YearEndReport2017

GreetingsfromSumba!2017wasagrowingyearforTheSumbaFoundation.WiththesuccessofthefundraisingeventinSan Francisco fresh in the air and the hiring of new staff in key positions late in 2016,wewereposedtoheadinto2017withafreshfocusonexpandingthemanyprojectsalreadycoveredbythefoundation.Newsupportfromthegovernmentalsoallowedusforbetterpositionswithaccesstomedication and joint collaborations for expanding our training programs for local nurses in thehealthsectorsthroughoutSumba.Belowisarecapoftheworkachievedthroughthecourseof2017alongwithsomehighlightsofparticularexamplesofwhere thedirect interventionofTheSumbaFoundation changes the lives of people within the local communities. We have also taken theopportunity to sharewith you all someof theplans for 2018 andwhat you can expect from thevariousteamsandprojectworkthatwilltakeplaceoverthecomingyear.So,sitback,takeamomenttocollectthosememoriesofyourlastvisittothisspecialislandandthepeopleyouencounteredalongthewayandenjoyreadingupontheworkthathasbeendonewithyoursupport.Oursincerestgratitude,KennyKnickerbockerGeneralManager

Contributionstothisreportprovidedby:CosmosBiaya(SocialandCommunityRelations),RainyOctora(HeadofNutritionProjects),Dr.ClausBogh(DirectorofHealthPrograms)andKennyKnickerbocker(GeneralManager)

CoverphotoandendpagephotocourtesyofJasonChilds(instagram@childsphotos)

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Index:

Waterproject: 4

Nutritionprograms: 5

SchoolLunchProgram: 6

MalnutritionProgram: 7

Healthprograms: 9

SumbaFoundationClinics: 10

MalariaControlProgram: 11

SumbaEyeProgram: 13

SFNursingScholarshipProgram: 14

Mama2Mama: 15

MalariaTrainingCenter: 16

TuberculosisTrainingProgram: 17

GeneralFoundationNews: 18

MissionStatement: 20

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WaterProject SinceSeptemberof2016thewaterprojectteamhasfocused on primarily on renovating projects thatuse either gravity fed systems or electricsubmersiblepumps.Theinitialprogramwassetonrenovating 19 water projects and through thecourse of 2017 that number increase to 21 as twobrand new projects were added into the programfor extending our coverage.Out of the 21projects,13(or62%)arenowfullyoperational,upfromonly15% inSeptemberof2016.These renovationsandnew projects are benefiting 5,536 people spreadacross 8Desas in Lamboya andWanokaka, (Hobawawi, Rua, Prairara,Weihura, Bali Loku,WatuKarere,KabukarudiandLamboyaDete)atthefollowingwaterprojectsites:Galuwatu,Weikabonu,MataWeimarada /Hobawawi II,Hutan Jati, Pateaung Jara, SMAN1Wanokaka, Bali Loku,Alang,Larawatu,Welajung,Werata,LolowoandSodana.Seethecharttotherightforyearrundown.The13waterprojectsinoperationarecomprisedof131waterconstructsbrokendownasfollows:15wells,54profilfiberwatertanksand62faucetstations.Wells:During2017,thewaterprojectteamhassuccessfullycompletedtheconstructionof5wells

(3 new wells – SMA N1 Wanokaka,PraikoikiandWerataand2renovatedold wells – Larawatu andWelajung).The renovationwork for thewells atLarawatu andWelajung created newcontainment structures allowingbettercontroloverkeepingthewaterclean and potable and at the sametime safer for those using the wellandwatersource.Aboveyoucansee

the before and after photos of the well constructs and additional work that went into therenovation.

Profil fiber water tanks and faucetstations: Out of the 54 profil fiberwater tanks,17were constructedorrenovatedoverthecourseoftheyearacrossthe13projects.Theremaining37profil fiberwatertanksthatwerenot renovated did have a need formore extensive work and thereforeroutinemaintenancewascarriedoutas and when necessary throughoutthe year. As for the faucet stations,16new faucet stationswere created

and 2 previous faucet stations were completely renovated and the remaining 44 other faucetstations are still in good enough condition that they do not require any additionalwork beyondroutinemaintenanceandreplacementofsparesasnecessary.

Welajungbeforerenovation Welajungafterrenovation

WatuNgoduWaterTankandFaucetbeforerenovation

WatuNgoduWaterTankandFaucetafterrenovation

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In addition to theworkmentioned above, the teamalong with the local participation from the variousbenefitting communities has laidmore than 15,000meters worth of new piping to connect/reconnectstations to each other and to the main well watersource, installed electricity into two separateprojects, built a newPLNelectrical roomatWerataandcompletely renovated themaingenerator roomattheLarawatuproject.

All of the afore mentioned workwould not be possible withoutCommunity Participation. Thewater project activitiesundertaken in 2017 involves theactive participation of thecommunitieswho are benefittingfromthewaterprojectsoperatingtoday, both on renovated and

newprojects.Theformsofcommunityparticipationare:tobeinvolvedinsocializationmeetingsofcleanwater in the villages, actively assist in excavationof pipelines and installationofpipes andpowerlines,helpingwiththetransportationofbuildingmaterials.Inaddition,thecommunityalsocontributes Batu Gunung (a local rock), rice, coffee and tea during the implementation of theproject.As we look forward to 2018, we have achieved a considerable progress in upgrading and re-establishing ourwater projects over the past 1.5 years throughout our coverage areas, howeverthereisstillmuchtobedone.NutritionProjectsAfteraddressingthemajorconcernsofwaterandhealthcare inourcorecoveragearea,webeganto lookatchildrenspecificallyas theyare the future of the Sumba. In 2008, we started the school lunchprogram providing healthy, nutritious high-protein meals forstudents in twoPrimary Schools, encouraging class attendance, andproviding thenecessarymeans formental growthanddevelopmentand launched our Infant Nutrition Project starting with directintervention for just 6 children who were life-threatening severelymalnourished.StuntedingrowthisamassiveprobleminruralSumbaandwefindasmanyas70%ofschoolchildrenbeingbelowthenormalaverageheightandweightfortheirage.Thisistheresultsofamultitudeofproblemsinthelocaldietandavailabilityoffood.Firstofall,thereisjustnotenoughfoodforallandthestandardlocalmealsarelowincalories, protein and micronutrients. Also, the children in ruralSumbanormallydonot get any formof lunchpackor snackwhenthey go to school and even breakfast can be a random treat. To

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alleviate these major issues, we added the malnutrition program in 2008 and the school lunchprogramin2010andhavesincebeenexpandingtheseprogramstoreachthousandsofchildren.SchoolLunchProgram2017Inearly2017wewereservingschoollunchtwiceaweekatsixdifferentPrimarySchools:Kadoku,Larawatu, Anakaka, Padedewatu, Pantai Rua and Alang School totaling 983 children. The menuconsists of: rice, vegetable, egg or fish and is sometimes interchangedwithmung bean porridgeenforcedwithmilk.Oftenthekidshavetogotoschoolwithoutanybreakfastsoby10-11theyarestarving,whytheschoollunchalsobecomeshugelyimportantfortheircapacitytofocusandlearn.

We do not only feed the kids but in between normal lessons weteachthemaboutnutritionandimportanceofproteinandvitaminsin theirdailydiet. Ifwehaveenough food for theprimary servingwegive theremaining food for thechildren tobringhometo theirsiblings. Another great result of this lunch program is thatattendance is always be 100% on the days we provide food andsometimes the children will even bring their younger brother orsistertoschooltogetapropermeal.

Attheendof2016ourfriendsandsupportersinSanFranciscoheldahugelysuccessfulfundraisingeventthathasmadeispossibleforustomassivelyexpandourcapacitytocooklargenumbersofmealsandcoverevenmoreschools with high quality meals. Our goal was to double ourcapacitywithina6monthsperiod.Inthefirstquarterof2017webuilt abrand-newschool lunchkitchen, expanding from4cookingstationsand1preparationareato16cookingstationsand2preparationareas (one forvegetablesand theother forraw meat and other produce). In addition to building a newkitchen,wepurchasedtwonewvehiclestohelpcopewiththeadditionaltransportoffoodandadded5newkitchenstaff.The school lunch team now consist of 9 staff that purchasing, prepare, cook and transport the

thousands of weeklymeals. By June 2017we could add 6 more schools to ourprogram, so in total we now serve 11primary schoolswith a total ofmore than2,394children.Also,insteadofproviding2mealsperweek,all11schoolsnowreceive3 meals per week, why during 2017 wecould deliver a total of 207,524 healthy

meals to3,632 children!Themeals arealso further improvedand themenu isnow:2dayswithrice,vegetable,fish,eggorchicken,and1daywithmungbeanporridge.Pleaseseedetailsbelowtoillustratehowmanyschoolsandliveswenowsupportandtheincreaseinprogramcoveragefrom2016to2917.

2016 2017 IncreaseNoschools 5 11 120%Nochildren 983 2,394 144%Nomeals/week 2 3 50%Totalmeals/month 8,272 20,752 151%Totalmeals/year 82,720 207,524 151%

Schoollunchincrease2016/2017

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Donorparticipation

We now have a lot of guests from Nihi Sumba Island visiting theSchoolLunchProgramofferingthemtheopportunitytovisitusattheSchoolLunchKitchenandhelpuscook,ortocomeoutandmeetandhelp serve lunch to the children at the schools who are benefittingfromtheSchoolLunchProgram. InMarch2017,wehadsomelovelyguestswhodonated andhelp distribute propershoes for thechildrenatAlang school while wedistributed their lunch.Itisalwaysgreattohave

guests visiting the school lunch project, especiallywhentheybringtheirchildrensotheycanexperiencehow tough life is for Sumbanese children and that amealshouldnotbetakenforgranted.Thegoal forourSchoolLunchProject in2018 is toaddanother5primaryschools to theprojectandwehope to increase thenumberofmealswecanserveperweek.Thankyousomuch forallyoursupportfortheschoollunchandforthekidsin11primaryschoolsinSumba.MalnutritionProjectAfteraddressingthemajorconcernsofwaterandhealthcareinourcorecoveragearea,webeganto address the issue of severely malnourished children in our area. In 2008, we started themalnutritionprogramprovidinghealthy,nutritioushigh-proteinfoodstartingwithjust6childrenwhowerelife-threateningmalnourished.TheprogramhassinceexpandedandbyJanuary2018atotalof1,017childrenhavebeenthroughour6monthsnutritionprogram.

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The local governmentmonitorsall theareasbabiesonceamonthuntilthe age of 5, hence why we work with the local midwifes to collectinformation about any malnourished children. Once we have theinformation,wewilldoublecheckaccording to theWHOgrowthchartsandgovisit thekids at their village to see theirphysical conditionandenrolled them in our program. Wechooseameetingpointineachnewareawhere we provide a weekly meal,measure the children andprovide eggs,powdered milk and vitamins for thecomingweekshomeuse.Everyweekwegive all the children1boxofpowderedmilk and 7 eggs. We also give theminformation about nutrition and basic

informationlikehowtousethepowderedmilkandcookinahygienicmanor.Weenrollchildrenforabout6to11monthsmonitoringtheirweightgainandcheckandassistwithanydiseasesonaonceweeklybasis.Whenthechildrenreachtheapproximateproperweightfortheirage(basedontheWHOinternationalgrowthcharts),werelease themfromtheprogramsonewchildreninneedcanbeenrolled.

In2016,wehelped95childrenfortheyearandin2017wedoubledthenumberofchildrento185.

Their average time in the program was 6.8months in2016and8.1months in2017and theaverage 6 months weight gain was 2.2 Kilos.During 2017 we provided 5,528 meals for thechildren and gave them5,528 boxes ofmilk andprovided38,696eggsoverthefullyear.

VitaminSupplementStarting in August 2017, we received agenerous re-occurring donation of multi-vitamin supplement from Amway calledNutrilite Little Bits, that we now give outalong with the food for the malnourishedchildren. We mix it directly in the mung

PopulationareaNoChildren

Av.Weightbefore

Av.Weightafter

Gain,Kilos

Wightgain

Monthsinpgm

6monthsgain Meals

Milk/box

Eggs/grain

Nalo 25 10.4 13.3 2.9 29.7% 7.0 2.5 675 675 4,725Alang 18 10.6 13.3 2.6 25.3% 6.5 2.4 486 486 3,402Watukarere 21 11.3 13.2 1.9 17.9% 7.5 1.5 651 651 4,557LeteMalaona 31 10.4 13.2 2.7 28.9% 6.0 2.7 744 744 5,208

Total2016 95 2.5 25.5% 6.8 2.3 2,556 2,556 17,892Ringurara 40 10.9 14.8 3.9 38.0% 11.0 2.1 1760 1,760 12,320Palamoko 20 9.7 12.8 3.1 36.2% 10.5 1.8 880 880 6,160Bodowunta 13 9.4 11.9 2.5 28.8% 6.0 2.5 312 312 2,184Ubumaleha 70 10.4 12.2 1.9 19.0% 5 2.3 1400 1,400 9,800Tailelu 42 9.7 7 1176 1,176 8,232

Total2017 185 2.8 30.5% 8.1 2.2 5,528 5,528 38,696

2016 2017 IncreaseChildren 95 185 95%Meals 2,556 5,528 116%

Milk/box 2,556 5,528 116%Eggs/grain 17,892 38,696 116%

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beanporridge and serve it for the kids at ourmeetings and alsoprovide each childwith7 dailysachets(inadditiontoaweek’sworthofpowderedmilk/formulaandeggs)tobringhomeforthecomingweek.ThisNutriliteLittleBits ishighinVitaminAandisreallyhelpingthemalnourishedkids.MalnutritionSpecialCases

Back in October 2016, wereceived information abouttriplets that was going to beborn in our core area.Fortunately, the mother hadgone to one of the SumbaFoundation Clinic to get USGScreening a week before duedate,soournursecoulddetectitandshecouldbereferredforSection at the Government

Hospital in Waikabubak. On 25th October 2016, she gavebirth to 3 babies girls, all of which were well below theaveragenewbornweight(evenforSumbawhereitis2.5kg).Thefirstwas1.4kgandthelastbornonlyweighed1.2 kg.We immediately started support andprovidedmilks for the triplet and themother.

All three babies survived and slowly started to gain weight. Abeautifulstorywherewecantrulysaythatourcombinedeffortsof themama2mama program, our clinics and themalnutritionprogramsavedthelivedofthe3babiesandmostlikelyalsothemother.Westillmonitoringthetripleteveryweek.TheirNameare:Asnia,AstriaandAulia.IthasnowbeenayearsincewehelpdeliverthetripletsandtheyaredoingamazingwithAsniaweighing8.5kg,Astria8.5kgandAulis 8.2kg. We couldn’t be prouder and this has all beenpossible because of The Sumba Foundations many supportersoverthepastyears.

HealthProjectsDuring 2017 our team of 18 nurses,midwives and other healthprofessionals diagnosed and treatedmore than 32,000 patientsthroughourclinicsandmanyoutreachprogramsthroughouttheisland of Sumba. This is the highest number of annual caseswehave helped over the past decade and indirectly we furtherassisted100,000+patientsthroughthemalariadiagnosisdonebyourMTCgraduatesworkingalloverSumba.Moremosquitonetsand eye glasses were distributed and our scholarship programquadrupled over the year. All of thiswasmade possible by ourdedicated staff and themany generousdonations toThe SumbaFoundation. We intend to assist, alleviate and save even morelivesin2018.

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SumbaFoundationClinics.Our Foundation Clinics treated thousands of patients for a large range of infectious and non-infectiousailmentsduring2017.Alldiagnosisandtreatmentisfreeofchargeandanypersonfromanyareacanwalkintoget freequalitycare.OurcoverageareaisthereforemuchlargerthanthecoreMalariainterventionareaofabout20,000people.InparticularmanypeoplefromGauratravelupto20kmtogettoourclinicinLamboya.The total number of patients treated in 2017was 22,189 and again the clinicswith the highestnumberofpatientswereHobawawiandLamboya.Bothclinicshaveverylargecoverageareasandhave patients coming in from areas up and down the coast, in particular Lamboya see manypatients from Gaura. The total number of patients dropped 14% compared to the all-time high(25,797) treated in 2016. Again in 2017 the most common ailments treated were respiratoryinfections, primarily flu and common cold, followed by general fevers, malaria infections andchronicpain(fromheavy,manual farmwork). Illustratedhere is thetotalnumberofcasesof the

maincategoriesseenateachof our 4 clinics. Anotherimportant health serviceprovidedatourclinics is theweeklyeyediseasescreeningand provision of glasses by

ourEyeCareNurses,NefryandSany.SeasonalvariationinpatientnumbersWeusuallyseearathersignificantvariation innumberofcasesovertheyearasseveraldiseasesaremore common during the rainy season (October through February). Illustrated below is theseasonalvariationintotalpatientnumbersatourclinics,withthedrivingforceofvariationcomingfrommalariainfections.

MalariacasestreatedatourClinicsAgain in 2017 the third highest reason for clinic visitswasmalaria diagnosis and treatment.Wehave come a long way over the past decade but malaria does not go away by itself and takesconcertedcontrolefforts.Belowisthenumberofmalariacasesatourclinicsandthereductionswesaw over the past year. The total number of clinicmalaria cases (2,365) dropped by 23% from2016.Themostsignificantdecreasewasat theHobawawiclinicwherewesawa44%drop from1,708 to only 955 cases for the year. Rua clinic also saw a drop from 172 cases to 118 cases,however theLamboya(1,238)andtheRajaka(54)hadmoreor less thesamenumberofmalariacasesyeartoyear.LamboyaseesalotofcasescominginfromtheGauraandthatareahasalotofmalariabeingoutsideourcoreinterventionandmosquitonetdistributionarea.Wehaveeducated

Clinic Hobawawi Lamboya Rajaka Rua 2017Total

TotalPatients

8,472 8,016 3,474 2,227 22,189

Malaria 955 1,238 54 118 2,365

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thegovernmentlaboratorystaffinGauraattheMalariaTrainingCenterbuttheiroverallcapacityisstilllimitedandequipmentisnotcomplete.We are very happy to see this general drop in confirmed malaria cases however the numbers

illustrate the massive needfor proper diagnosis andtreatment, further reductionofcasesinourcoreareasandeven more so the need forfurther expansion of our

controleffortsoutsideofourcoreareasintoneighboringareas. Thisshouldincludeexpansionofnetdistributionwherethegovernmentdoesnotreach, improvementof localtestingfacilitiesandclinicaloutreachtotheneighboringareasinPatialaDete,Gauraareasandbeyond.SeasonalityinmalariacasesMalariatransmissionisstronglytiedtothe annual variation seen in rainfallandmosquitodensityinSumba.Belowisillustratedthetotalnumberofthe3main types of malaria infections seenover the full year. As expected thepatient numbers closely follow therainy season and sees a strongresurgence in October when the firstrainsappear.Laterainyseasonhasfarfewer cases as the breeding sitesbecome full of predators as the rainyseasoncontinuesandnumbersdropofinFebruaryevenwhenrainscontinueinto April. It is important that we have completed mosquito net coverage before the end ofSeptember ahead of the 2018/2019 rainy season, parasites cleared must be from the corepopulations and the stock of drugs ready before transmission increase inOctober 2018.Wewillfurther increase the use of single dose Primaquine in combination with the standard malariatreatment.Primaquinekillsthemalariagametesthatcaninfectthemosquitoesandtherebyfurtherreducetheriskoftransmissioninourcoreareas.Generalmalariacontrolprogram

The Sumba Foundation’s overall Malaria control program hasnowoperatedsince2004andwehavecomealongwaysinceweopenedthefirstSFclinicwith4 juniornursesatHobawawi.Thecore elements of ourMalariaControlProgramare: Freemalariadiagnosis and treatment at our clinics, mass blood screening ofthepopulation in thevillages,provisionof freemosquitonets tofurtherreducereinfectionriskandexpertlevelmalariaeducationofallhealthstaffworkingonmalariainSumba(attheMTC).Withthesecomponents,wehavereducedmalariaby93%inourcoreareaandfacilitatedtheoverallreductionofmalariaonSumbaby70%(detailedinthe2016report).

2017 955 1,238 54 118 2,3652016 1,708 1,172 44 172 3,066Reduction 44.1% -5.6% -22.7% 31.4% 22.9%

TotalMalariacases Hobawawi Lamboya Rajaka Rua

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In2017,weaimedtofurtherreducethenumberofmalariacasesatourclinicsandinthevillages,distributenetsandmoppedupmalariacasesinourcoreareaaroundtheHobawawipeninsulaandinlandatdesaWatukarere,PalamokoandRingurara.Massmalariascreeningsinthevillages

Asdescribedabovewesawa23%reductioninoverallmalariacasesatour clinics with a 44% reduction seen in the center of our core areaaroundHobawawi.Tofurtherreducethenumberofmalariacasesinourcore areawewent back to screen the entire populations living in thecentral desaswithinour area.This is doneby first doing apopulationsurveyinallthevillages,includingnamesandagesofallpeoplelivingineachhousehold.Thisisthenfollowedupwithmassbloodscreeningandtreatment of all people living in the villages and assessing additionalmosquitonetneeds.In2017,wetestedatotalof5,668villagerslivingin102villageswithinourmainarea.Pleaseseedetailsbelow.

Testinga totalof5,668peopleonlyyielded172malariacasesor just3%of thepeoplescreened.That is an excellent result and illustrates how the malaria cases are being weeded out by ourconcertedefforts.Sinceitisalotofworktofindthesefewcasesamongsomanypeopleithighlightsthechallengewe face ineradicatingmalaria.Wewill stillhave togobackandscreen these largepopulations toweed out sources of infection and the relative effort required increaseswith thedrop inrelative infectionrates.Another interestingobservation is thatwehaveseenasignificantchangeinwhatmalariaspecieswefindinsideourinterventionarea.Seethetablebelowcomparingthisyear’sspeciescompositionwiththatfromthe2004surveys.Backin2004malariacasesweredominatedbyP. falciparum(60%)andwithsomeP.vivax(25%),P.malariae(15%)andP.ovale(2%).NowweseenoP.ovale,P.malariaeisreducedby92%andP.vivaxhasmorethandoubledinrelativenumbersto52%andisnotthemostcommonmalariaspeciesinthevillages.Thischange iscausedbyeffectivelykillingofftheP.ovale,P.malariaeandP. falciparumbutP. vivax can hide in the liver for decades andre-emergewithoutmosquitobites,hencewhyit is somuchharder to eradicate. In our nextstage ofmalaria intervention,wewill aim fortotalmalariaeliminationwhywewillhave tointroduceremovaloftheliverstageofP.vivaxwiththedrugPrimaquine.TodothissafelywewillneedtotestallP.vivaxcarriersforG6PDdeficiency(PQisonlysafeifproficient)andthatrequiresaccess toconstant refrigerationatourclinicsandamoresophisticated laboratorysetup.Allverypossibleandsomethingweseriouslyneedtoconsidertogetthejobdone.

Desa Villages Notested P.falciparum P.vivax P.malariae Mixedinf TotalInfHobawawi 25 709 8 16 0 0Palamoko 12 695 15 22 1 0Watukarere 27 2,107 36 39 1 8RinguRara 38 2,157 18 8 0 0TOTAL 102 5,668 77 85 2 8 172Percentage 1.4% 1.5% 0.0% 0.1% 3.0%

Malariatype No 2017 2004 ReductionP.falciparum 77 47% 60% 22%P.vivax 85 52% 25% -107%P.malariae 2 1% 15% 92%P.ovale 0 0% 2% 100%

Malariaspecieschange

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The primary source of infections in our area will soon be inflow of malaria cases from peoplevisitingor coming fromareasoutsideourcore interventionareaand isalsowhy the islandwideincrease in proper malaria diagnosis and treatment provided by the Malaria Training Center isessentialforeradicationsuccess.ToillustratethesizeoftheproblemoutsideourcoreareapleaseseethetablebelowwithresultsfromamalariasurveywedidintheKodiarea50kmupthecoast.

Herewesurveyedtwosmallvillageswithatotalpopulationof96people.Ofthese17hadmalariaonthedayor18%ofthepopulation.Thesedatashowthesimilarhighmalariaprevalencewesawinourcore interventionareaadecadeagoand illustrates themagnitudeof the islandwideneedforproperMalariacontrolandeducation.MosquitoNetDistributionTheGlobalFundassistedtheIndonesiangovernmentwithaverylargenumberofmosquitonetsforSumbabackin2014andpromisedtoassistagainin2017,howeverthelatestmassdistributionhasbeendelayedandwepurchased3,000newnets(Brand:Permanet3)inDecember2017tocoverthe

population in our coverage areas in general andany other shortcomings in the governmentprograms.Through2017,wedistributedatotalof1,005 nets in the Hobawawi, Ringurara andNihiwatu area. These distributions were done inconnection with the mass blood screenings to

ensuretheriskofre-infectionwasaslimitedaspossibleandthatthenewnetswerewellreceivedinthevillages.Our plan in 2018 is to distribute all 3,000 newly acquired mosquito nets (and maybe more)dependingongovernmentdistributionplansandhowmanynetsareneededtofillthegapssotheentirepopulationisprotectedbeforethe2018/19rainyseason.SumbaEyeProgramThis year was another great year for the SumbaEye Program and the Eye Care Nurses who arededicatedtoalleviatingthepeopleofSumbafromtheir eye diseases and refraction needs.Throughout 2017 we screened 2,561 patients,dispensed 2,262 pairs of eye glasses andperformed126eyeoperations(seedetailsbelow).TheEyeprogramhasbeenhugely successful and2018willbethe10thyearweconductandexpandour collaboration with Dr. Mark Ellis, PeterSteward,PeterLewisandtherestoftheteamfromTheRoyalAustralAsianCollegeofSurgeonsinAustraliaandUNHASinMakassar.TheAustralianandIndonesianmedicalteamsnowcometwiceayearforaweekeachtrip,onceinMaytosurveyandscreenpatientsandagaininAugusttoperformfurthermasseyescreeningsandeyeoperations.TheSumbaFoundationEyeCareNurses,SanyandNefry, provide patient follow up after the surgery sessions and perform eye screenings andprescriptionglassesdistributionatourclinicsandinourcorecoverageareathroughouttheyear.

Desa Villages Notested P.falciparum P.vivax P.malariae Mixedinf TotalInfKodi 1 96 11 6 0 0 17Percentage 11.5% 6.3% 0.0% 0.0% 17.7%

Hobawawi 473Ringurara 432Nihiarea 100Totalnets 1,005

SFMosquitonetdistributiuon2017

SumbaEyeProgram Screened Glasses Cataract PterigyumHobawawiClinic 201 171 18 11LamboyaClinic 119 105 18 7RajakaClinic 133 114 18 5RuaClinic 69 60 5 4Villages 119 108 24 7ECNtotal 641 558 83 34

Mayscreening 817 693 64 10AugustScr/ops 1,103 1,011 96 30

TOTALSCR/Ops 2,561 2,262 96 30

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MayscreeningThisyear’sprimaryscreeningsession tookplace inMayandincluded four optometrists and one ophthalmologist (Dr.Ellis) along with SF Eye Care Nurses Sany and Nefry.Educationoftheeyecarenursesandpatientscreeningstookplaceat2SFclinicsandatseveralvillagesintheElopadaandinCentralSumba.Wescreenedatotalof817patientsforeyediseases.Ofthese,74werereferredforCataractorPterigyumsurgery inAugust and693 eye glassesweredispensed.Thiswasagreatfollowupfromatwo-weektrainingprogramthatNefryandSanydidinMarchof2017inSydney,Australiawheretheyspenttheirtimeattachedtothe Sumba Eye ProgramDoctors and learnedmore in-depth knowledge about eye care and eyedisease.Moreabouttheirstudiesinthefollowingsections.AugustscreeningandSurgeryThisyear’sAugusteyeoperationswereconductedat thegovernmenthospitalinAnakalang,CentralSumbaaswehavenowbeenoperating8years inWest Sumba district. The main reason was that the patientoperationneedsweremuchlargerintheareathereandthisoutreach

illustrates how the Sumba Foundationis here to help all of Sumba. The teamconsisted of 3 Australian surgeons, 5Indonesian surgeons, and 4 nurses aswell and 4 optometrist and variousgovernment health staff, translators and drivers assisting. Thescreeningandsurgery sessionswerevery successful anda totalof1,103 patientswere screened, 1,011 received eye glasses and 126

patientswereoperatedovera5-dayperiod.Eyecarenurseeducationandclinicalwork:InMarch2017,wesent Sany and Nefry to Australia for a 10 days eye educationprogram.Thiswasahugesuccessandthegirlsobviouslylearneda lotandenjoyed the trip.Over theyear thenursesconducteyescreenings and provide eye glasses at our 4 clinics and conductvillage level surveys in our area, and in 2017 screened 641patients,provided558eyeglassesandidentified117patientsforeyeoperations.SFNursingScholarshipProgramOne of our core strategies to improve the lives of people inSumba is the many ways we seek to improve the generaleducationlevel.Ourscholarshipprogramisaprimeexampleofhow we seek to give opportunity to bright young Sumbanesefrom impoverished and poor families. To enroll in ourscholarship program, the students must have graduated fromhighschoolgettingtheirdegreeandpassedtheentryexamforahealth education in addition to coming from a proven poorfamily. Based on individual and institutional donations,we invite underprivileged students fromimpoverishedfamiliesforaninterviewandweselectthebrightestandthosemostinneed.Wealsoassistfurthereducationofourcorehealthprogramstafftoimproveskilllevelsandretainourbest

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staff. In 2017, two institutional donations made it possible for us to significantly expand ourscholarshipprogram. In thebeginningof theyearwehad just threestudentsenrolledandbytheendof theyearwehadenrolleda totalof16 studentsatvarioushealtheducation institutions inJava,Sumba,BaliandWestTimor.FourofthestudentswereFoundationstaffwhoneededaoneyearNursingextensiontoreceivetheirbachelordegrees.AgustinaMbilyora finished her 3-year nursingdegree in Bali back inMarch 2017 and isnow back at the MTC training students.Hapu, Marta and Anita will all wrap uptheirdegrees in the firsthalf of2018andreturn to the SF Health Project Teamfurtherincreasingthequalityofourhealthcareservices.In2017,weenrolled11newnursing students for the East and WestSumba Akber nursing schools and onemidwifebasedinKupang,WestTimor.Notonlywillthesenursesgetaneducationforlife,eachofthemwillprovidehealthcareforthousandsofpatientsinSumbathroughouttheircareers.Mama2MamaOurMama2mamaprogram focusesonpreventive care inpregnancy for the ruralpopulationofWest Sumba. The local government has localmidwives employed in our area but their tools arelimitedandwhyourprogramaims toadd lifesavingservicesat clinicandvillage levels.Wehavetwoportableultrasoundunitsandweusethemtoidentifypotentialissuesinthepregnanciesandofcausetoreassuretheexpectingmotherswheneverythinglooksfine.InJuneof2017,wesent3stafftoreceivefurthermid-wifetrainingatBumiSehatinUbud,Bali,theregionspremieremid-wifeeducational center. There they took aweek-long course to retrain and further their education inUSGscanning,prenatalcareanddelivery.

By theendof2017wescreeneda totalof226expectingmothersandforamajorityofthemotherstherewerenoissues,howeverinone of our general screenings at the Lamboya clinic, nurse Atiidentified awoman from a remote village inGaurawith PlacentaPrevia. This is a potentially life-threatening condition for bothmother and child where the placenta blocks the cervix, severelycomplicating normal delivery.With this information,we referredthe woman for caesarian delivery at the district hospital inWaikabubak. This saved thewoman’s life but sadly the baby hadothercomplicationsandherlifecouldnotbesaved.Thisisthefirstcase where we, with confidence, can say the equipment saved aperson’slife.In2018theprogramwillexpandtoworkmorecloselywiththelocalmidwivesandinremotevillages.

No Studentname Degree University/School Duration EnrolledExpfinish Sponsor

1 AgustinaMbilyora Bachelor+Nurse Udayana,Bali 3years Mar-14 Mar-17 SFdonor2 HapuAmmah Bachelor+Nurse Udayana,Bali 3years May-15 May-18 SFdonor3 MartaHoro Nurseextention Stikes,Semarang 1year Jun-17 Jun-18 SFdonor4 AnitaDianaOle Nurseextention Stikes,Surakarta 1year Mar-17 Mar-18 SFdonor5 MariannaPandi AkberNurse Akber,Waikabubak 3years Aug-16 Aug-19 SFdonor6 RambuAnamotor AkberNurse Akber,Waingapu 3years Aug-17 Aug-20 Genesis7 ErdinanBayo AkberNurse Akber,Waingapu 3years Aug-17 Aug-20 Genesis8 RicardRuben AkberNurse Akber,Waingapu 3years Aug-17 Aug-20 Genesis9 MarianaLede Midwife Poltekkes,Kupang 3years Aug-17 Aug-20 Adecco10 RaniBetsiLado AkberNurse Akber,Waikabubak 3years Aug-17 Aug-20 Adecco11 AnggreiniBili AkberNurse Akber,Waikabubak 3years Aug-17 Aug-20 Adecco12 NoviaB.DWawu AkberNurse Akber,Waikabubak 3years Aug-17 Aug-20 Adecco13 StefanusC.W.wunga AkberNurse Akber,Waikabubak 3years Aug-17 Aug-20 Adecco14 ArdiantiMargaretaSam AkberNurse Akber,Waikabubak 3years Aug-17 Aug-20 Adecco15 RiniDeboraLado AkberNurse Akber,Waikabubak 3years Aug-17 Aug-20 Adecco16 AniMaryani AkberNurse Akber,Waikabubak 4years Aug-17 Aug-20 Adecco17 DewiRambuB.Uka AkberNurse Akber,Waikabubak 3years Aug-17 Aug-20 Adecco

SumbaFoundationScholarshipProgram2017/2018

2017 Hobawawi Lamboya Rua Rajaka Nihiwatu Villages TotalUltrasoundscreenings 103 73 7 20 6 17 226

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MalariaTrainingCenterIn2017,wehadatotalof119studentsin8groupsofstudentsgraduate from the MTC courses, 6 groups certified from theWHO Malaria Program and one group from our jointgovernment Filariasis program (another mosquito bornedisease).We also conducted amalaria training course inEastSumbaatthegovernmentNursingschoolthere.77nursesandteachersparticipatedand40passed the finalexam inMalariaintroduction.ThetotalnumberofWHOMalariagraduateswas60 students.Of these 15passed asWHOExperts, 45 asWHOReference microscopists, plus 16 graduated from the

LymphaticFilariasismicroscopyprogram.Belowlistedarethegroupsofstudentsfromthisyear’scourses.

TraininginLymphaticFilariasis(elephantitis)DiagnosisandControlTheMTCconducteda join trainingsessionwith theprovinceHealth Laboratory and the Central SumbaHealth office. Thistraining was focused on the debilitating disease LymphaticFilariasis or Elephantitis that create grotesque limbs, if nottreated.ThisdiseaseisspreadbymosquitoesinsomeareasinSumbaandupto10%ofthepopulationsareinfectedinsomehotspots.Fortunately,thediseaseisveryhardtotransmitandan effective island vide intervention program has been inplace for the past year. Still, we need to have the diagnosticskillspresentatallthehealthcentersandiswhythistrainingin night time blood sampling and parasite identification isessential.Thediagnosisismadebymicroscopyofbloodtakenfrompatientsafter9pmwhenthemicrofilariaappearsinthebloodstreamofinfectedindividuals.NationalAccreditationProgressin2017InDecember2016,wesignedaMemorandumofUnderstandingwith theProvincialHealthOfficethat includes full government recognition of theWHO level malaria training and certificate andrecognition of the 4-week training program allowing graduates to get full education credits andrank/salary increase within the Government system. During 2017 we arranged a number ofmeetingswiththevariousProvincialHealthOfficesinKupangtoaccommodatetheNationalMalaria

District TOPIC Expert Reference InTraining TotalFebruary WestSumba Malaria 1 5 0 6March CentralSumba Malaria 5 4 1 10May EastSumba Malaria 3 8 1 12June SouthWestSumbaMalaria 1 8 1 10August EastSumba Malaria 1 9 0 10Nov EastSumba Malaria 4 11 0 15

2017 Total Malaria 15 45 3 63

May CentralSumba Filariasis 0 16 0 16

Dec EastSumba IntroMal 0 40 0 40

2017 TotalGraduates 15 101 3 119

MTCGraduates2017

FilariasisstudentsfromCentralSumbaattheMTC

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Curriculum with our 4 weeks program. Both our and the Nationalprograms are based on theWHO guidelines but the national course isonly 2 weeks and much more focused on theory/admin and has nofieldworkor treatmentcomponents to them.Wehavenowincludedallcomponentsfromthenationalguidelines(easy)andtheProvinceHealthDirector is now co-signing our malaria graduation certificates for fullrecognition. In2018,wewillpush toget the fullnationalaccreditationfromtheIndonesianMinistryofHealthandplantohave2-4ofourstaffparticipate in the national andWHOTrainer of Trainer course later in2018.

TheaimistobecometheCenterofExcellenceformalariacontrolandqualityassuranceforEasternIndonesiaandeducate500to800moremalariastaffoverthecoming3years.Thesegraduateswillgoback to their clinicsandhospitals inSumbaandNTTandwilldiagnose inexcessof200,000+malariapatientsperyearhammeringtheoverallmalariaoccurrence.Thiseducationprogramhasthe widest impact on the overall health on Sumba of any of our programs. The SF MicroscopyTrainingCenterisuniqueinIndonesiaandwehaveacapacityandqualitytoeducatelikenootherandthisneedstobenefitasmanyaspossible.WorkshoponthedevelopmentsoftheTuberculosistrainingprogramfortheMTC

Sumba, and our coverage area, has a highoccurrence of Tuberculosis in all age groupsand positive cases are on the rise because oftheadvanceofHIVandmultidrugresistantTBontheisland.DuetothesuccessoftheMalariaTrainingProgramtheProvinceHealthDirectorasked ifwe could develop a comparableWHOleveltrainingprogramforTuberculosisControland this is now included in ourMOUwith theProvince. In 2017, we have worked with theProvinceHealthOfficeandateamofAustralian

medical Doctors and universities to develop a WHO level Tuberculosis training programcomparabletoourMalariaProgram.Wedevelopedtheprogramcomponentssuchas:PowerPointpresentations,TBmicroscopeslidesandothertrainingtoolsneededforthetrainingprogram.Alotofmanhourshavegone intodevelopingmanuals,slidesandsevendifferentpresentationsontheepidemiology,diseasepatterns,diagnosis,preventionand treatment of Tuberculosis. The preparationsculminated in aworkshop in June 2017where all oftheAustralianteammemberscametoSumbaandwefield tested the program, presentations and madeplans for further development of this much-neededtraining program.We visited government clinics andsawhowurgently theprogram isneededandgainedessential knowledge on how to fine tune the variousprogram components and planning of fieldcomponents.Stillwehavealotofworkaheadandarecurrently developing the high-quality TB microscope slides jointly with the Karitas hospital,provinceHealthofficeandtheFreeportMineHealthPrograminWestPapua.

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GeneralFoundationNewsThisyearouronlinepresenceshowedexcellentgrowthparticularlywithourInstagramaccountingwhich nearly doubled in followers from 1,276 followers in 2016 to 2,507.We continued to seegrowthonourFacebookpageaswellbutinamuchmorelimitedcapacity,growingfrom2,085to2,291followers.ThistrendisnotsurprisingtoseeasmorepeopleareshiftingawayfromFacebookforexpandingbrandawarenessandlookingmoretowardsthesimplicityofphotoandvideowithlimitedtext.Onaverage,wedid13toursconsistingof40overpeoplepermonth,takingprimarilyguestsfromNihiSumbaIslandouttoseeourprojectworksspecificallytoseetheHealthClinicworkandSchoolLunchProgram,pointingoutwaterprojectsandstationssetupbythefoundationalongtheyway,while sharing more information about the other projects and plans to continue to expand ourworksinthearea.FutureProjects2018Our main focus as we look forward to 2018 is to establish further our focus on education. OnNovember 2nd 2017, we held our first ever fundraiser in Asia that took place in Hong Kong,organizedbyguestsofNihi Sumba Island, JulieKooandFrankLonergan.Theeventwas amajorsuccess for a first-time event in a location where awareness about Sumba and The SumbaFoundation is very limited. Through their connections and networking, we were able to raisearound$150,000overthecourseofanhoursilentauctionandfund-a-needliveauction.Thefundingraisedfromtheevent that evening was specifically geared towards thebuilding of a Learning Development Center in the spaceadjacenttoourHealthClinicatHobawawi,withaninitialfocus on teaching daily English language skills andComputerSkillsallintheaimofgivingtheyouthofSumbatheskillstheywillneedastheislandcontinuestodevelopandmore jobsthatrequire theseskillsbecomeavailable,giving them a competitive edge over businesses hiringstafffromoutsidetheisland.To kick start this project, twoweeksafter returning from Hong Kong, webegan to sponsor a local teacher bythenameofRosewitaAstyKulawhowasalreadyteachingchildrenduringher free time in the afternoonwhenschool let out basic English lessons.Throughher,wearenowsponsoringjust shy of 1,000 children from 4years old to 18 years old with alldifferent levels of English languagelessons and have hired Rose Asty aspart time while she finishes her government teaching contract to be our Head and Trainer ofTeachersaswemovetowardstheopeningofourmainLearningCenterestimatedtoopeninmid-July2018. In the interim, tobetterassisting thechildrenRoseAsty isalreadyteachingatKereweBeach(seenoppositefromNihiwatuBeach)wewillbuildthefirstsatellitelearninghutwhichwillwork intandemwiththemainLearningCenterandexpandourreachforeducationdevelopmentevenfurther.

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In2018,wewillalsobefocusingonre-engaging local farmers,bothnewandprevious, toexpandourlocalfarmingprojectsandbringthembackintoacenterpointofeconomicopportunityforlocalfarmersinthearea.ThefarmingprojectswillbedirectlyrelatedtotheNutritionProjectthistimethrough and the farmers will be educated in year-round farming techniques in growing thevegetables we require to supplement the food being cooked by the School Lunch Team, furtherdecreasingtherelianceonoutsidesourcesandvendorswhoprimarilygettheirproducefromotherislandssuchasBima.Wehaveseengreatsuccess in2017andwhileourexpectationsfor2018areevenhigher,weareconfidentthatwiththecontinuedsupportfromourdonors,contributors,supportersandleastofallourgrowingSumbaFoundationTeam,thatwewillbeabletotaketheSumbaFoundationProjectsfurtherandprovideabetterqualityoflifeandeducationforthefutureofSumbathaneverbefore.OnbehalfoftheSumbanese,SumbaFoundationStaff,BoardofDirectors,andallthoseinvolved

behindthescenes,thankyouallforyourcontinuedsupport!

TheSumbaFoundationwww.sumbafoundation.org

OurMission TheSumbaFoundationisdeeplycommittedtolesseningtheconsequencesofpovertyontheislandofSumba.Ouraimistoprovidehumanitarianaidbyfosteringvillage-basedprojectsthatimpacthealth(includingaccessandmalariacontrol),education,water,andincome-generation,while

preservingandrespectingthefragilecultureandtraditionsoftheSumbanesepeople.

AlargepartofthefinancialsupportforthefoundationcomesfromguestsoftheNihiSumbaIsland.Withtheirinvolvement,wecancreatesmallmiracleseveryday.