I am back in Uganda to see how our NCD pilot project with our partner LifeNet, supported by Letshego, is progressing. In particular I am looking forward to learning how the health centres are getting on implementing new systems and caring for the newly enrolled NCD patients. We have come to Mbirizi, a small health centre 3 hours west of Kampala, not far from the shores of Lake Victoria.
Firstly, we meet a group of patients who are enrolled at the health centre. Pauline, the NCD-in-charge, and Tracey, the clinic officer have been trained, as part of the project, in NCD management and have since set up improved NCD systems at the health centre. They had asked some newly diagnosed diabetic and hypertensive patients to come and talk to with them. Tracey explains about the risks of heart attack and stroke and that medication helps prevent these.
Rose is one of the patients at the clinic this morning.
“I am diabetic, and I also have hypertension” she tells us.
Rose tells us that after she was diagnosed Tracey called her on her mobile and persuaded her to come back to the clinic for treatment.
“I used to be so afraid I would have a stroke,”, she said,” but now I take my medication every day and I am not afraid anymore.”
She says she will be safe if she keeps taking her medicine and even though she has to pay for her treatment she is determined to keep doing so. All the patients know that they have a chronic condition and even without symptoms they need to take their medication every day. I am surprised at their acceptance and dedication to this added burden in their lives.
Tracey and Pauline use the time with the group to help them understand what having hypertension and or diabetes means and the best way to manage their health. The questions are mostly about diet and the patients want to know what they can eat. In Uganda the cheapest and most abundant foods are carbohydrate heavy and main dishes are piled high with potato, rice and matooke (steamed and mashed green banana).
All of them say that the hardest thing is the cost. Most are subsistence farmers and finding extra money to pay for medication for a disease, or transport to the clinic, that is currently not causing them any problems is hard. Francis is the only man. He says paying is even harder for the elderly who have to continue to farm as much as they can.
We then take some time with the health centre staff looking at the clinic records. The clinics are having some difficulty with managing individual records and we try together to find some solutions.
HIV is the only chronic treatment they currently manage, and this is a well-established programme with standard Ministry of Health records. All HIV care is free for patients and the health centres have good funding and support from donors. NCD treatment has none of these advantages and is a new concept requiring extra time and effort for health care staff to manage. Even with the extra work they are keen to make the programme work and by the end of the visit we have worked out a system of record keeping that will be much more streamlined and similar to the one they already manage for HIV. LifeNet will work with the three pilot health centres to help them implement this.
By January 2019, LifeNet will expand the project to include 10 additional health facilities. Importantly as they expand they will be able to integrate the learning from this pilot project with PCI and Letshego.
A recent study has shown how important it is to increase awareness of NCDs in communities in lower- and middle-income countries, and to provide psychosocial support as well as treatment in order to help patients understand and manage their diseases.
We are pleased to see that the primary care health centres we are working with to develop a whole system of NCD care are able to provide the framework for that community-based patient support. They will continue to work with patients like Rose and Francis to better understand and manage their diseases to prevent and delay onset of life changing complications such as stroke and heart attack.