"I have worked in the Embu project for non-communicable diseases (NCDs) such as asthma, hypertension and diabetes since March 2017 when the project first started. The project´s main objective was to bring care for NCDs closer to people's homes, so away from big hospitals and into the community. This objective was to be achieved mainly through mentorship to clinical officers, nurses and community health volunteers working in community health facilities. For the clinicians and nurses, we mainly wanted to build skills and knowledge and attitude in terms of treating NCDs while with the community health volunteers, we focused on building their capacity to be able to teach the community about NCDs, including prevention measures in terms of their lifestyle and counselling the patients.
We quickly realized there were many NCD patients in Embu, because through the life of the project, we had had a cohort of almost 7,000 patients. We have been working in 11 facilities – eight health centers and three dispensaries dealing with five NCD conditions of Asthma, hypertension, diabetes, chronic obstructive pulmonary disorder (COPD) and epilepsy We also started working on mental health two years ago, given the mental health impact we witnessed of chronic conditions. The patients are given free medication, and are monitored through the laboratory, which tests for kidney function and blood sugars.
We have worked to build the capacity of the local health service, so that they are able to treat patients fully and refer those with complications to level five for specialized care.
In this project, we have achieved our mentorship target to the clinicians with over 60 mentees graduating from the program. We have been able to build the capacity and improve logistics within the facilities including setting up waste disposal sites and even renovated some of the facilities. We were also able to supply drugs and laboratory re-agents and advocate to the county government for the supply of essential NCD drugs and including them in the list of drug management of community level health facilities. Previously, some NCD drugs were not in the system of drug management by the lower level facilities.
Now that we have achieved these objectives, and improved the capacity of the local health service, our project is soon coming to an end. To try to ensure the provision of drugs to patients we are trying to put in place a community revolving pharmacy initiative which is meant to ensure continuous supply of NCD drugs when the MOH system runs out of stock. Through this initiative, patients will be able to buy drugs from a community-based organization at a subsidized price. We hope that this benefits the patients, lowers the default rate and reduces morbidity and mortality rate. This will enable us to achieve both in terms of disease prevention and advocating for better access of treatment for patients.
Insulin management is one area we have heavily invested in. As we know, insulin is quite expensive and as MSF we have been able to procure and supply insulin to lower level facilities. We have built the capacity of the healthcare workers in insulin usage so that they are now able to administer the insulin, teach the patients how to use and dispose insulin.
For the patients, we have provided them with free insulin, syringes, swabs and taught them how and where to inject. We also provide them with a safety box for placing the used insulin and vials which they bring back to the facility for proper disposal after it is three-quarters full. This was necessary because it is safer for the community so that we don’t find needles everywhere or in neighborhoods where there are children playing around.
What gives me fulfillment with my work is the patients. When you see a mother with an asthmatic child coming to you to tell you that her child doesn’t wheeze anymore and that the inhalers we gave them work perfectly compared to the syrups they used to be given, that satisfies me as a healthcare worker. The fact that we came up with a protocol on how to treat these conditions has also enlightened the local healthcare workers.
What is unique about this project is that you get to be at the core of patient empowerment. Sometimes, they would invite us to witness their elections for their support groups representatives. This was encouraging to watch as patients take up the challenge of managing their conditions. I cherish some of the joyous moments we shared at the same time as educating them."