We will have 360,000 patient visits a year by the fourth year of the project and will have outreach programmes impacting another 89,000 lives. That is a modest estimate.
Solve Refugee Crisis with Safety & Health Care
Seeking donors to sponsor each of 31 medical outposts for returning displaced to Rojava. https://rinj.org/donate/ the best way to mitigate the refugee crisis is to create safety and general health care at the source of the problem. Rojava will test the theory.
**ROJAVA UPDATE – FOCUS KOBANE CANTON**
* Nothing has changed since last visit. This time I had testing equipment including ordnance detection.
* We determined that Kobane is UNSAFE for families (150,000 former residents) because of hundreds or booby traps, mines and possibly unexploded bombs.
* We saw improvised explosive booby-traps in homes
* Possibly as much as 20 loads of rubble have been removed from the city. Some 300,000 tons of rubble have yet to be moved.
* In August, 50 people were killed by unexploded bombs or other explosvies. Incidents continue.
* Workers are still in danger. We were told half a dozen (unverified) have been killed in the past few weeks.
* Well water is not pottable.
* The Kurdish Regional Government in northern Iraq and the Turkish government is NOT allowing medical people; medical equipment; demining equipment; water purification or anything that would be of use to the humans already in the city.
* Workers in Kobane are determined to succeed and are taking a course in demining but have no equipment. We gave some of them our gear before we left.
* We tested soil around the city and there are “contaminants” that have yet to be identified.
* The main streets of the city are cleared of explosives but that is not much and danger remains from falling structures and failing foundations in the main city streets.
* The city has no infrastructure but workers are repairing what they can.
* It is categorically not true that Turkey is allowing medical people and supplies into the area.
* The municipality estimates it is in need of $4 Billion in assistance.
* People are getting sick.
* There are some 400 villages in the region.
* we encountered maybe two dozen that are empty, booby trapped; mined; have unexploded ordnance or are destroyed.
* We also encountered many villages that are inhabited.
* There are still some decaying bodies everywhere. Humans and animals.
* An Emergency Health Care clinic is now in discussion.
* Nobody cares about this area of Rojava
* The people of the Kobane canton are very determined but because they are liberals who are peaceful, they are disliked by the Barzani Government in the KRI which blocks legitimate help to Rojava by placing illegal search-and-seizure enforcers at the border to oppose people LEAVING the KRI.
* Some new options have been offered to us.
* A closed project meeting takes place on the 29th.
Revolutionary “Community Health-Team” Concept
- In the conduct of its mandate The RINJ Foundation has learned the best way to achieve its objectives is to offer full medical care to the community served by RSAC mobile units and to establish long-term relationships with female and child patients and their families for the purpose of establishing and understanding in absolute privacy the complete range of needs of the patient. Any patient seen at our doorstep can be assumed to be a general health care patient.
- RINJ is pioneering “Team-Based Health Care”. Mobile RSAC Team Leads are most likely to be an RN (Registered Nurse) but regionally they report to and are delegated by a Nurse Practitioner (NP). NPs are an integral part of The RINJ Foundations primary care teams strategy and lead the move to team-based medical practice in community settings.
- NPs are especially effective in refugee and combat regions as well as rural settings where there are shortages of doctors, and with patients who suffer a multitude of chronic illnesses and are ill-suited for a traditional seven-minute doctor’s appointment.
- The Rojava Mission Concept: The operational model uses one main brick-and-mortar building in Kobane, Rojava and thirty 20-ft (or 40-ft) heavy steel containers, converted into mobile self-contained medical clinics, as a means of providing full medical health care services including treatment of GBV survivors to the autonomous region of northern Syria known as Rojava. These mobile clinics are desperately needed by the rural people of Rojava since much of the area’s medical infrastructure has been devastated by years of the Syrian Civil War and two years of fighting the Islamic State terrorist group.
- Most Syrian Refugees Wish To Return Home!
Kurdish people in the north of Syria have kicked out ISIS from Rojava region and are working industriously to rebuild. We are building a health care system in Rojava. Give us a hand please.
For detailed information about Rojava:
Medical Health Care Mission In Rojava
- Initial team of 20 nurses inbound.
- Second team of 24 nurses to arrive 2 months later after imaging department & tele-health centre built.
- Nurses will do hospital shifts fit to their RSAC-R1 Facility work schedule
- Delivering Medical services and script fills after 4-days from arrival.
- Hosted by Canton in 1st 4 days while eng. team roughly fixes building and sterilizes nominal facilities in one section of the building while other work continues.
- Two Team Leaders (RN and NP)
- Advance team 20 Nurses
- Edge of city Rojava HQ building, Kobane HQ (Kurdistan)
- The first of thirty regional mobile clinics arrive with varying capabilities–the first units to Sinjar area or the current priority area of thirty villages in Rojava and eastern Kurdistan (KRI – near Dohuk.
- RSAC general health care facilities
will focus on women and children health care including obstetrics, STD’s, infectious disease control, pregnancies, general trauma, overall health care. No patient is turned away, some will be escalated to a hospital.
- All Patients will Receive Full Care on First Visit
- International research provides clear evidence of the correlation of reliable access to effective practices with better population health outcomes. While it is not always possible for a patient to see her own nurse or her other medical team members, efforts are made to ensure that continuity of care remain central to access planning and quality which is why I favour a small leave-behind presence (Two-Staff, Land Rover and Tent) when the Mobile RSAC moves onward in rotation.
- Establishing wait time targets in basic RSAC care is exceedingly difficult. Therefore, in lieu of setting access targets, we focus on enhancing access, specifically through same-day scheduling for things like pharmacological dispensing, blood tests, inoculations etceteras all done the same day as the face-to-face.
- Demographics of the population such as age, gender, language spoken, culture, socioeconomic status, and medical complexity determine the number of patient visits within a time line. We tend to favour the Murray and Tantau model which leaves 65 per cent of the day’s bookings open for walk-ins or deferrals and 35 per cent booked.
- The 35 per cent are for patients who ‘couldn’t make it in on Friday and chose Saturday instead’ or ‘patients whom the intake deliberately scheduled today for follow-up’. Direct visits, after-hour appointments, and Smartphone communication or other digital follow up can take up shortfalls. The goal is to see all patients scheduled and unscheduled, avoiding as much as possible, long wait times. That’s the basic model.
- We have a performance model for this work and need to see a certain number of patients per month to justify the location. Most return pt visits are weekly. So you see a 20ft Mobile RSAC unit supported by a two-staff, a land-rover and a tent to do follow ups when the Mobile RSAC unit moves to the next camp could well be the precursor to dropping a 40ft RSAC unit if the patient load calls for that. (The 40ft units have triple the staff and can handle four times the number of pts as a 20ft RSAC Unit but they can’t move and operate 24/7)
- Until we have enough units in the field
every five days we make a move–the 20ft Units are good for this. The follow ups are pt progress and treatment monitoring. Procedures are only done in the Mobile Units. We really do want to stick to our mission and don’t want to get into a bog where we are locked down doing general practice work only. We in this manner focus on finding and regularly seeing as many sexual violence pts as we can. We prevent suicides, quash the spread of dangerous STDs, and collect sexual-violence testimonial and forensic evidence related to law enforcement; and everyone is better served by that focus.
- The 20 foot units have a 55 gallon water tank and pump system. This allows for one week of water supply at normal usage. Water must be obtained and purified once a week and this is the job of the administrative person.
- The split a/c is D/C inverted and very efficient. All equipment and lighting is universal power with universal outlets. Solar equipment/system can be programmed for 110 volt – 220 volt 50/60 hz. There are six solar panels that can be permanently mounted on the roof which can produce 1500 watts of electricity. There are eight sealed lead-acid solar batteries which is the primary source of stored power. The whole clinic’s average power consumption with all equipment on (including a/c unit) is 500 watts. Even on a rainy/cloudy day our supply verses demand of power is usually 4:1 ratio.
- Every surface can be disinfected. We use Parkland Plastic Non-frp on the ceilings and the walls. The flooring is Armstrong seamless vinyl and is coved up the walls 3 inches. There is four inches of 1/2 lb icynene expandable foam insulation in the walls and ceilings which in effect gives you a R16 value. Electrical is to international code. Walls are steel studded and Everything is level 1 commercial product. Meaning we have designed our units to be very durable to withstand the most austere environments.
- More information.
therinjfoundationfreeposters. wordpress.com/rinj-rsac- mobile-clinics-for-kurdistan- iraq-and-various-african- nations/
Budgets and Costs
(Money is in $USD and Year-Dollars are 2016)
- Each clinic has a total need of:
- $52k x 5 (3 Nurses, 2 security/assistants)
- $35k x 1 Health Care Administrator (Certificate)
- $3500 x 3 Regional volunteers who speak the language of the locals.
- $52K Meds we must buy
- $20K Equipment maint., spares, O2, disposables.
- 377,500 Per year Per Unit
- 30 Mobile Clinics for Delivery of Medical Services, Including Treatment of Rape Survivors, in The Rojava Districts of Syria Incl. Initial cost per 20ft. clinic is about $70k and shipping is $5k. This concept is designed to use thirty 20-ft containers, converted into mobile self-contained one room medical clinics, as a means of providing medical services including treatment of rape survivors to the autonomous region of northern Syria known as Rojava. These mobile clinics are desperately needed by the people of Rojava since much of the area’s medical infrastructure has been devastated by three years of the Syrian Civil War and two years of fighting the Islamic State terrorist group.
* Total Project Amount: $47,550,000.
* Total Project Duration: 48 months
Unless Notified Otherwise Each paid and unpaid worker gets:
- Pre-departure training through a combination of readings, e-learning and face-to-face meetings and workshops
- Reimbursement of required vaccinations and related medical fees
- Assist required visas and work permits
- Paid vacation (25 days per year)
- Accommodation and transportation in Canada for briefings and debriefings
- Accommodation and food in the field
- Round-trip transportation to the field
- Medical evacuation coverage
- Medical/professional indemnity (health workers)
- Luggage insurance
- Psychological support after returning to Canada
- Access to an Employee Assistance Program for one year after returning to Canada
- Confidential peer support network that contacts you before departure, and after returning back to Canada to ensure a smooth re-entry
- Note: a) There are as many as 9 people per clinic because we work outside too. There would ordinarily only be two or three registered medical persons, two security and four volunteers for logistics and records. They are an administrator and the other three are local volunteers we train for doing logistics like community projects of hygiene instruction, babysitting, lectures, entertainment. When we see one patient we also do group health of hygiene, water prep/food prep/public health and infectious disease prevention, individual intake, common ailment instructions (i.e.: we take 5 people together aside and give them instruction son how to avoid and care for boils and skin lesions, sunburn, cuts, insect bites, etceteras. Also we instruct on women’s issues and on safety of the person. The safety of the Person talks often yield one-on-one patient consultations for GBV.) These workers are important and are peers to the patients. We feed them but don’t pay them. Cost is about $3500 per year for the local people.
- Note: b) The cost for each “registered” medical worker or security person is monthly gross salary is approximately $1,900, with subsequent increases based on expertise and experience. We estimate the total annual cost for basics including salary is $52000 USD per ‘registered” medical person per year.
- Note: c) Non ‘registered’ workers are usually not paid but they get a per diem allowance of $600 month if we can. Their cost to support is $35,000.00 per year in total.
- Note: d) Cost to ship 40 ft empty shipping container ranges from $5,000 upwards depending on where the boat goes.
- Note: e) There is one examination/procedure room for each 20ft of space. (40ft unit has two plus lab/sterilization room). Intakes and consults begin under an awning or in a tent outside.
- Note: f) Cost of dispensables (meds)varies: Our model is to see 300 pts per week including medical procedure, pharmacy, and mental health. Mental health counselling and psychotherapy is done mostly one-on-one outside the Clinic in a tent or open-air awning whichever has the privacy needed.
Estimate is $620,000 retail value meds.
The type of work: https://rinj.org/rsac/
Rojava or Western Kurdistan is a de facto autonomous region in northern and north-eastern Syria. The region gained its autonomy beginning in November 2013 as part of the Rojava campaign, establishing a society based on principles of direct democracy, gender equity, and sustainability.
- Trauma care and mass trauma surge capability;
- Physical injuries treatment and minor surgery;
- Sexually transmitted disease detection treatment and prevention;
- Sexual assault forensic testing;
- Obstetrics-Pregnancy issues, from abortion to delivering your baby;
- Legal course of action counseling;
- Criminal prosecution assistance;
- Mental health care; and
- all needed follow-up care.
Red Crescent Camp
Solidarity with our sisters.
February 2015 – Kadija, 44 years old, a Syrian refugee fled from Syria with her 4 kids, now living in a makeshift shelter in Erbil (Iraq). Her husband died in Syria. She is leading the family, but they are in desperate situation with huge needs. Soon they wil come back to Kobane. Dear Recep Tayyip Erdogan President of Turkey Let our patients come home to Rojava.
Dear Recep Tayyip Erdogan President of Turkey — It Could Be Your daughter — Let our patients come home to Rojava.