Context

The inhabitants of affected districts express deep concerns that are emphasised by the local specialists about their health and their children's health.

Local, national and international actors, together with scientists, also express concerns about the long-term health impact of radioactive contamination, particularly on the health of children.

Purpose of the TP

The Topical Project aims at securing partnerships with mothers, identifying their health needs, monitoring the health of mothers and children living in the district, and collating the results of individual medical and dosimetric check-ups in view of discovering a possible link between radiation doses and pathologies.

The TP will be grounded on a partnership at local level with Working Groups involving mothers from different villages, together with health specialists at a district or national level. A medical check-up of these children is also organised at the district level. Some engaged pregnant mothers will receive training at the regular seminar on practical radiation protection. At the international level, the Topical Project involves the participation of a non-governmental organisation Medecins du Monde, together with several European institutions, co-ordinated by the French Institute of Radiation Protection and Nuclear Safety (IRSN).

Local, national and international partners of the Topical Project

Local partners: Chechersk and Stolin district hospitals, village dispensaries;

National partners: Gomel Centre of Radiation Medicine and Human Ecology, Brest Branch of Research Institute for Radiology, Belrad;

International partners: Medecins du Monde, IRSN (Institute of Radiation Protection and Nuclear Safety). Envisaged complementary partnerships: INVS (French Institute for Health Follow-up), DGSNR (Directorate General for Nuclear Safety and Radiation Protection).

Success criteria of the TP:

• Better understanding of the medical status of children in the Chechersk District;
• Reduced sanitary risks for pregnant women and children, regardless of the source;
• Upgraded equipment in the Chechersk hospital and, if the budget allows, in village dispensaries as well;
• Emergence of local population as co-expert and co-actors of their health quality;
• Better understanding of the health effects of chronic radioactive contamination.

Co-ordination and integration of the Topical Project within the framework of the CORE Programme

During the first three months of implementation (early in 2004), the Project will be labelled as a CORE Topical Project by the CORE instances: Preparation and Assessment Committee (PAC) and Approval Board (AB).

Once a year, concerned actors at local, national and international levels will be informed of the Project implementation within meetings of the Health Care Priority Area Liaison Committee.

The Topical Project results will be assessed through:

• annual PAC meetings;
• annual integration seminar in the Chechersk District.

Main activities provisioned throughout the CORE Programme duration

The Topical Project includes two complementary activities implemented, with the help of local facilitators, in the four selected villages and in the Chechersk hospital:

Activity A: Partnership with mothers and organisation of a regular seminar on practical radiation protection for pregnant women.

Activity B: Medical check-up for the children of the Chechersk District.

Co-ordination is also envisaged with the Mother and Child Health Project implemented in the district of Bragin by the Swiss Agency for Development and Co-operation (SDC).

Activity A - Partnership with mothers and organisation of a regular seminar on practical radiation protection for pregnant women

Objective

This activity aims at facilitating a partnership with mothers (including pregnant women) of four villages in the Chechersk District. The objective is to identify their health-related expectations and initiate actions for a sustainable improvement of their health quality through reduction of sanitary risks. In this perspective, the practical radiation protection education for pregnant women will start right from the very first year of the project implementation.

Later on, along with the implementation of Activity B, the results of the medical check-ups of the district's children shall be widely discussed at various levels (among mothers, local medical personnel, Belarusian and European paediatricians). This activity will be implemented under the supervision of Medecins du Monde.

Work Programme

The implementation agenda for the first year includes the following activities:

1. Recruitment of a local facilitator (first quarter of 2004) by Medecins du Monde.
2. Creation of partnerships with mothers, identification of local concerns and expectations concerning health (first quarter of 2004). Mothers` working groups will be set up in each one of the four villages of the Chechersk District with all the needed local facilitation mechanisms in place¹. During the first year, in each village, about fifty mothers should be thus involved, which adds up to about 200 mothers for the four villages. Discussions in the Working Groups will be structured by the local facilitator and the French paediatrician. Once the working groups are set up, the mothers will start to identify their concerns and expectations concerning children's health and public health care.
3. Preparation and implementation of a regular seminar on radiation protection for pregnant women of the Chechersk and Stolin Districts² . Within the training for pregnant women provided by the Chechersk District Hospital, a regular seminar on radiation protection will be proposed to pregnant women in 2004, such courses will first take place in the Chechersk and Stolin district hospitals, and later on (2-3 years into the Project), in village dispensaries. The seminars will be conducted by local specialists with the help of Medecins du Monde. They will include:

• A direct dialogue with pregnant women during the implementation of Activity B, as well as during individual consultation (before and after the birth);
• Video presentations³;
• Elaboration of a radiological quality guidebook in co-operation with pregnant women;
• Training in radiological monitoring of food and persons at home.

2005 and 2006

Results of the medical check-ups in the villages and the district will be analysed and discussed by the women's working groups with the help of the French paediatrician and the local facilitator. The results shall be collated with individual radiological data.

Activity B - Medical check-up for children of the Chechersk District

Objective

This activity aims at facilitating a local, national and international co-assessment of the medical check-up for the Chechersk District children of 3-15 years of age.

In the contaminated areas, each child's health status is annually checked up at the district hospital. The objective of this Activity (co-ordinated by IRSN) shall be met through the following interventions:

• Analysis of the comprehensive individual medical check-up data;
• Individual retrospective dosimetric evaluation;
• Integrated analysis of both medical and dosimetric results in view of discovering a possible link between radiation doses and pathologies;
• Integration of local concerns regarding health status expressed by the mother` working groups implemented within Activity A.

Specific attention will be paid to informing parents on their children's health status. Extrabudgetary funds might be raised to attend to the diagnosed pathologies.

This activity will take place in the Chechersk District and will involve about 3,000 children. A financial contribution will be provided for the upgrading of the equipment in the district hospital and (depending on the identified financing) in the village dispensaries.

Work Programme

The following activities are scheduled for implementation in 2004:

1. Elaboration of the local, national and international co-operation framework;
   • Collaboration of IRSN with local medical professionals from the Chechersk hospital and villages dispensaries. In this perspective, a seminar for the local stakeholders identified in Activity A might be organised.
   • Setting up of national and international expert groups in the different fields (dosimetry, medicine, biostatistics, etc.)
2. Elaboration of a medical check-up protocol in co-operation with local, national and international specialists. The protocol, introduced through this Activity, must conform to the rules of medical ethics (potentially traumatic examinations, like gastroscopy, shall be conducted only for diagnostic reasons).
3. Identification of hospital equipment needs for preliminary calculation of required investments. Depending on the amount of identified financing, this activity might also involve village dispensaries.
4. The medical check-up for children of the Chechersk District will start in the second half of the first year of project implementation. A sustainable information-exchange framework will be set up for local, national and international experts of various expertise (dosimetry, medicine, biostatistics, etc.). Once assessed at a village or district level, results will be discussed and analysed within mothers` working groups as provisioned by Activity A.

2005 and 2006

1. Continuation of the medical check-ups for children.
2. Individual retrospective dosimetric evaluation.
3. Integrated analysis of individual medical and dosimetric data.
4. Discussion by mothers` working groups of individual check-up data acquired at a village or district level (see Activity A).

Budget

The proposed budget of the project for the 3 year period is 148 000 _. The initial investment for the TP activities is equal to 88 000.

¹Cf. Nota Bene: the establishment of mothers` working group requires an operational system of radiological quality monitoring at the district level.

²Training of pregnant women in the ways of radiological culture also requires an operational system of radiological quality monitoring at the district level.

³E.g. video presentations developed within the "Pregnant Women" project in the Stolin District.

All Rights Reserved, CORE, 2004