Managing chronic diseases after an emergency: piloting WHO Kits in the Caribbean

We’ve recently been supporting primary healthcare workers to pilot the use of WHO’s NCD emergency kits in the Caribbean. Working with PAHO and the Ministry of Health we trained front line healthcare providers in St Vincent and the Grenadines on addressing the needs of people living with chronic conditions in the aftermath of the La Soufriere volcano eruption.

It had already been identified that at least 30% of the deaths after 2017 hurricanes in the region (Irma and Maria) were due to poorly managed non-communicable diseases (NCDs) such as hypertension, diabetes, and heart disease. The high burden of NCDs in the Caribbean combined with the increased risk for severe climate-induced weather events there makes this region particularly prone to NCD-related deaths.

WHO’s NCD emergency kits were developed with this purpose in mind. Since the launch of the kits in 2017 they have been used successfully in the Eastern Mediterranean and South-East Asia regions – and PAHO is now working to deploy these kits in the Caribbean, as part of the response to natural disasters there.  Part of this process will involve training health providers on the use of the Kits.

PCI has been supporting healthworkers in the use of the WHO NCD emergency Kit since its beginning. We’re worked with primary healthcare providers in Syria, Libya, Afghanistan and Somalia to support healthcare workers in the management of NCDs.  We also participated in the WHO’s regional expert consultative meeting earlier this year to review the NCD kit deployment in the Eastern Mediterranean region – sharing our lessons learned – for example that understanding the local context is key, and that the success of any training depends on leadership, aligning expectations and joint planning.

Building on this experience, as well as lessons learned from the development of our online training for our new PCI Academy, PCI ran a series of live webinars for key clinical staff in St Vincent over the summer this year.

 

Those participating were a mix of district medical officers, family nurse practitioners and pharmacists. The focus was on the key NCDs as well as mental health and epilepsy. There was also an element of ‘training of Trainers’ included – to support the healthworkers to cascade the learning to their colleagues. After the training a WhatsApp group was set up with the participants so that additional questions and clinical situations could be discussed an participants experiences shared. The healthcare workers identified changes they would make as a result of the training.

“I will be more aware of displaced patients’ mental health status along with their physical health – use more holistic care to address issues. I will also use the opportunity to get the patient involved in their treatment more actively, so they get a better understanding of their health situation.”

Refresher training will be taking place soon with healthworkers from the primary care clinics and pharmacy. This will include a focus on the use of medicines in previous modules, using a trouble-shooting/case-based approach.

This pilot is part of a broader study to test and assess the feasibility, acceptability, and preliminary effectiveness of the WHO NCD Kits for post-disaster care of people living with NCDs in the Caribbean. This study was initially funded by the Yale Institute for Global Health and led by a collaboration between the Eastern Caribbean Health Outcomes Research Network, the Yale Center for Climate Change and Health, the Pan American Health Organization, the Office of Eastern Caribbean States, and the Healthy Caribbean Coalition.  Dr. Saria Hassan, previously at Yale, and now at the Emory School of Medicine/Rollins School of Public Health has been leading this collaboration. Discussions are now ongoing as to the next steps for this study and evaluation.

“The training provided by PCI has provided the frontline healthcare workers with the knowledge and skills they need to help people manage their chronic conditions when the usual healthcare systems are disrupted – and stop an emergency situation having an even worse impact on their lives.” (Dr Saria Hassan, Saria Hassan, MD. Assistant Professor, Emory School of Medicine/Rollins School of Public Health.)

 

Volcano photo: credit PAHO