Training the Trainer in Western Tanzania’s Refugee Settings

As our new programme of work with the UNHCR gathers pace, a PCI team travelled to Tanzania in February to roll-out the “Caring for Refugees with Non-Communicable Diseases” project to operations in Western Tanzania. 

From the shores of Lake Tanganika in Kigoma in the far west of Tanzania, we made our way North, winding along rich red dirt roads through spectacular green hills looking towards Burundi and beyond.  It is difficult to imagine the route that many have travelled in order to reach the relative safety of the three camps that lie on this border, or to understand their journey that in many cases started as long ago as 1997. 

Nyaragusu, Mtendeli and Nduta camps house approximately 315,150 people, of predominantly Congoloese and Burundian origin.  New arrivals are still increasing this number daily although the majority of people here are living in well-established communities. Most houses have mud walls and straw or iron roofing, maize is growing in the neighbouring small plots and there is a bustling weekly market. 

We met committed healthcare staff who travel long distances to work in this remote area, away from their families and under difficult living conditions, facing similar challenges to government health facilities in the surrounding area.  We were inspired by their welcoming approach and enthusiasm to improve NCD care from the roots of the community to the clinic level.   For example, in Nyarugusu camp, Mama Helen, a nurse matron who is a diabetic herself, leads a team of community health volunteers on a fleet of bicycles, most of whom started in this camp as refugees themselves and who visit patients in their homes to perform vital health education.   She shaped our understanding of how NCD care could be de-centralised in the camps and how screening and referral for new cases of diabetes and hypertension could be implemented.   An assistant medical officer, having just completed a caesarean section, made time to discuss the issues surrounding drug supply in the pharmacy, and laboratory staff talked us through the challenges of procuring essential equipment.

During the five days of NCD training we were 26 clinicians in total, the majority Clinical Officers and several Medical Doctors.  We covered a large amount of material and all shared challenges and stories from our own practice. Small group teaching, role play, examination skills, a quiz and an eagerly fought competition all featured during the week.  We laughed together as participants made up energisers (including a Mexican wave) and took turns in a debate to act out and explore how difficult it can be to convince a patient to give up smoking. We took time to make spacers from water bottles and discussed their use against evidence based guidelines to improve the management of asthma as just one example. 

As a group we established daily learning points that could be taken back into the camp clinics, and concentrated on formulating realistic action plans to be achieved over a timeline with support by UNHCR and its health partners, the Tanzanian Red Cross, the International Rescue Committee and Médécins Sans Frontières.  The participants selected as ‘NCD Champions’ for the project were enthusiastic about sharing their learning and cascading the training in their camp settings. They also helped modify our monitoring and evaluation plans for the coming months. 

With a Whatsapp group set up to stay in touch, we have been encouraged to hear action plans already translating from paper to practice. We’ll also be working more formally with the UNHCR Public Health Officer and the NCD Champions in the coming months to support implementation, monitoring and evaluation. And we are already looking forward to returning later in the year to continue supporting the Tanzania team as the project develops.