This mission made it possible to start the humanitarian project of the ACTUME association in Mauritania. It follows an identification mission in April 2007 initiated by Oumar Kane to help tuberculosis patients in the Trarza region.

Saturday December 5, 2009: return from Mauritania
The return was difficult: scheduled departure from Nouakchott on December 4 at 10 a.m., postponed to December 5 at 3 a.m. Take off with 2 hours delay for Casablanca. Once in Casablanca, we missed our connection to Bordeaux. From Casablanca we joined Marrakech to take a plane that takes us to Bordeaux. We finally arrived on 5 at 8 p.m. in Bordeaux. Phew what a human adventure !!!

Reminder of the mission objectives:
- set up a network of community agents in the municipality of Tekane;
- create a structure in Mauritania to relay the actions of Actume Bordeaux
- finalize partnership agreements with the Ministry of Health in Mauritania and local partners: Tékane health center, Tékane town hall.

People and organizations met:

Nouakchott
- Fatimata SY, President Actume
- Dr EL Hadj Ould ABDALLAHI, World Health Organization
- Dr Lo Baïdi Boubou, National Research Institute
- Mr. Bernard Goldtein - French Embassy - SCAC
- Dr Seydou NIANG - Ministry of Health
- Mr. Isselmou Ould MAHJOUB - Ministry of Health
- Dr Mohamed ould SIDATT - Ministry of Health
- Mr. Aziz DIALLO - Médicos del Mundo - Spanish NGO

Tekane
- Mr. Ciré Kane - Mayor of the municipality of Tékane
- Mr. Cheikh Kane - Manager at the Town Hall
- Mr. Brahim Kane - Head of the Health Center
- Ms Khady SARR (Diagnel) - Head of the municipal health commission
- Mr. Mamadou NIANG - Director of Tékane Primary School
- College of Tékane
- Meeting with various representatives of cooperatives, ...

Rosso Hospital
- Dr TRAORE Abdallahi - Regional Director of Health and Social Protection of Rosso
- Mr. Hemeth Ould Bilal - Training officer
- Mrs. Fatimata SALL - Head of the diagnostic and treatment center (CDT)

Report : (This report is not exhaustive, it provides information on the essential points of the mission, a more detailed account will be visible on the Actume website).

Presentation of the municipality of Tékane
The mayor of Tékane provides us with information on the division by zone (East, North and South) of the municipality of Tékane. It brings together 66 villages with a population of approximately 24,000 inhabitants. Note that the areas are difficult to access during the rainy season. He suggests that we meet Ms. Khady SARR in charge of the municipal health commission. The meeting is very fruitful.

Mr Brahim KANE responsible for the Tékane health center which will be the relay point for ACTUME actions, completed the presentation by emphasizing the health map of the municipality of Tékane. The commune is made up of seven health centers managed by state nurses or senior technicians and eleven health huts managed by community workers. This presentation of the health map will be explained in the final report.

Ms. Khadi SARR in turn informs us of the establishment in 2002 by the NGO Medicos del Mundo of a network of Community Agents spread throughout the municipality of Tékane. There are 10 of them and they are trained to sensitize the population to endemic diseases.

Screening resources (3 microscopes) have been made available to the main health centers, namely: Tékane, Gani, Oumoul Ghoura. This equipment is apparently not used for lack of accessories: dyes and lamps ...

We count with the approval of course from the managers of the Tékane health center to rely on this structure already in place in order to carry out our action. In addition, those in charge of the health center are satisfied with the work carried out by the community workers except for two who do not have the required level.

Recommendations:
- Need to “retrain” Community Agents in order to update their knowledge.
- Complete the technical means in order to be able to carry out screening.
- Train laboratory assistants: managers of health posts equipped with microscopes

Observations
Ms. Khady SARR (Diagnel) who is familiar with the health structure in place, speaks the different Hassaniya and Pulaar languages and is used to reporting on activities. It therefore seems to us to correspond perfectly to the coordinator profile that we were looking for. (Specify)

Visit of a patient in EL ECHE - 4 km from Tékane

During this visit we were accompanied by:
Mr. Cheikh Kane, Town Hall manager and ACTUME Mauritania benefactor member and Ms. Khady SARR deputy head of the Tékane health center.
This tuberculosis patient is 46 years old, married and lives in "El Eche" near Tékane. This village consists of a dozen tents. The inhabitants are mainly goat herders.

She has been continuing her treatment normally since July 2009. She notes that her immediate entourage has not been detected: her husband, neighbors, etc. In addition, she knows two other people living 10km from Tékane who have had tuberculosis. She supports the Actume project and volunteers to support communication actions with those around her. For details, a testimonial video will soon be available online.

December 1: Return to Rosso hospital -
Mr. Khadi SARR takes advantage of our trip to Rosso to confide in us a patient: she has been coughing for more than 15 days, shows a state of fatigue and weight loss, tuberculosis is suspected.

During this trip, we followed the typical journey of a patient from his home (Tékane) to Rosso hospital (CDT). The distance between the two towns is 70 km. We found that the patient spent:
- the cost of the Tékane-Rosso- Tékane trip: 1400 Ouguiyas (5 €)
- the cost of the radio is 1000 Ouguiyas (UM)
- Ordinance: 1800 ouguiyas.

Finally the patient after control, does not have tuberculosis. She suffers from chronic bronchitis. She had a prescription for her bronchitis.

All these costs (4200 MU) are borne by the patient. This represents a large sum and often impossible to obtain for villagers who have little or no income. Because of these additional charges, some patients, for lack of funds, go to the center very late for a consultation…. hence the importance of early detection.

Noted that in Mauritania in principle, the PNLTL (National Program for the fight against Tuberculosis and Lepra) covers the costs of screening and treatment of tuberculosis.

Interview with the Regional Director of Rosso:
Dr Traoré Abdallahi warmly welcomes us. He assures us of his support. It also emphasizes in the communication component to associate tuberculosis and HIV-AIDS. In addition, he insists on the importance of early diagnosis of patients, awareness and the means implemented. For communication operations, he suggests:
- carefully study the message to be transmitted: take into account the cultural disparities in the region;
- monitoring and accompanying patients: among nomads there is sometimes an interruption in treatment.

Dr Traoré puts us in contact with Mr Hemeth Ould Bilal in charge of training community workers and Ms Fatimata Sall in charge of CDT at Rosso hospital.
Mr Hemeth tells us about the practical modalities of the training of community workers and laboratory workers.
- Location Rosso (AC) and on site for laboratory assistants;
- program (to be specified) and duration (7 days);
- minimum number of trainers (2);
- provide periums for trainers and ACs.

The training of the CAs could be carried out in Tékane, for the laboratory technicians the training in Rosso would certainly make it possible to see BK (Bacillus of Koch).

The cost of the training will be borne by the PNLTL. The detailed training program will subsequently be defined in close collaboration between the Tékane health center, PNLTL and ACTUME.

Conclusion of the mission:
The objective has been fulfilled:
- Identification of a network of community agents and their coordinator
- Profiles of community workers
- Signature of a partnership agreement with the Ministry of Health in progress
- Signature of a partnership agreement with the municipality of Tekane in progress
- Information of all our partners and stakeholders in Mauritania

Upcoming schedule:
- Launch in March of the training of Community Agents.
- Beginning at the end of March of a vast communication operation on tuberculosis and screening in the municipality of Tekane.

All our thanks to the various partners in Mauritania.