Cascade training in Rwanda: hearing from an ‘NCD Champion’

Dr Charles Nahimana, 31, is Health Co-Ordinator at Nyabiheke Refugee Camp in Rwanda. Dr Charles attended PCI’s ‘cascade training’ last November. and became an ‘NCD Champion’ in the camp. This is part of our UNHCR project – working to roll-out clinical guidelines, build clinical and managerial capacity of medical staff to improve NCD management, monitor patient care and cascade learning to other healthcare workers.

Dr Charles and his clinic nurse Fiston have recently participated in refresher training and we hear how he has found this experience of being an ‘NCD champion’.

People in my district don’t know their status [if they have an NCD], they can be sick and not aware. So many only consult us when they have pain or another serious symptom, and they are diagnosed too late. Then all we can do is to try and reduce their symptoms and stop the damage to their bodies from getting worse.

Neither is there always much knowledge or information about NCDs among health care staff – how to prevent or treat, but also many misunderstandings. Even now I can sometimes hear patients talking to health care staff and telling them typical symptoms, and the staff are not understanding and do not know what they should do.

The PCI training was very professional and I have since had a chance to train others. We were updated with knowledge and skills and to manage patients using the same protocols that will really benefit patients’ health. We used this to train our clinic staff in our staff meetings in the camp clinic and on the job. We have trained 2 doctors, 18 nurses, 3 midwives and 12 volunteer refugee nurses. We have also trained 38 Community Health Workers who cover half of the villages in the camp.

After being trained about the signs and symptoms of NCDs and how to measure blood pressure we did a mass screening in these villages. It was the community health workers who sensitised the population, then they used loudspeakers to call the people for screening. They took the blood pressure and I just interpreted the results. It was really impressive: after just a few hours training they were saying things to the people as if they had attended medical school! We have a Patients’ Association for people with Diabetes now. It meets monthly. They help me a lot. They tell me when someone is too sick to come to clinic so I can find them at home, and they make sure people attend regularly.

In the future we want to go above expectation, but we need more materials for testing people, once we are helped with this we can do more and more. We have so many people who need to be screened and found before symptoms so that we can treat them before they develop complications.

I have pleasure in what I am doing, just having love of the patient and continue to work for their wellbeing. Once people get better they thank you. You feel good when people say you are doing great and you want to do more.’