Congratulations to Edilu Robert, a clinician from Arua, Uganda. Robert is the first of our NCD champions to obtain the certificate as part of our multi-country project with UNHCR. He tells of his experience of working in a refugee setting, and the importance of a team healthcare approach.
“It’s a year now since I became an NCD champion, a title which didn’t come out of the blue, but from the commitment that I personally made after the 5-day interactive training on Non-communicable Disease (NCD) care in a refugee setting.
At the end of the training I was full of enthusiasm, eager to put my last drop of sweat into improving NCD care at the facility where I was a clinician and also the facility in charge.
I would love to take a moment and share with you the successes and challenges of implementing this training course that I personally fell in love with.
Working together as healthcare workers: a team approach
Equipped with all the diverse knowledge and experiences of managing NCD patients obtained from interactions with PCI trainers, myself and other colleagues – now all registered as NCD champions – were sent out into the world to preach the gospel of NCDs. To mentor, treat, establish functional systems and above all monitor and evaluate the implementation of NCD care at the various refugee settlements where we worked.
One of the key items in our workplan was to train all the health care professionals on management of NCDs: the clinicians, nurses and the village health teams (community health workers).
At the health post where I worked, we successfully trained on all the NCD topics. The clinical role plays like using an inhaler and diabetic foot exam were the ones best enjoyed by my team. I was personally impressed when the staff then had an open discussion on how far the facility was doing in terms of NCD care, the challenges and what more could be done.
We also had good experience working with the village health teams within the settlement; this group of community health workers was more eager to learn than anyone I have met before. The ultimate goal was to see how we could work hand in hand with them as a team to improve community management of NCDs. Mostly helping with home follow up of patients and establish a functional call and recall system. Also better using a community based approach to detect NCD cases as early as possible.
“I feel I have left a consolidated team that is inspired to care for NCD patients.”
A patient centered focus
What is really important to me is seeing the benefit of the training on my patients in the settlement. It is about quality and not numbers.
Key things we focused on were ensuring each patient was correctly diagnosed, managed appropriately, monitored for complications routinely followed up to evaluate for their progress and proper documentation. After achieving quality at facility level we then moved address community level management of NCDs where we rolled out programs like active case finding and community dialogues on NCDs, while involving the important community structures like the refugee leadership and community health workers.
Challenges specific to a refugee setting
NCDs are truly a big deal in this setting; the inclusiveness of everyone in prevention programs is key to realising the global targets to mitigating this.
Dietary modification is always difficult to discuss with patients, given they are dependent often on food rations. Though we were out of the emergency phase with expected improved community welfare and some people being able to carry out agriculture; this was not the case where I worked, given the landscape of the settlement and the fact that most of the patients were quite elderly. It’s not always possible to get adjustments in food rations for diabetic patients – this needs multi-sectorial collaboration with other partners.
We were fortunate to have had no major stock out of essential medicines for NCD care. However occasional stock outs of some supplies, especially diagnostics like RBS strips, always affected patient management.
It is hard to ensure a functional health system of care at all levels, with no gaps, in such a setting. We had a few challenges at higher levels of care. It is difficult to refer a patient for further management and they are sent back without getting adequate help; this causes them to refuse any future attempts for referral. Again this stresses the importance of a team approach to healthcare.
Given the limited space we have in the settlement it can also be challenging to keep good patient records. It would be good to think of developing an online database to save space.
Cheers to all the NCD champions of Arua field
We started by doing what was necessary, then the possible and we are optimistic that we shall continue to realize that we are doing the impossible; I would love to congratulate all the entire medical teams that have participated in ensuring that we end the global burden of NCDs from top management to the entire field level; to all the clinicians and nurses and village health teams. In our setting, clinical diagnosis is an art, and the mystery of an art has no end, you can always be a better diagnostician.
“We are delighted that Robert has become the first person to obtain the UNHCR/PCI certificate: ‘Caring for Refugees with NCDs’. Following his participation at on our face to face trainings he was required to cascade his learning to colleagues and complete further online clinical training. Congratulations Robert, we hope you continue to share your learning and passion to inspire others.” (Ros Kirkland, PCI’s Head of Programmes)