John* is a doctor in a refugee camp in Tanzania and sees first-hand how non-communicable diseases (NCDs) have affected the lives of people living in the camp. Having recently become an ‘NCD champion’ as part of our project with UNHCR, he shares his experience and the initial results of this.
“NCDs have a big impact on people’s quality of life in the camp: limiting the capacity for everyday life of work and socialising. They can lead to an increase in depression; reduced self-esteem and absence from schools for children. I see how the hospital becomes a daily part of life at a point when playing with other kids was supposed to be the main activity. This is true in particular for diabetic type I patients – most of whom are children – if they have to always get their injections from the hospital.
There is often not enough knowledge in the camp around prevention of NCDs or about adherence to treatment. A number of myths and traditional beliefs still revolve around some of the NCDs such as epilepsy being linked to bad spirits.
The training from PCI updated my level of knowledge on NCDs. The training also built our knowledge of broader programmatic management and systems.
For example there was a focus on the importance of medical records – patient files – and on the need to ensure a systematic way of approaching NCDs comprehensively in daily consultations , for example what should be done at every consultation of a diabetic patient. This should lead to improved care, such as early detection of complications.
The training allowed for an active participation of the participants, with group discussions, debates and role plays through which we were able to share the different things we do in our camps.
I learned a lot from colleagues in other camps and recognised their challenges and they learned from me too I hope.
All training participants formulated action plans to implement in their respective camps to improve services when they go back. We developed an evaluation tool which included criteria to measure in order to determine the quality of care.
There was also a real focus on building skills for participants to themselves take up a trainer role (training of trainers) – to become NCD ‘champions’. And so, since the original training, I have trained colleagues and provided continuous support to teams, including some from neighbouring camps.
Some changes still need to happen to better address NCDs in the camps. For example, further improve medical records and patient tracking systems; and improvement in drug supplies. We also need more comprehensive consultations and proper laboratory follow up of patients. We need to do all this with limited resources and competing priorities.
It is important to have sustained and ongoing support from the training and supporting teams to follow up the implementation of changes and improvement strategies and give ongoing support when the implementers face challenges regarding new interventions in their camps.
To me, being an NCD Champion means a lot of things. It means being a source of widespread knowledge on risks and ways to prevent NCDs to both health care workers and lay community members. It means helping colleagues put up more quality NCD care points in the camp. It means advocating for NCDs patients in terms of mobilising the best possible care that can be provided.
Being an NCD champion is important to me. My community and society are significantly affected by NCDs and I have personally lost loved ones to these diseases. NCD care is not developed and prioritised enough in my country and I wish to be one of the practitioners to change to this.”
*not his real name