Meeting the chronic disease challenge
HIV is not the only disease that can cripple economies and devastate families. Just like communicable diseases such as TB and HIV, there are non-communicable diseases, such as hypertension, diabetes, asthma and various cancer types that can be fatal if left untreated.
“Diabetes is one serious silent killer, as is hypertension,” said Molly Mosiea, Free State assistant manager, chronic diseases.
“Few people recognise the signs and symptoms of diabetes, which includes excessive thirst, excessive urination, dryness of the mouth, blurred vision, tingling sensations in the lower extremities, dry skin, weight loss and wounds that don’t heal.
“Type 1 diabetes affects children and presents very early in life. In Type 1, the pancreas does not produce insulin or has insufficient insulin production. Type 2 affects adults mostly due to unhealthy lifestyle, such as unhealthy eating, lack of exercise, smoking, alcohol abuse and sometimes, long-term use of drugs. It is incurable but can be managed by healthy lifestyle changes and medication”
“There is a national policy on adherence strategy. All patients with chronic conditions will be educated on adherence to improve retention to medication. Adherence clubs for patients with HIV and Aids will include non-communicable diseases.
“We are saying that it is important to include non-communicable diseases in these clubs, as these are chronic conditions requiring chronic medication — people simply don’t realise the treatment of these conditions is a lifetime commitment. It is also essential to test for these conditions,” said Mosiea.
“Attending adherence clubs means getting educated about illness, having a platform to voice out their issues, their challenges with medication or side-effects that disturb them”, says Mosiea. “This is one of the strategies to reduce long queues in our health facilities.”
Health Calendar
World Diabetes Day is one of the events that are part of the province’s health calendar. While the day is on November 14, Moseia says “in the Free State we observed the day on
November 12, in partnership with Bongi Ngema Zuma Foundation and other stakeholders. We also welcomed Novo Nordisk Cyclists on their tour to George via Hoffman Square in Bloemfontein. This was a build up towards World Diabetes Day 2016, and the main purpose was to create awareness.”
According to Mosiea, these events are used to screen the public for “diabetes, hypertension, TB, HIV and Aids, eye care and cervical cancer.”
“On World Diabetes Day, 20 bicycles were issued to promote healthy lifestyles. This year our annual target for diabetes and hypertension screening is 700 000 people, respectively.
“We have achieved our performance
targets for the first and the second quarter. Our services are adequately responsive and geared primarily towards saving lives. During screening, patients with elevated blood pressure or blood glucose are immediately put on [a] non-drug or drug management programme depending on the severity of the elevated numbers.”
“Every person who enters a facility with an ailment must get a full screening. This includes screening for cancers such as prostate and testicular cancers for men, and breast and cervical cancers for females,” concluded Mosiea.
Circumcision
Sam Boleme, deputy director of the Free State health department’s medical male circumcision (MMC), condoms and high transmission areas, said that circumcision — the removal of the foreskin — is a known way to counter sexually transmitted diseases.
“The foreskin has cells inside it that are prone to infection, or act as reservoirs or entry points for infection. When you remove it, you remove the threat,” said Boleme. “It also reduces — but does not remove — the threat of HIV infection from female to male.
“From our point as a man, we do not encourage MMC only. We combine MMC with other prevention methods, specifically condoms, to increase the protection.
“The process of MMC is not that
painful and is performed under local analgesic, and there are other devices as an option. The primary pain felt is from the injection and the pain is the same for adults or children.
“Post-op care is essential, particularly dressing and strapping the penis to the abdomen to prevent pain, swelling and bleeding. If it does start swelling then there will be pain. Usually there will be a little bit of discomfort for two to three days. However, if by the third or fourth day wound care has been poor, then by day four or five you run the risk of an infection.”
Boleme said that while they urge that this procedure is preferably done in a medical centre or a well-equipped mobile clinic, they acknowledge that there are ancient cultural circumcision rituals still in practice. He stressed the importance of trying to promote safe circumcision without discrediting these rituals, but said information needs to be available so a man can make an informed choice.
“We work with those who perform these [rituals], train them and give them information to simply make it safer. The MMC is not replacing circumcision for religious or traditional reasons, and we are not competing with those people.
“From birth to death you can be circumcised and for the purposes of HIV, we are targeting the sexually active, especially boys and men from the ages of 15 to 25,” he said.