Project MARC
Reaching out to forgotten island communities by sharing our resources, time and love to help create a future for all children
What are we doing & why
Objectives & Approach
~ General Objectives and Approach ~
The general objective is to provide volunteer medical services to Vanuatu's most remote island communities.
In December 2003 the Vanuatu Ministry of Health approved our new 5-year operational plan which calls for extending our assistance to new target areas where the medical infrastructure has collapsed, e.g. in Vanuatu's remote northern island groups (Torres and Banks islands) as well as in the NW coastal areas of Espiritu Santo.Meanwhile, we will gradually wrap up full-scale support of the first three target areas where the medical infrastructure has now been brought up to par with modern Vanuatu standards.
Phase I concentrates on exploration and evaluation of potential new target areas to be carried out in direct collaboration between both MOU partners.
Phase II centers around the rapid "Jumpstart" of basic primary care in selected areas.
Phase III involves special programs designed to address the specific medical needs of a given community or region.
~ Specific Project MARC Objectives ~
Specific task objectives are to provide:
1. Preventive medical & dental care plus education
2. Early diagnosis and screening programs
3. Training of local village health workers and nurses
4. Urgent primary care (medical and dental)
5. Establishment of telecommunication and telemedicine links
6. Technical and logistic support of aid posts, dispensaries and health centers
1 - preventive medical & dental care plus education
A major focus of Project MARC is on preventive care and public education. Our medical teams can only visit each community a few weeks each year, so most primary care must remain in the hands of local health workers.
Preventative care issues receiving special attention include:
· Perinatal care (e.g., performing checkups of pregnant women, young mothers and their infants)
· Health education of school children (e.g., with regard to dental care, eating habits and personal hygiene)
· Health education of adolescents and adults (e.g., with regard to personal hygiene, balanced nutrition, STDs and other infectious diseases, family planning, substance abuse and proper use of medication)
· Incidental immunization of children who were missed by earlier programs (e.g., because of lack of refrigerated vaccine storage facilities).
2 - early diagnosis and screening programs
This is an area where our outpatient clinics can make important contributions with their advanced diagnostic capabilities. However, screening programs will only be initiated with the specific encouragement and permission of MOH, the full support of local community leaders and the patient's or parent's informed consent.
Ongoing or planned screening programs focus on:
· Rapid malaria diagnosis and early tuberculosis detection
· Cataract detection, including vision screening in school children
· High blood pressure, diabetes, arthritis or cataract
· Cancer detection in adult women and/or men.
Some medical problems detected during screening tests can be dealt with immediately by giving advice and medication, performing minor surgery or providing corrective devices. In all other cases, Project MARC will contact one of Vanuatu's central clinics to decide on a suitable course of action.
3 - training ni-Vanuatu village health workers and nurses)
Our rotating teams of medical experts with their diagnostic tools provide a unique resource for hands-on training of local nurses and nurse practitioners. Besides refreshing basic diagnostic and treatment skills by working side by side with core team members and specialists, ni-Vanuatu trainees will practice some specialized (e.g. dental, surgical or ob/gyn) skills while learning how and when to use of some of the newer diagnostic procedures, instruments, drugs or treatment regimes. In return, their participation helps the team build linguistic and cultural bridges with the island communities and provides an important reservoir of knowledge about relevant local health concerns, dietary habits and living conditions.
4 - urgent medical and dental care
Project MARC teams cannot visit frequently enough, or long enough, in a particular community to take permanent responsibility for first-responder medical and dental care, particularly not in urgent situations. On the other hand, wanting to provide medical care to patients who have a medical problem that is urgent enough to prompt them to make the often long journey to the clinic not only is the natural response of our dedicated medical personnel but also creates the best conditions for hands-on teaching of primary care skills to village health workers ("aid post workers") and the nurses at the regional health centers.
For the "life-and-death" medical emergencies that tend to occur every few weeks, our teams and outpatient clinics are likely to be better equipped and have more access to transportation and telecommunication resources than most regional health centers. Therefore, the team must to be able to respond promptly to medical emergencies occurring within a fairly wide radius around the clinic and/or support vessel anchorage.
Special emergency care preparations include:
· A sturdy and stable shoreboat with strong outboard engine enabling fast transport of people and supplies between neighboring villages, bays and islands under moderate weather conditions
· Well-equipped emergency medical response kits
· Portable diagnostic equipment and test kits
· Telecommunications equipment (marine VHF, mini-M Inmarsat phone).
5 - Development of telecommunication and telemedicine links
Multiple national and international health initiatives and programs currently underway in Vanuatu can be expected to improve overall access to medical care over the next decade. However, the sheer number of remote island communities and lack of economic resources make it unrealistic to expect the level of physical access to health care to approach that of populous, industrialized countries.
In principle, recent developments in satellite-based telemedicine techniques now provide many South Pacific islands with around-the-clock access to expert medical advice. In practice, many technical and logistic issues remain to be resolved. The cost of commercial telemedicine services also tends to be very high. However, there appears to be no reason why volunteer telemedicine networks could not be successfully established, as well.
The mobile outpatient clinic's advanced telemedicine equipment (ECG, spirometer, digital camera and Inmarsat M phone) enables us to test the viability of these concepts. We also are in the process of permanently installing small SSB transmitters at each of the three Project MARC outpatient clinics.
6 - technical and logistic support of aid posts, dispensaries and health centers
Technical support ranges from helping to construct new dispensaries to repairing and improving existing health centers and dispensaries. During the 2002 season two new outpatient clinics were completed near Ranon (N Ambrym) and on Sakao island (the Maskelynes). Solar power systems, radio transmitters, plumbing, window screens, door locks and medical equipment were installed or repaired at the Banam Bay, Ranon and Nopul clinics.
With regard to logistics, most aid posts, dispensaries and health centers on Ambrym and Malekula visited by Project MARC teams appear to have reasonably adequate access to supplies from the the Central Medical Store (CMS) in Port Vila. However, the distribution is often very slow, causing temporary shortages. As a result, arrivals of new supplies tend to trigger "runs" on the distribution point, with consequent risky and wasteful hoarding of drugs and other supplies in people's homes.
For this reason we try to coordinate planned visits of Project MARC support vessels to remote island communities with the VCH Central Medical Store in order to help deliver essential supply packages to specific aid posts, dispensaries or health centers. In addition, Project MARC sponsors supply local health centers and dispensaries with approved basic equipment items such as refrigerators, generators, sterilizers, radios, stretchers, etc. not yet distributed by MOH on a regular basis.
Project MARC Movies
The MARC@WORK movies on this webpage were produced by Peter Brouwer and Sylvia Steinert from video footage shot while traveling with Project MARC volunteer teams in September of 2005.
