NCD training in Syria: my own experience

PCI has been supporting optimal use of the WHO’s NCD Emergency Kits by key medical staff working in Syria. We have been providing cascade training and follow-up distance mentoring. Here, one of the participants – Dr Molham Saflo – shares his experiences.

“Since the conflict hit Syria in 2011, the focus has been on the trauma medicine and emergency surgical needs. Of course that was important…..but on the other hand, there were another different type of patients who were dying slowly and silently. Yes I am talking about chronic diseases – often known as non-communicable diseases (NCDs), which were neglected.  And what made that worse was the war and its results including poverty, ignorance and forced displacement.

NCDs constitute the largest proportion of diseases that affect the people where I live. However too many patients are not motivated to follow their treatment plans In addition the medical staff often see NCDs as less important – due to many reasons eg poor health education support, the unstable situation, the limited resources.

The NCD Training of Trainers programme, organized by WHO and provided by PCI, was a candle in that darkness. It has shifted the focus to this important part of people’s wellness. It targets medical staff, mainly doctors and nurses working at primary health care centers. It was a valuable chance to meet PCI skilled trainers who were full of motivation and enthusiasm.

This training covered the core information about the common chronic diseases like cardiovascular diseases, diabetes and chronic pulmonary illnesses, taking in consideration the current situation in Syria. We went through the knowledge of how to make a diagnosis, the treatment needed, and follow up with patients – all based on the last updates of WHO recommendations and protocols. This training covered not only the clinical skills but also the communications ones, like how to be a good listener to patients and gain their trust or how to convince someone to quit smoking or improve a bad diet. These skills are essential to keep patients motivated and complied in such long-term diseases.

Personally, this training has changed my perception to these illnesses. It has refreshed my knowledge and made me more confident to approach NCD patients. The trainers opened the door to many discussions and I was able to share my existing knowledge and experience related to NCDs.

The most important result for me was to be able to use PCI’s resources on chronic disease care to train other medical staff in different areas of northwest Syria. During the last three months I have trained eighty people in four trainings, including doctors and nurses, working mainly in primary health care centres in different areas, especially camps for displaced people. According to the restricted resources in Syria these days, I have focused more on the medication stewardship and how to reduce the laboratory tests related to NCDs.

I believe that the cornerstone of the best management for such chronic illnesses is to focus on the patients themselves: what they know about their diseases? How do they look at medications? What are their concerns or expectations? These questions became familiar for NCDs trainees as the training was about the art of management.

It was an amazing experience. It was amazing when you motivate other medical workers to support vulnerable groups of patients and achieve real progress. I was so passionate and full of confidence as I have fully believed in this training’s positive impacts on the whole community. After each training, I keep in touch with the trainees on a Whatsapp group in order to keep motivation and energy levels and mainly to discuss any challenging cases. Trainees were enthusiastic to get back to clinics and apply what they had learnt.

Now these trainings and others carried out in north Syria have reactivated the basic role of primary health care centres in screening, education and regular follow-up and remarkably reduced the number of referred patients to the specialists, which was important to ease the pressure and improve the distribution of the good-quality medical services across the region. Also they have equipped a large number of medical workers with the needed skills to handle different NCD cases in spite of the poor resources and the tough conditions.

I can see an increasing need to conduct NCDs trainings due to the increase in these diseases. Other health workers in Syria are thirsty for such rich and effective medical training.”