Kaduna government provides medical assistance to 12,251 malnourished children

The Kaduna state government claims to have treated no less than 12,251 malnourished children between January and August 2021.

National nutrition officer Ramatu Musa revealed this to Zaria on Saturday at the end of a two-day third quarter review meeting with local government nutrition focal points.

Musa said that figure was out of 24,548 admitted to various community acute malnutrition management sites across the state.

She explained that of the 24,548 children, 16,358 were new admissions, while 8,190 were spillovers from untreated cases from 2020.

The official also said 46 children died of deficiency during the period, indicating a significant reduction from the 124 deaths recorded between January and September 2020.

She said to deal with the situation, the government has increased the number of local governments providing CMAM services from two in 2017 to 16 in 2021.

Musa added that the state currently has 82 primary health centers offering outpatient therapy programs to treat children with severe acute malnutrition with 17 secondary health facilities as stabilization centers.

Kaduna State Nutrition Emergency Action Plan project manager Umar Bambale said the government and partners are investing more in community feeding practices for infants and young children.

Bambale noted, “C-IYCF is a preventative approach that promotes adequate nutrition for children during the first 1,000 days of life. ”

He said that so far, a total of 558 health care providers and 1,156 community volunteers have been trained in C-IYCF services in 22 local government areas of the state, with only one outstanding area.

He also explained that through support groups, community volunteers would educate and enlighten mothers and caregivers on best C-IYCF practices for strong growth and healthy development in infants and young children.

The Coordinator of the Accelerating Nutrition Outcomes Project in Nigeria, Zainab Muhammad-Idris, explained that there has been a general improvement in the activities of the local government nutrition focal points.

Muhammad-Idris noted that there had been a significant improvement in the presentation of performance, challenges and issues that required advocacy, especially funding.

She said: “Malnutrition prevention activities in local governments are also resuming with many C-IYCF promotion activities implemented by nutrition focal people.

“This is quite encouraging, and we hope that with continued support, NFPs will do better and record more results in the fourth quarter.”


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Massachusetts lawmakers consider legalizing physician-assisted dying

Almost a decade after voters narrowly dismissed a ballot question to legalize physician-assisted dying, state lawmakers are once again ready to delve into emotional testimonies, ethical debates and claims. logistical questions around the issue.

Ahead of a Friday Public Health Committee hearing on bills (H 2381, S 1384) that would allow terminally ill patients who meet certain criteria to request and be prescribed a lethal dose of drug to end in their days, supporters and opponents each organized video calls to make their case.

Donors, including some patients with incurable diseases who wish they could make decisions about their end of life, present the policy as a way to alleviate pain and suffering when death is imminent and note that 10 more states adopted a version of the measure.

Those who oppose it warn of the potential disparate impacts on people with disabilities, people of color and those who cannot afford life-prolonging treatments, and say palliative and home care should rather be made more accessible.

This year, the COVID-19 pandemic is also part of the discussions.

Kim Callinan of Compassion & Choices, a national group that supports legislation on physician-assisted dying, said the pandemic “has demonstrated the fragility of our lives and also the limits of modern medicine in alleviating end-of-life suffering. life”.

Meanwhile, palliative care physician Dr Laura Patrillo said the latest push for legislation came “literally at the worst possible time” to implement policy that would require thoughtful planning on the part of the system. health worker who is still reeling from COVID-19.

“We are in the midst of a global pandemic and are thinner than ever before,” she said. “The public perception of science and medicine is more strained and the relationship is more strained than it has ever been. We are losing staff and the people who are still there are exhausted and exhausted. The administration of health care is completely taxed.

Versions of bills have been tabled in Beacon Hill for years. Last year, the Public Health Committee reformulated and advanced the bills to the Health Care Funding Committee, which took no further action on them.

Callinan said this session’s legislation has more than 80 cosponsors, including Rep. Ted Phillips, who drafted the bill’s first draft in 2008 as a staff member of his longtime legislative supporter, the former representing Louis Kafka.

“This bill is not for everyone,” Phillips said. “We have worked very, very hard over the years to make it very clear in the legislation that there is no ambiguity around who this bill affects, that this decision cannot be made for you. This decision would be yours alone.

Phillips said those interested in seeking medical assistance in dying should ‘jump through the hoops’ – including asking two doctors to confirm they have terminal illness and are expected to die within six months. , being considered “sane” and making the request on two separate occasions, with a delay in between.

Opponents fear that people will feel compelled to make these demands.

In an appeal organized by the Patient Rights Action Fund, Stephanie Packer, a mother in California – one of the states that has legalized physician-assisted dying – said her health insurance had it informed once that she refused to cover her “extended life treatment” for scleroderma, but she could have obtained medication to end her life for a co-payment of $ 1.20.

“There is so much fear out there, and to hear that the drugs that might give me strength, that might help me take care of my family, that might help me live long enough to see my kids do amazing things, that these I wouldn’t have any way to access it, but if I wanted to, I could pay a dollar and miss it all, just because it’s cheaper, ”he said. she declared.

Those wishing to see a physician-assisted dying policy in place described their distress at not having this option available.

Lee Marshall, a Gloucester resident, who has stage four metastatic breast cancer, said she had a prognosis of “less than a year” and may enter hospice care soon.

“I want more time to be stupid with my husband Paul and my friends. I want more time to dance, joke, make pottery and enjoy nature walks, ”she said. “I thought I would live to be 80, but I probably won’t see 70. I am terrified of the lingering pain that will leave me with no pleasure in life and no option to say enough is enough. “

Marshall testified on earlier versions of the bill, as did Dr. Roger Kligler, a retired physician with incurable metastatic prostate cancer.

Kligler listed the names of those who had appeared before lawmakers previously to support the legislation and have since died, including the late Representative Chris Walsh. Kligler said if lawmakers waited, any action on the issue could also come too late for him, Marshall, or maybe “someone you know or love.”

“It is time for the legislature to act, and I implore them to do so,” he said.

Massachusetts voters in 2012 rejected a question on physician-assisted dying by a margin of 67,891 votes, with 48.9% for and 51.1% against.

Boston-based disability advocate John Kelly, who is director of Second Thoughts Massachusetts and regional director of Not Dead Yet, said the voting cards for that ballot question showed the numbers weren’t even there. statewide. Brookline approved the measure with 67% in favor, he said, while Lawrence voted 69% against.

“These laws place the perspective of a professional class obsessed with personal autonomy, achievement and status – hence the focus on the word ‘dignity’ – over the worldview of a working class that believes in family, connection and respect for elders, “he said.” By undermining the value placed on the elderly, sick and disabled, these bills encourage the devaluation of people as having too low a quality of life. “

In the nine years since the issue was put to voters, supporters have “tightened” the bill, said Rep. Jim O’Day, who tabled the House version this year. O’Day said he expects this work “to really make a huge difference” and that the latest bill contains definitions – like details of why a person would be considered phased. terminal – which, he hopes, will reassure critics.

O’Day said he wished the bill had been law when his father was at the end of his life.

“We had had this kind of conversation, and he was really convinced that he had the opportunity, to have this ability to make the decision for yourself, and as we drafted the bill, in consultation with the staff. medical and those who make sure the person is at full capacity, ”he said.

O’Day is a division chairman on President Ronald Mariano’s leadership team, and Phillips said he appreciates him being a member of the House leadership “carrying this bill.”

“We are confident this is the year when we can finally get there,” he said.

End-of-life bills are the only items on the agenda for Friday’s public health committee hearing, which will be televised live and is expected to start at 9 a.m.


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Role of the clinical pharmacist in a medical assistance team during the quarantine of the novel coronavirus (COVID-19) – Cheaib – – Journal of Pharmacy Practice and Research

For the publisher,

Quarantine to control outbreaks of infectious diseases such as COVID-19 has long been used by Australia and involves restricting the movement of individuals or groups suspected of having been exposed at home or at a designated facility.1, 2 We describe a role of clinical pharmacist serving quarantined passengers on two separate occasions – involving an international cruise ship and an international flight, respectively – where approximately 200 returning travelers each performed a mandatory 14-day quarantine on the trip. Rottnest Island, 20 km off the port of Fremantle. .

Rottnest Island has approximately 330 permanent residents, but can accommodate 15,000 people during peak tourist periods.3 The island has basic medical services: a nursing station with two nurses and a general store with a Schedule 2 poison control permit and a limited range of drugs.

The Western Australian Medical Assistance Team (WAMAT) is a multidisciplinary health support team dispatched to disaster sites in the short term.4 WAMAT was deployed to Rottnest Island to provide medical management of passengers during the two quarantine periods. Tourists have been evacuated and quarantine zones have been established. WAMAT typically includes doctors, registered nurses, paramedics, and logisticians, and pharmacists are not routinely included. For the first period of quarantine involving elderly cruise ship passengers, a pharmacist was asked to help with the expected high drug load. After this successful deployment, WAMAT also asked the pharmacist for the subsequent quarantine.

Passengers in quarantine filled out health questionnaires upon arrival. Medication replenishments used “The Commonwealth’s Special Authority for Emergency Supply of Schedule 4 Medication During COVID-19” and was authorized by the pharmacist. The new prescriptions were handwritten by the WAMAT doctor, reviewed by the pharmacist, and emailed to Fiona Stanley Hospital (FSH), a quaternary hospital with governance for the nursing station, for deliverance. The drugs were delivered in sealed boxes via the passenger ferry.

WAMAT staff provided daily medical rounds, including assessing passengers in their quarantine accommodation for symptoms of COVID-19.

The role of the pharmacist during these deployments included:
  • Identification and triage of passengers at risk on the basis of health questionnaires.
  • COVID-19 test.
  • Regular medication replenishment; medication reconciliation through liaison with health care providers (community pharmacies, general practitioners and community mental health clinics).
  • Primary health care advice regarding: seasonal allergies, constipation, cystitis, thrush, hemorrhoids, conjunctivitis and analgesia.
  • Advice on choosing antimicrobials, managing pain, insomnia, cold chain breaks, and storing refrigerator items.
  • Supply of sharps containers to insulin dependent diabetics.

Several important roles of the pharmacist have been identified during the phases of prevention, preparation and response to disasters;5 however, to our knowledge, there is no description in the literature of the pharmacist’s contribution to the management of patients during quarantine periods in the event of a pandemic.

The demand for pharmacists to be included in the WAMAT team during the second quarantine deployment is recognition of the unique skills they provide, especially when access to standard medical care is limited.

Declaration of conflicts of interest

The authors have no conflicts of interest to declare.


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Referrals to physician-assisted dying have been cut off due to increased demand and COVID tensions in Nova Scotia

HALIFAX – An increase in demand that has led Nova Scotia to temporarily suspend referrals for physician-assisted dying is a symptom of stress – including COVID-related stress – on our healthcare system, and a former Senator closely involved in the problem said other provinces could soon face the same pressures.

The province’s Clinical Director for Assisted Dying, Dr Gord Gubitz, said this week that Nova Scotia Health will suspend requests for medical assistance in dying by 30 days as province faces “significant backlog “.

Referrals for MAID in Nova Scotia this year have already exceeded last year’s total. In 2020, there were 373 references; in September of this year, there were already 395.

Since the passage of the original MAID legislation in 2016, Nova Scotia has recorded 1,465 referrals, increasing steadily each year from 36 in the first year to 395 so far in 2021. Of these, Marketing Authorization was carried out in 667 cases.

“As we receive more referrals than ever before, we are also struggling to find enough clinicians to perform assessments and procedures according to patient requests,” Gubitz said in an emailed statement. “Maybe we can attribute a little of that to the demands of our health care system while dealing with the pandemic.”

Senator Jim Cowan, a board member for Dying With Dignity, said the organization had heard of an increase in referrals for assisted suicides across the country that reflects the situation in Nova Scotia, spurred by part by legislative changes this year that made eligibility criteria easier to meet.

“I think it’s fair to say that as Canadians become more aware of the availability of and the possibility of accessing physician-assisted dying, it increases the demand,” said Cowan said.

“We’re worried, but we understand the reasons why this needs to be done,” Cowan said of the Nova Scotia break. “I think the government should be commended for at least being transparent about the situation and not just letting people wonder why.

“It highlights that there are problems in our health care system accessing services, not just medical assistance in dying. Wait times are a big issue for so many procedures, even outside of COVID times. “

In March, changes to Canada’s MAID law made referral easier by changing some of the eligibility criteria. With the changes, the law no longer requires that a person’s natural death be “reasonably foreseeable”.

The law still requires that people wishing to be referred be at least 18 years old, able to give their informed consent to receive MAID, suffer from a serious and incurable illness, disease or disability, excluding – until March 2023 – mental illnesses and are in an advanced state of irreversible decline in abilities.

The law also stipulates that the applicant must suffer “lasting and intolerable physical or psychological suffering which cannot be alleviated under conditions which the person considers acceptable”.

According to statistics from Health Canada, there have been 21,589 deaths from MAID nationwide since the law was enacted in 2016. Of these, 7,595 – 35% – occurred in 2020 alone, latest year for which the federal government has statistics. Deaths related to MAID in Nova Scotia increased by 28% from 2019 to 2020. By comparison, these numbers increased by 42% in Quebec, 35% in Ontario and 47% in Alberta.

At the same time as announcing the suspension of referrals in Nova Scotia, Gubitz sent out a call offering training to physicians and nurse practitioners who may have the capacity to become involved in the MAID process. He also said Health Nova Scotia would hire a full-time nurse practitioner to help ease the workload.

“Our priority is to focus on those who are currently waiting to support them throughout the process,” said Gubitz. “It is important that we are transparent about our situation and the potential for extended wait times.

“We know that waiting for an assessment or MAID procedure can be a source of increased distress and anxiety for patients, their families and others who support them, and we want to minimize that as much. as possible. “


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Referrals to physician-assisted dying have been cut off due to increased demand and COVID tensions in Nova Scotia

HALIFAX – An increase in demand has prompted the Nova Scotia government to press the pause button for medical assistance in dying (MAID) referrals, at least temporarily.

The province’s clinical manager for MAID, Dr Gord Gubitz, said this week that Nova Scotia Health will suspend requests for medical assistance in dying by 30 days as the province faces a “significant backlog” caused by increased demand exacerbated by COVID-19 pressures on the health system.

So far in 2021, the references for MAID have already exceeded those of all of last year. In 2020, there were a total of 373 referrals; in September of this year, there were already 395 references.

“We know that recent legislative changes have made MAID an option for more people looking for it. We also know that awareness grows over time, ”Gubitz said in an emailed statement.

“On the other hand, as we receive more referrals than ever before, we are also struggling to find enough clinicians to perform assessments and procedures according to patient requests. “

In March, changes to Canada’s MAID law made referral easier by changing some of the eligibility criteria. With the changes, the law no longer requires that a person’s natural death be “reasonably foreseeable”.

The law still requires that people wishing to be referred be at least 18 years old, able to give their informed consent to receive MAID, suffer from a serious and incurable illness, disease or disability, excluding – until March 2023 – mental illnesses and are in an advanced state of irreversible decline in abilities.

The law also stipulates that the applicant must suffer “lasting and intolerable physical or psychological suffering which cannot be alleviated under conditions which the person considers acceptable”.

Since the passage of the original MAID law in 2016, Nova Scotia has recorded 1,465 referrals, increasing steadily each year from 36 in the first year to 395 so far in 2021.

Among these, MAID was performed in 667 cases.

In 329 cases, patients died before MAID procedures were adopted. Of these, 186 have completed their assessments but have not planned the procedure.

Gubitz, at the same time as he announced the suspension of referrals, appealed for training for doctors and nurse practitioners who may have the capacity to become involved in the MAID process. He also said Health Nova Scotia would hire a full-time nurse practitioner to help ease the workload.

“Our priority is to focus on those who are currently waiting to support them throughout the process,” said Gubitz. “It is important that we are transparent about our situation and the potential for extended wait times.

“We know that waiting for an assessment or MAID procedure can be a source of increased distress and anxiety for patients, their families and others who support them, and we want to minimize that as much. as possible. “


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30-day temporary suspension of recommendations for physician-assisted dying

Nova Scotia Health says it faces significant backlog caused by increased demand for the service

PRESS RELEASE
HEALTH OF NOVA SCOTIA
*************************
The Nova Scotia Department of Health will temporarily suspend recommendations for medical assistance in dying (MAID) for 30 days while facing a significant backlog caused by increased demand for the service. The program has already exceeded the total number of referrals received in 2020 and is working to secure assessments and procedures for those on the waiting list.

“Our priority is to focus on those who are currently waiting to support them throughout the process. It is important that we are transparent about our situation and the potential for extended wait times. We know that waiting for an MDA assessment or procedure can be a source of increased distress and anxiety for patients, their families and others who support them, and we want to minimize this as much as possible ”, explains Dr Gord Gubitz, Clinical Manager of the AMM. “We continue to work to prioritize patients, families and our MAID care providers in this process. “

The AMM Access and Resources team strives to reduce wait times and resume referrals as quickly as possible. Nova Scotia Health will immediately begin work to hire a full time nurse practitioner to help support this work.

“We owe a big thank you to the clinicians who support this service across the province. If you are a physician or nurse practitioner who may have the temporary or continuing capacity to participate in the MAID process, please contact our team at 902-454-0379. We can provide training and support, and we need you more than ever, ”says Dr Gubitz.

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Pennsylvania Increases Medical Assistance Income Limit |

(The Center Square) – Workers with disabilities in Pennsylvania can now earn up to $ 61,000 a year before losing access to some of their medical assistance benefits.

Bill 69 came into effect on July 1 and nearly doubles the income cap of $ 32,000 for the program in an effort to tackle widespread unemployment and underemployment for beneficiaries often forced to choose between maintaining coverage and accept a better paying job.

Representative Katie Klunk, R-Hanover sponsored a version of the legislation in the House and said it was inspired by a man she knew who was living with a “debilitating” illness requiring continued care.

“When he returned to work, he found that he would earn too much money to qualify for the necessary medical services covered by MAWD. [Medical Assistance for Workers with Disabilities], “she said.” Instead of returning to the position he loved, he chose to take a lower paying position in order to continue to contribute while receiving much needed services. “

Klunk and his co-sponsor, Representative Dan Frankel, D-Pittsburgh, said 35% of disabled program beneficiaries work and only 21% report full-time employment. Others refuse marriage because their partner’s property would result in disqualification.

“For people who need help dressing in the morning, getting into their wheelchairs and meeting other basic needs of daily living, Medicaid is the only way to meet those needs,” said Klunk. “This means that skilled, hardworking and capable employees must put ambition aside. “

The “Catch-22” that many recipients find themselves in is “the opposite of what our public policy should be doing,” she added.

“This means that families are denied the necessary income, that individuals are denied a fulfilling professional life and that our communities are denied the talents of very capable and willing workers,” she said.

Under the new law, workers who earn more than $ 61,000 will not lose their coverage either. Instead, they will contribute more of their income to cover their services. The Department of Health and Human Services estimates that these changes will expand coverage to 1,000 residents.


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Emergency vaccine response from the Australian medical assistance team on national soil

The Australian Medical Assistance Team, or AUSMAT, is an emergency disaster response team that deploys overseas to provide emergency humanitarian support during major disasters. They never imagined that their longest deployment would be on their national soil.

Since 2019, AUSMAT has seen an increasing number of deployments to Australia in response to disasters, such as the devastating bushfires of 2019, and more recently as an emergency response to the COVID-19 pandemic.

Emergency nurse practitioner Angela Jackson has been on the front lines of many international AUSMAT rescue missions, but this deployment, while closer to home, is shaping up to be a much bigger challenge.

Angie and her team have been tasked with providing COVID-19 vaccination support to isolated communities that are home to many isolated, vulnerable and indigenous Australians.

Regional local health services in the far west region of New South Wales have faced the monumental task of covering this vast, remote area to deliver vaccines with resources already stretched before the pandemic.

Alison Jackson has helped deliver more than 700 COVID vaccines to vulnerable and isolated communities in the far west of New South Wales.(

Provided: AUSMAT

)

“My main task was to try to focus on vulnerable communities and hard-to-reach communities,” Ms. Jackson said.

Providing emergency medical support in these remote and sometimes foreign places had its challenges.

Ms Jackson said language barriers were always the first hurdle and communities were not prepared for a group of foreigners arriving in town with full PPE.

Healthcare workers standing in front of an airplane
The AUSMAT team landed at the newly refurbished Wentworth Airport.(

Provided: AUSMAT

)

Deployed on the floor of the house

Patricia Algate is the Health Services Manager at Dareton Primary Health Service, based in the far southwest of NSW.

She said local health workers welcomed the announcement of help with the immunization program and the opportunity to work with AUSMAT.

“Our services seized the opportunity to provide vaccines throughout the county to everyone, including vulnerable people, and to learn from their expertise,” Ms. Algate said.

The immunization program required a combined effort from a number of local service providers, including Wentworth and Broken Hill District Hospitals, the Local Aboriginal Lands Council and Wentworth County, who provided immunization staff, found sites and provided materials.

Protect isolated communities

The vaccine rollout in the indigenous community of Namatjira was carried out door to door with a friendly face from the local health care team and an AUSMAT practitioner.

Ms Algate said the AUSMAT team, who were extremely engaging and culturally sensitive, answered residents’ questions to dispel myths or anxiety and enable them to make informed decisions about their vaccination.

Team of healthcare workers carrying bags at the airport
Deployment of AUSMAT in Tacloban, Philippines, in response to Typhoon Haiyan.(

Provided: AUSMAT

)

Uptake of the immunization program by the community has been excellent, with families grateful for the opportunity to ask questions and to have the immunization safe in their homes.

“The majority of vaccines were delivered to homes, often starting with one or two people, and then the rest of the household would follow,” Ms. Algate said.

At the end of the busy three-day mission, more than 700 vaccines had been administered to the community of Dareton before the AUSMAT team traveled to Balranald.

The team plans to return next month to administer the second doses as part of the massive vaccine rollout effort.

Two people in full ppe standing behind a car
Deployment of the Namatjira community vaccine in Dareton, NSW.(

Provided: AUSMAT

)
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Director of “Margaret’s Museum” opts for medical assistance in dying

Mort Ransen, a Montreal-born filmmaker best known for his Genie Award-winning film Margaret’s Museum, died on Salt Spring Island on September 4.

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Mort Ransen, a Montreal-born filmmaker best known for his Genie Award-winning film Margaret’s Museum, died on Salt Spring Island on September 4.

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The 88-year-old has decided to end his life with medical assistance after a long battle with dementia.

Ransen has directed eight feature films and dozens of documentaries during his 42-year career, including “Ah, The Money, The Money, The Money,” on the battle to stop logging and development on Salt Spring Island . It aired on CBC’s The Nature of Things in 2001.

The longtime Salt Spring Island resident directed and wrote the screenplay for the highly acclaimed Margaret’s Museum, which starred Helena Bonham Carter as Margaret, a woman who suffers from a nervous breakdown after the death of her husband and his brother in a Cape Breton coal mine.

Margaret enters a surreal world to create a museum to honor the memories of all those who have died due to the horrific mining conditions.

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It won the Most Popular Film award when it debuted at the Vancouver Film Festival in 1995 and won two Genie Awards the following year for Best Director and Best Screenplay.

Ransen was the son of Jewish-Ukrainian immigrants and leaves behind four children and four grandchildren.

Her partner, 22, Libby Mason, said Ransen’s last day included a visit with family and close friends to the palliative care room at Lady Minto Hospital, where they enjoyed bagels, lox and cream cheese brought from Montreal.

“He was clear-headed, loving and funny,” Mason said. “And he looked very good in his favorite shirt.”

No funeral is planned, but a number of commemorative events are organized.


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Israel provides medical assistance to Vietnam to fight COVID-19

Israel’s Ambassador to Vietnam Nadav Eshcar on Friday handed over to the Vietnamese Foreign Ministry medical supplies to help Vietnam fight the severe wave of COVID-19 that is spreading in the country.

The equipment, which included ten ventilators for a new field hospital set up in Hanoi to treat COVID patients, was handed over to Vietnam’s deputy foreign minister in a ceremony attended by Israeli ministry officials. of Health.

In the coming days, the Israeli company Poli Film is expected to donate 10,000 medical masks, 20 oxygen bottles and antiviral plastic sheeting to a central hospital in Ho Chi Minh City. In addition, they will also donate covers for ATMs to be placed in central cities of Vietnam.

Vietnam was able to stop the spread of the virus for a few months, but the Delta variant entered the country in May and spread widely as it did in Israel.

The deputy foreign minister thanked Israel for its help and said it reflected the strengthening of friendship between Israel and Vietnam. In response, Eshcar expressed hope that cooperative efforts between Israel, Vietnam and the rest of the world can bring the pandemic to a complete stop.

A package containing medical supplies donated to Vietnam by Israel to help fight COVID-19 (credit: ISRAELI EMBASSY IN HANOI)

Prime Minister Naftali Bennett and Vietnamese Prime Minister Pham Minh Chinh spoke by telephone in July. One of the topics covered in the conversation was the medical assistance provided on Friday.


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