No medication, diagnostics, manpower for NDC management

Dr Brian Nyagadza is a medical doctor at the Medecins Sans Frontieres Manicaland non-communicable diseases project. He shares his experience working with patients in Mutare where is supporting the Ministry of Health and Child Care (MoHCC) to provide treat

“WHAT we see on the ground is that there is a shortage of medication, diagnostics and human resources. The patient to health care provider ratio is high. Basic medication for diabetes cannot be found in most health facilities. We have noted that while there is a lot of funding for other chronic diseases like HIV, there is a lack of funding for NCD management in Zimbabwe. We see that availability of insulin for patients with Type 1 diabetes is very limited.

Type 1 diabetes mainly affects young people and if the condition is not diagnosed early, we fear that they will die.

For the management of Type 1 diabetes, there is need for constant monitoring of blood glucose for patients that inject themselves with insulin. We have noted that there is also a shortage of monitoring tools like glucometers, glucometer strips and reagents for laboratories.

Type 1 patients are supposed to monitor their blood glucose at least four to seven times a day. It is important to monitor the blood glucose because Type 1 patients inject themselves and if there is an imbalance between insulin need and diet that they are taking, they risk having abnormally high or low blood sugar.

Hypoglycemia, also known as low blood sugar, is when blood sugar decreases to below normal levels. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures or death. A feeling of hunger, sweating, shakiness and weakness may also be present.

Patients are supposed to know when they have hypoglycemia because if they constantly have it and are ignorant about it, they will enter the “hypoglycemia unawareness” phase and lose the ability to perceive that they have low sugar. The result is that they may collapse suddenly and die, without experiencing any warning signs.

Information and education material for patients is very important. Patient literacy enables patients to know about the condition, the common side effects, like low blood sugar and kidney malfunction, so that if they have signs and symptoms, they can consult their health care providers.

Renal impairment means that your kidneys are not functioning normally. One of the major complications that can follow a liver transplant is a sudden loss of kidney function. This is known as acute renal failure and affects as many as one in four people.

One of the challenges that patients encounter is lack of financial resources such as transport money to go to the hospital. Because most of the patients cannot afford transport money, they will only visit the hospital if they are very sick and they normally ignore the early signs.

We have sadly noted that, some patients that come to the casualty section of the hospital are patients that were well managed before but because they are now failing to get their insulin, they will decide to ration the medicine. For example, they will inject themselves on one day and they will skip the following day or they inject less so that they ration the little insulin that they have. The implication of not following instructions is that, they are not controlling their blood glucose and they are at risk of developing the complications related to diabetes. Complications that patients can develop include kidney impairment, diabetic ulcers, strokes, heart attacks etc. Patients need to be managed well for them to have a quality life. While managing these chronic conditions, the aim is to reduce the likelihood of having complications. Implications of not taking insulin If a patient stops taking insulin for a day or two they run the risk of developing complications. Insulin helps the utilisation of glucose in the blood. If insulin is not there, no energy is produced. The glucose will be accumulating in the blood but because of lack on insulin, the body will fail to use it. Some of the complications that develop are irreversible like kidney impairment. Once the function has gone down to what we call ‘the end stage of renal disease’, you cannot reverse it. Patients need to be managed optimally to avoid complications.

Before patients start self-administering insulin at home, they undergo a series of counselling sessions to ensure that they understand how they are supposed to self-administer. We then ask them to come back as early as they can to check if they have understood. We also involve the family .Patients should be capacitated to monitor their blood sugar at home, adjust their diet and physical activities so that they augment the treatment that is offered by the clinic or hospital.

Patients need the necessary materials to do it. MSF procured glucometersand glucose strips so that patients can monitor themselves at home.

In Zimbabwe, doctors do the management of NCDs but as MSF, we are trying to show that it is possible for nurses to diagnose and manage NCDs. We are seeing that this is happening quite well. Apart from showing that nurses can do it, we are also offering free diagnostics and free medication. Patients need to own the management of their conditions.