upgraded and maintained, guaranteeing the sustainability of efforts to improve their laboratory.

At present, there is a real need to upgrade the Children’s Hospital’s laboratory. This is because at the time of the Children’s Hospital’s construction, in 1962, serology laboratories were much more expensive, well beyond the means of a small, regional health facility. In addition, the whole HIV/AIDS epidemic was still in its early years, with no real presence in Togo. Even up to the 1980s, people in need of blood work, especially serology diagnostics, had to either leave the country or have their blood sent for analysis in France, Germany or the United States. At the time, there were no hepatitis vaccines. The best that the Peace Corps (for example) could do was to provide regular "gamma globulin" shots, which could at least boost the body’s resistance to the various strains of Hepatitis A, B, C. These shots were similar to those given to soldiers in World War II and later wars. While the Hospital has tried to upgrade its laboratory over the years, they are still unable to do many of the most important diagnostic tests to screen blood for their blood bank and provide necessary blood analysis for their patients.

Now that Hepatitis B and A vaccines have been introduced on the American and European markets (and are even available at much higher prices in Dapaong), the need for proper diagnosis is even greater, because there is hope that the disease can be effectively prevented if the extent of the epidemic is known and the necessary resources allocated for vaccinations. This project could be an important first step, since there is an ongoing effort within the World Health Organization (WHO) to push for the inclusion of the Hepatitis B vaccine in the international vaccination campaign. Better documentation of the extent of the crisis can only help this effort.

The Dapaong Rotary Club is ready to oversee this laboratory project and to contribute to its cost, but they will need help from partner Rotary Clubs for this project to be successfully completed.

1. The Children’s Hospital (Hopital d’Enfants) of Dapaong is the primary beneficiary of this laboratory project, but is also a partner in its funding and maintenance. The hospital already has a trained laboratory technician who is capable of managing and using a serology laboratory. His salary and continuing education and training expenses are covered by the Children’s Hospital, which received a part of its funding from the local Catholic mission and is officially recognized by the Togolese government as the primary children’s healthcare center in Dapaong. The hospital already has a laboratory, and the space will be used to house the new equipment. Any modifications and construction needed to accommodate the new laboratory equipment will be covered by the hospital itself, and by funds raised locally by the Dapaong Rotary Club. There is also a fund in existence in Togo, donated by Swiss Rotarians, which can be used for this purpose. No matching grant funds will be used for any salaries or construction costs. The Dapaong Rotary club has estimated their contribution to these local costs at 2,348,000 (Two million, three hundred and forty-eight thousand) Francs CFA for fixing the laboratory space to accommodate the new equipment, with an additional 4,216,000 (Four million, two hundred and sixteen thousand) Francs CFA for follow up and cash value of hours of work provide on site. These expenses are not included in the attached budget, since they are not requesting any of this assistance from their international partner clubs.

2. The Dapaong Rotary Club is the Togolese partner in the project. This club received its charter in November 2001 and has already begun to have an impact in the region. In addition to the local club members, the project has the support of a member of the Lome Cote d’Azur Rotary Club in Lome, Togo, the capital city. Mr. Bawa Mankoubi, himself originally from a small town near Dapaong, is a project mentor. He is a former Rotary District Governor, and is currently the President of the Rotary Polio Plus campaign in Togo. His work with Polio Plus and his long career of public service in Togo have given him excellent contacts and a good working relationship with the Ministry of Public Health. When I first spoke with him about this project, he was quite firmly convinced of its value. Since 1997, the project has become more clearly defined and the nuns in charge of the Children’s Hospital have been able to acquire the necessary staff and infrastructure to make the improvement of their existing laboratory a very viable project. Furthermore, another Rotarian, Dr. Gogue Tchaboure, former Mininster of Finance and former Vice-Rector of the Universite du Benin in Togo, has agreed to assist in the mentoring of this project from his club in Ouagadougou, Burkina Faso, where he is currently working for the United Nations.

3. The Northfield Rotary Club is the principal United States partner in this laboratory project. The Northfield Club has raised $12,000 (Twelve thousand dollars) for this project. These funds have been raised through two targeted fundraising events, our Jesse James Bike Tour and our Turkey Run. In addition, we have solicited and received generous support from local Rotarians and families with an interest in health care and in Togo, as well. The District has approved $2,000 in Share Grant funds to assist this project.

4. The Faribault Rotary Club has agreed to support this project with a contribution of $1,000. This has been approved for a District Share match of $1,000, and then will be submitted to the Rotary Foundation.

5. The Farmington Rotary Club has agreed to support this project with a contribution of $500. This has been approved for a District Share match of $500, and then will be submitted to the Rotary Foundation as a part of this matching grant project.

5. The Evanston Lighthouse Rotary Club (Evanston, IL) has long been a supporter of this project, and has pledged $2,000. A Share Grant from District 6440 has already been approved to match this contribution.

6. Rotary Districts 5960 (MN) and 6440 (IL) have also approved Share grants to match the above club donations as itemized above.

7. The Rotary Foundation will match 50% of the donations from the clubs and 100% of the District Share grants. The itemization of the Foundation’s anticipated matching grants is found below on page seven.

Communities all across the Savannah Region of northern Togo, with a population of approximately 800,000 people, would benefit from this laboratory. Because this serology laboratory will be able to do both Hepatitis and HIV/AIDS testing, the impact will be very important. Hepatitis is especially widespread in the region, though the lack of adequate laboratory facilities has made it very difficult to measure the extent of the epidemic. Since the symptoms of hepatitis: jaundice, fatigue, vomiting, etc. are also often symptoms of malaria, yellow fever, and other local maladies, it is very difficult to make an accurate diagnosis without the proper equipment. A laboratory capable of making an accurate diagnosis can allow for more effective treatment of the many illnesses prevalent in northern Togo. It will also allow for thorough screening of blood donations for the Children’s Hospital’s blood bank, which can make it possible for the hospital to offer safe blood to its patients, avoiding the risk of using contaminated blood from unscreened donations.

Some clear benefits of this laboratory would be:

-Improved diagnosis and treatment of Hepatitis strains A,B,C

-Improved diagnosis of HIV/AIDS

-The avoidance of mistreatments of hepatitis, since symptoms often resemble those of other illnesses, like malaria and yellow fever.

- Improved monitoring of the scope and scale of the current health care crisis in the region (heptatitis, HIV/AIDS, and other blood-born illnesses).

- Ability to document (for the first time) the number of cases of each disease. This can be very valuable to the Togolese government and the WHO in their efforts to support the international efforts to include Hepatitis B and other vaccines in the WHO’s vaccination campaigns.

-While treatment of hepatitis is still limited in its effectiveness, prevention is now possible through vaccination. It is also possible to prevent vertical transmission from mother to infant at birth (per Dr. Phair at the Northwestern University Medical School).

-Proper diagnosis will save many lives that would otherwise be lost through misdiagnosis and mistreatment based on insufficient diagnostic tools.

-Proper screening of blood donations would allow for a guarantee of safe blood for the Children’s Hospital’s blood bank.

There will be one main and several minor institutional beneficiaries of this project. The two main health centers will Children’s Hospital (Hopital d’Enfants) of the Catholic Mission and the Regional Hospital of Dapaong. Both are located in the city of Dapaong. The choice to install the laboratory equipment at the Children’s Hospital is carefully made.

The Children’s Hospital is run and funded by the Catholic Mission in Dapaong, under the auspices of and with the full backing of the Ministry of Public Health in Togo. This laboratory will also be an important beneficiary, and a contributor to the laboratory’s ongoing operational costs. Since the nearest serology laboratory in Togo is over 600 kilometers away in Lome, this laboratory will allow the Pediatric Hospital to diagnose Hepatitis A and B in pregnant mothers, as well as in young children, allowing for proper treatment and prevention. The success rate in treating pregnant mothers to avoid vertical transmission of Hepatitis B is quite high now, so timely diagnosis can play an important role in improving the health care provided by the Children’s Hospital in a region where Hepatitis is a serious problem.

There are also a number of village-level healthcare centers, which refer their patients to the Regional Centers in Dapaong for laboratory work. These include the Dispensary of Nadjoundi (also partially funded by the Catholic Mission), as well as local dispensaries in the villages of Naki-Est, Yembour, Borgou, Pana, Barkoissi, and others. These local centers are all under the umbrella of the Ministry of Public Health, so cooperation with the serology laboratory in Dapaong will be effective. Since many people living at the village level consider even a trip to Dapaong (often on foot) to be a major voyage, this will bring the level of health care available to the average person to a much higher level.

As mentioned above, there have been extensive discussions within the World Health Organization about the need to incorporate the new Hepatitis B vaccine into their global vaccination campaigns. The relatively high cost of this vaccine has combined with insufficient data on the scope of the health hazard that Hepatitis B presents in Africa (due primarily to the lack of laboratories like the one proposed in this project, which could generate data on areas which currently have no diagnostic capabilities) to delay its inclusion. This laboratory could provide reliable data to the Togolese Ministry of Public Health and the local branches of the WHO, which could assist in the effort to get the Hepatitis vaccines into the WHO campaign.

At present, expatriate workers, as well as high-ranking Togolese functionaries, have to go to the capital city, Lome, to have access to a serology laboratory. This is a luxury that is not available to the average resident of a city like Dapaong, where many people are from farming families whose disposable income does not allow them to travel long distances for medical care. This laboratory will meet a very real local need.

The technology needed to set up a serology laboratory is now much more affordable than it was in the mid-1980’s. Since the same basic technology used for hepatitis testing can also be used for HIV/AIDS testing, the impact of the laboratory can eventually be expanded to an even greater level. While Togo has not yet been devastated by the HIV/AIDS epidemic to the extent of many nations in southern and central Africa, there have long been Togolese migrant laborers in neighboring countries like Ghana and Ivory Coast. Since some of these countries have been harder-hit, the serology laboratory could help to get a handle on the extent of a number of different health problems in the region. Until the extent of a problem is known, it is very difficult to work on possible solutions.

The Children’s Hospital, in collaboration with the Rotary Club of Dapaong, has put together a project, including equipment and supplies needed to upgrade their existing laboratory to allow them to do serology work. Although their cost estimate is in French, I have provided a brief translation of their budget to facilitate its evaluation by members of this committee.

The Children’s Hospital already has a highly-trained laboratory technician, who is qualified to administer a serology laboratory. His salary and training needs are already a part of the budget of the Children’s Hospital and this project will not need to support any of those costs.

This ongoing cost will be covered by the Children’s Hospital through their ongoing fundraising efforts and through their regular budget through the local Catholic Mission.

c. Cost of Supplies to keep the Serology Laboratory functioning on an ongoing basis

These costs will be covered by the Children’s Hospital. The hospital charges its patients a set fee, which is very low, in keeping with the abilities of families in a nation whose per capita income is approximately $300 per year. The fees do not cover the entire cost of the services provided, but the Catholic mission supplements the hospital’s budget each year, to allow them to meet their ongoing costs.

1. Northfield Rotary Club $12,000
2. Faribault Rotary Club $ 1,000
3. Farmington Rotary Club $ 500
4. Evanston Lighthouse Rotary Club $ 2,000
5. Rotary District 5960 Share Funds $ 3,500

1. 1 to 1 match of District Funds: $5,500 +$5,5 00 (Match)=$11,000
2. 1 to 2 match of Cash funds raised: $15,500+ $7,750 (Match)=$23,250
3. Total so far: $11,000+$20,250.00=$34,250.00