Wad Onsa Mycetoma Satellite Centre

Wad Onsa Village, Eastern Sennar locality, Sennar State, Sudan

 

 

Background

Mycetoma is a profound subcutaneous infection caused by specific fungi or bacteria, marked by extensive deformities, destruction, and disabilities if not promptly and adequately treated. Despite advancements in mycetoma research, there exists a significant knowledge gap in understanding its pathogenesis and epidemiology, leading to the absence of targeted and efficient control and prevention programs. Currently, the primary method for disease control involves early case detection and proper management. However, a majority of patients seek treatment late, facing severe disease progression, with surgical excisions or amputation being the prevailing treatment options.

Addressing the challenges in managing mycetoma patients, there is a need for a comprehensive approach encompassing medical, health, social, and financial care. In response to these challenges, The Wad Onsa Mycetoma Satellite Centre (WOMSC) was established in Wad Onsa Village, Eastern Sennar locality, Sennar State, Sudan – the region with the highest mycetoma prevalence. The aim is to implement a holistic management strategy to enhance the overall well-being of mycetoma patients.

The Locality

Sennar State is situated in the southeastern region of Sudan, covering an area of 37,844 km² and boasting a population of around 1,100,000. It shares its borders with Gezira State to the north, White Nile State to the west, Gedaref State to the east, and Blue Nile State and South Sudan to the south.

Eastern Sennar locality is subdivided into five administrative units, namely Dooba, Wad Al-Abbas, Wad Taktook, Alreef Alsharqi, and Wad Onsa, comprising a total of 292 villages and a population of 353,196 inhabitants.

Wad Onsa village, positioned in the northeastern part of the state on the west bank of the Aldindir River, is approximately 37 kilometres away from Sennar town. Recognised as one of the prominent agricultural villages supported by the Alsuki Foundation, Wad Onsa plays a crucial role in the region’s agricultural landscape.

WOMSC Objectives

The objectives of the satellite center encompass the execution of the following initiatives within the Eastern Sennar Locality, Sennar State:

  • Early identification of mycetoma cases.
  • Provision of both surgical and medical treatments.
  • Training of medical and health personnel.
  • Advocacy and awareness campaigns for mycetoma.
  • Enhancement of local environmental and hygiene conditions.
  • Supply of prostheses.
  • Implementation and conduct of epidemiological research.

WOMSC Facilities:

Surgical Complex Unit

Comprising two operating theaters, a recovery area, a sterilisation unit, and changing rooms.

Wards

Featuring a male ward and a female ward, each equipped with eight beds.

Out-Patients Unit

It consists of three rooms where patients receive regular check-ups and register for appointments with the MRC team mission. The local medical officer and medical assistants oversee this unit.

Ultrasound Suite

It is equipped with a state-of-the-art ultrasound machine generously donated by the DNDi. This advanced machine facilitates scanning, recording, and storing of images, significantly enhancing early mycetoma case detection and management.

The Laboratory

Officially opened on Thursday, January 9th, 2020, the laboratory was inaugurated by His Excellency, the Governor of Sennar State, Sudan. Its establishment was made possible through a generous contribution from DNDi.

The laboratory is well-equipped with suitable instruments for fundamental microbiological and molecular testing, complemented by excellent storage facilities. The laboratory technologist underwent training in Good Clinical Laboratory Practice as well as other molecular and mycology techniques. With its advanced capabilities, the laboratory is well-equipped to diagnose prevalent medical issues in the region. It efficiently processes and stores samples for subsequent analysis and examination at the MRC.

The Telemedicine Unit

This unit establishes communication links via the internet between the satellite and the MRC located in Khartoum. It is equipped with a data storage facility. The establishment of this unit was made possible through generous support from the Ministry of Higher Education and Scientific Research, Sudan.

The Pharmacy

The pharmacy dispenses all the mycetoma medicines free of charge. It also dispenses other medication and has a storage facility.

The Satellite Activities

Early Detection of Mycetoma Cases

Since 2015, the different MRC medical and health missions to the satellite center have conducted numerous house-to-house surveys across various villages in the locality. These surveys were designed for the early detection of mycetoma cases, with suspected cases being referred to the satellite center for management.

In the villages, all suspected cases underwent thorough clinical interviews and examinations. The patients’ suspected lesions and their geographical locations were recorded using an electronic data collection device and transmitted to both the MRC and WOMSC. At the satellite center, patients underwent additional clinical examinations, followed by lesional ultrasound assessments. Those with ultrasound-suspected lesions underwent surgical excision unless contraindications were present, in which case they were referred to the MRC for further investigations and treatment.

The surveys conducted

Some of the conducted surveys

25th July 2018 14th August 2018 21 villages 4382 household 458 suspected case
22nd June 2019 18th July 2019 60 villages 7799 household 515 suspected case

 

Surgical and Medical Procedures

Upon being referred to the center, individuals suspected of having mycetoma undergo assessment either before the MRC mission’s arrival or during their stay. Each patient undergoes a thorough clinical examination and lesional ultrasound assessment to confirm the diagnosis. Suspected patients then undergo preoperative preparation and surgical procedures and receive careful post-operative monitoring. Wound dressing after surgery is administered either at the center or at their local health units. All these services are provided at no cost to the patients. Additionally, mycetoma treatment is dispensed, and follow-up visits are conducted. More than 1500 ultrasound examinations and 1000 surgeries have been carried out, all offered free of charge.

Training of Medical and Health Staff

Medical and health personnel in the Eastern Sennar region have undergone various training courses focusing on the care of mycetoma patients, indications for referral, community health education, and disease advocacy. Regular clinical and ultrasound training sessions have been conducted at the satellite center. These activities were attended by the Sennar State Minister of Health and the Governor of Eastern Sennar locality. Trainees were provided with newly designed referral cards.

Additionally, in collaboration with the Ministry of Health, Sennar State, the Mycetoma Research Centre organised an Awareness & Advocacy Training Workshop for all medical assistants on January 21, 2016, in Sanga Town, the state capital. The workshop, inaugurated by the Sennar State Governor and the Minister of Health, saw the participation of 270 medical assistants and senior staff from the Ministry of Health.

The workshop commenced with a pre-test, followed by a comprehensive talk by Professor Fahal on various aspects of mycetoma. Objective discussions and a post-test were conducted, revealing a significant improvement in participants’ knowledge, attitude, and practices related to mycetoma.

The overarching goal of the training workshop was to lay the groundwork for a new policy decentralising mycetoma services to reach affected communities in Sennar State. It sought to identify effective tools for early mycetoma case detection and management, control disease transmission, and assess the impact of service decentralisation on the economic and social burden of patients. Read more

Mycetoma Awareness and Advocacy

In conjunction with MRC missions, the center has organised numerous awareness and advocacy sessions employing innovative techniques. Led by Khalid Hamid Youssif, a Conceptual Visual Artist renowned for his painting and artistic skills, the MRC advocacy team has conducted multiple health education sessions across various communities, addressing mycetoma presentation, treatment, and control. The team has also staged several open theatre performances in numerous villages, captured numerous photographs, and curated a photo exhibition as part of mycetoma advocacy efforts to enhance awareness. Read more

The Health Promotion Team of the Association of Aid and Relief, Japan, based in Khartoum and headed by health promotion officers Mrs. Hanan Faisal and Mrs. Insal Tawour, collaborated with a local Community Youth Organisation team to organise numerous health awareness events. These initiatives utilised diverse methods and health education materials, such as distributing notebooks on mycetoma to pupils and children, along with the dissemination of leaflets and posters. The Community Youth Organisation members actively engaged in various performances and open interactive theatre shows to promote awareness and advocacy. Additionally, the local Red Crescent Organization conducted multiple advocacy sessions, including house-to-house sessions.

Sennar Radio and TV conducted numerous interviews and programs, extensively publicising the activities of the missions and urging people to seek free treatment ahead of the mission’s arrival in villages. Local medical assistants and community leaders were enlisted to direct suspected patients to the Wad Onsa Mycetoma Satellite Centre for diagnosis confirmation and treatment.

The initiative “We Are With You Society,” led by Mr. Aism EL Bana, a mycetoma Ambassador and a prominent Sudanese celebrity, involved 40 singers, comedians, and fine artists. During their journey to Sennar, they held various performances and awareness sessions in different towns. In Sennar, they conducted a substantial campaign on mycetoma. Read more

In collaboration with the local community, the WOMSC organised several sessions to enhance the local environment and hygiene in many villages. These activities received support from the Local Government in Sennar State and the East Sennar local governorate.

Through a generous donation from Saimner Engineering Company in Khartoum, 72 new modern animal cages were constructed outside Wad EL Nimear village to minimise contact with animals and their excreta, eliminating thorny cages. Read more

Provision of Artificial Prostheses:

The majority of mycetoma patients hail from underdeveloped communities with low socio-economic status, often presenting at advanced stages where amputation of the affected limb becomes the only available treatment. In Sudan and other developing nations, amputation carries a social stigma, causing patients to withdraw, experience social isolation, and lose employment and educational opportunities. Many become financially dependent on family members, resulting in various negative impacts on patients, families, and the community.

As part of its crucial objectives to enhance the quality of life for these patients and uplift mycetoma-endemic communities, the MRC collaborated with the Sennar State Ministry of Health and the EL Zaka Fund. Together, they organised a mission to provide free prostheses for mycetoma amputees in their villages, utilising a mobile workshop mobilised to the Wad Onsa Mycetoma Satellite Centre. A total of 160 prostheses were provided free of charge at the center, alleviating the burden of travel, time, and accommodation costs for the amputees and their families who would otherwise have had to seek assistance in Khartoum.

Implementation and Conduct of Epidemiological Research

The MRC epidemiology team executed numerous house-to-house epidemiological surveys across various administrative units in the Eastern Sennar locality, aiming to investigate the high prevalence and burden of mycetoma.

The inaugural survey, led by Dr. Manar Elsheikh, Associate Professor of Biostatistics at the Faculty of Mathematical Sciences, University of Khartoum, was carried out in Wad El Nimer village. The team gathered essential demographic information for all household members and details about household characteristics. Suspected mycetoma cases identified during the survey were referred to Wad El Abbas Hospital for further assessment by the MRC mission team to confirm the diagnosis and initiate management.  Read more

Immunological and Genetic Studies in Wad Onsa and Wad El Numir Villages

Extensive immunological and genetic studies were undertaken in Wad Onsa and Wad El Numir villages to investigate potential associations between the high incidence of mycetoma and the background of the affected population. Read more

A highly trained epidemiological team executed a comprehensive house-to-house survey in both Wad Onsa and Wad El Numir villages, utilising a structured questionnaire to identify suspected mycetoma patients. Concurrently, environmental samples were collected from the two villages and subjected to DNA extraction for subsequent metagenomic analysis. Read more

Furthermore, an in-depth study was conducted to identify the aetiological and environmental factors influencing the occurrence and distribution of mycetoma in Sennar State. This study also aimed to delineate the geographical distribution of mycetoma.  Read more

In-depth Examination of Mycetoma Geographic Distribution:

A comprehensive analysis of mycetoma geographic distribution in the region was carried out. Additionally, an extensive environmental study was conducted to shed light on various aspects of mycetoma occurrence in eastern Sennar, focusing on climatic and ecological factors, as well as proximity to livestock. Read more

The study specifically targeted eighteen villages in the Doba and Wad Taktok administrative units within the Eastern Sennar locality. A meticulous house-to-house survey was undertaken in each village to detect early mycetoma cases, utilising the CAPI application through smart tablets for efficient registration of suspected patients’ information. The data collected encompassed demographic characteristics of suspected patients, contacts for community leaders and health personnel, photographs of suspected mycetoma lesions, and coordinates of the villages and patients’ localities. The survey team actively engaged in health education activities within the surveyed villages. A total of 62 suspected patients were studied during the survey. Read more

 

Community Involvement

Local village leaders and residents actively participated in mycetoma advocacy initiatives and awareness-raising activities. Volunteers from the local Red Crescent underwent training in mycetoma advocacy, contributing to the improvement of local environmental hygiene in affected villages through house-to-house surveys.

As part of community support, the MRC contributed by donating a toktoko (large motorcycle) to a community activist in Wad EL Nimear village. This vehicle facilitates the transportation of patients and medicines between different villages and aids in mycetoma advocacy efforts.

Government entities such as the Sennar State government, various ministries, and local radio and TV played active roles in these endeavours. Additionally, many local mosque imams and school teachers received training in mycetoma advocacy, subsequently becoming motivated advocates for the cause.. Read more

The MRC Missions

Starting in 2015, the Mycetoma Research Centre (MRC) has organised numerous missions to the satellite centres at the White Nile and Sennar States. Throughout these years, the success of these missions has been possible through the collaborative efforts of various organisations, institutions, and non-governmental organisations (NGOs), including the following:

  • The Ministry of Health, Sennar State
  • The Zaka fund
  • Faculty of Medicine, University of Sennar
  • The Federal National Medical Insurance Fund
  • Sennar State, National Medical Insurance Fund
  • The Institute of Endemic Diseases, University of Khartoum
  • The Association of Aid & Relief, Japan (AAR)
  • The Sudanese American Medical Association
  • Sennar Red Crescent
  • Local Donors, Sennar State
  • Eastern Sennar, Local Community Leaders and Activists
  • The Mycetoma Friends Association
  • ‘We Are With You’ Society

Mission Teams

The MRC has different teams to execute specific functions and tasks, and these include the following: The Clinical, Radiological and Laboratory Diagnostics Team, The Epidemiological Team, The Advocacy and Awareness Team, Public Engagement Team, and Logistics and Support Team.

The Clinical, Radiological and Laboratory Diagnostics Teams

  • Ahmed Hassan Fahal, Professor of Surgery, the Mycetoma Research Centre, University of Khartoum. Khartoum, Sudan.
  • Mr Elsamani Wad Allah, Consultant Surgeon, the Mycetoma Research Centre, University of Khartoum. Khartoum, Sudan.
  • Mr Hago EL Toum, Consultant Surgeon, Assistant Professor, Faculty of Medicine, University of Sennar.
  • Dr EL Rayah Mustafa, Senior Radiologist, Soba University Hospital, University of Khartoum, Khartoum
  • Dr Mustafa EL Nour, Assistant Professor of Radiology, Faculty of Medicine, University of Khartoum
  • Dr Badreldin Mirgani Yousif, Consultant Histopathologist,  Soba  University  Hospital.
  • Dr Najwa Jouda, Associate Professor of Mycology, The Mycetoma Research Centre, University of Khartoum
  • Mr Emmanuel Edward Siddig, Research Assistant, The Mycetoma Research Centre, University of Khartoum
  • Mr Ahmed Saif, Research Fellow, The Mycetoma Research Centre, University of Khartoum
  • Ten Senior Surgical Registrars
  • Three Medical Imaging Registrars
  • One Anaesthetic Registrar
  • Four Surgical Theatre Attendants
  • Four Anesthetic Assistants
  • Medical Imaging Nurse
  • Two Nurses
  • Medical Information Officer

The Epidemiological Team:

  • Ahmed Modiuwi Musa, Professor of Immunology, The Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
  • Dr Sahar Mubarak Bakhiet, Assistant Professor Molecular Biology, The Institute of Endemic Diseases, University of Khartoum
  • Dr Kebede Deribe, Research Follow, Brighton and Sussex Medical School, United Kingdom and School of Public Health, Addis  Ababa  University,  Addis Ababa, Ethiopia.
  • Prof Noma Mounkaila, Professor of Epidemiology, University of Medical Sciences and Technology,  Khartoum, Sudan.
  • Dr Manar El Sheikh, Associate Professor of Biostatistics, Faculty of Mathematics Sciences, University of Khartoum
  • Dr EL Tayeb Gannawa, Associate Professor, Faculty of Geographical and Environmental Sciences, University of Khartoum
  • Prof Hassan Saad Mohammed Hilmi, Future University
  • Dr Abdelrahman Eltahir Ahmed Musa, Environmental Sciences Consultant, Future University
  • Dr Roua Fath EL Rahman, Research Assistant,  the  Mycetoma Research Centre, University of Khartoum.
  • Mr Ahmed Mugtaba Anwar, Forward Environmental and technical services
  • Dr Alwaleed Yousif Musa, Head of Environmental Control, GIAD Company
  • Mr Fath Elrahman Yousif, Lecturer, Department of Geoinformatics, Future University
  • Mr Saif Eldin Abd elmajid, Lecturer Department of Geoinformatics, Future University
  • Dr Mohaemed Ali, Associate Professor of the Environmental Studies University of Sennar.
  • Post-graduate students from the faculties of Geographical and Environmental Sciences, Pharmacy and Science, University of Khartoum
  • Mr Fath El Rahman Yousif Ahmed, Faculty of Geoinformatics, Future University.
  • Miss Nisreen Fakhreldin, Teaching Assistant, Faculty of Science, University of Khartoum.
  • Miss Abeer Abdalla Hassan, Teaching Assistant, Faculty of Science, University of Khartoum
  • Dr Eiman Siddig, Research Assistant, The Mycetoma Research Centre, University of Khartoum
  • Dr Dania Mohamed, Research Assistant, The Mycetoma Research Centre, University of Khartoum
  • Dr Rayan Ali, Research Assistant, The Mycetoma Research Centre, University of Khartoum
  • Dr Arwa Tayfoor, Research Assistant, The Mycetoma Research Centre, University of Khartoum
  • Dr Abubaker Ahmed Yousif, Research Assistant, The Mycetoma Research Centre, University of Khartoum
  • Dr Mahmoud Koko, Research   Assistant, The Institute of   Endemic   Diseases, University of Khartoum.
  • Thirty-five Medical Students, Faculty of Medicine, University of Sennar.
  • The Advocacy and Awareness Team:
  • Mrs Hanan Faisal. Health Promotion Officer, the  Association of  Aid  &  Relief, Japan.
  • Mrs Ensaf Tawer, Health Promotion Officer,  the  Association of  Aid  &  Relief, Japan.
  • Mr Khalid Hamid Conceptual Visual Artist
  • Mr Tarig, Fine Artist
  • Mr Saied Khalifa, Musician
  • Miss Hana’a Hassan, Social Worker, Mycetoma Research Center- University of Khartoum.
  • Miss Hanan Mudathir, Social worker, freelancer
  • Medical Assistants, Eastern Sennar Locality
  • Community leaders and activists

Logistics and Support Team

  • Mr Yasser Adam, Medical Photographer, The Mycetoma Research Centre, University of Khartoum
  • Mr Ameer Faroug, Logistics Officer, The Mycetoma Research Centre, University of Khartoum.
  • Mr A. Razig  Abdulla,  Senior  Nurse, The Mycetoma  Research  Centre,  University of Khartoum
  • Three drivers

Public Engagement Team

Miss Hana Ahmed

The Outcomes

  • Community engagement in early disease detection was improved.
  • More patients with early disease were seen and treated.
  • The quality of care for mycetoma patients at the village level improved.
  • Better patient access to free treatment.
  • East Sennar medical and health staff were trained on mycetoma patients early care detection, referral and community advocacy.
  • A new digital data collection application (CAPI) was designed, tested, and useful.
  • The distribution of shoes to the poor school pupils at Wad El Nimer village to improve personal hygiene and reduce the risk of developing mycetoma
  • Establishment of 72 new modern animal cages at Wad El Nimer village
  • Appointment of local mycetoma Ambassadors for advocacy

Published Reports

  • Report on the Mycetoma Medical & Health Mission to Wad Onsa village, Sennar State 15th-18th October 2019
  • Report on the Epidemiological Study on Mycetoma at El AndalousVillage, The White Nile State, July 2010

Acknowledgement

The MRC would like to express its almost thanks and gratitude to many stakeholders who made these missions successful and unique stories, and they included:

  • The Governors of Sennar State:
  • Mr EL Daw El Mahi
  • Ministers of Health, Sennar State:
  • Mr Mohamed A Gadir EL Mamoun
  • Dr Alam EL Huda Mustafa, the Acting Minister
  • University of Sennar
  • Prof Banga Hassan Mohammed Sennar University Vice-Chancellor
  • Dr A Rahman Ahmed, Sennar University Dean of the Faculty of Medicine
  • Mr Hago EL Toum, Faculty of Medicine and Consultant Surgeon and his surgical team
  • The Director-General, EL Zaka Fund, Khartoum
  • Sennar State, Director, EL Zaka Fund
  • The Director-General, The National Medical Insurance, Khartoum
  • The Director, Sennar National Medical Insurance, Sennar
  • The Senior Officials, Sennar Ministry of Health
  • The different NGOs
  • Community leaders and activists

Special thanks and gratitude

The missions enjoyed the great hospitality of Wad Onsa community leader Shiekh Abdel Azziz EL-Bashir and his family. Who provided free accommodation and meals for all mission members.

Mr Mohamed A Gadir EL Mamuon, the Minister of Health at Senner State and his senior administrators made