Hope of a heart diseased patient restored through generous holistic care and support by ACCESS-EKFS Non Communicable Diseases (NCD) care program
Meet Janet, a 65 year old female peasant from Bamunanika in Luwero. She was diagnosed with high blood pressure 5 years ago. Despite the effort to look for blood pressure medications from different health centres in Nakaseke and medical camps, sometimes she could go without taking any medications to control her blood pressure. Six months ago, adding to the already complicated health of Janet, she developed relentless on and off fevers and joint pains which she initially thought was malaria. Musawo Sewannyana, a health care worker based at ACCESS NCD clinic and trained in HEARTS protocol received Janet and assessed her condition. He found out that Janet’s condition was indeed more than hypertension and malaria. “Janet had a low grade fever” he reported. What was astonishing was a finding of a systolic murmur and an irregular heartbeat. Musawo Sewannyana measured her blood pressure and random blood glucose which he found at 140/80 and 6.5mg/dl respectively. He also measured her weight, height and waist circumference. With the newly developed NCD charts at the clinic, Musawo Sewannyana was able to perform a relevant assessment of the patient. In addition he performed an ECG which revealed atrial fibrillation, a heart rhythm disorder affecting the upper chambers of the heart and left ventricular hypertrophy. He wasn’t in position to do further tests given the lack of capacity at the clinic. He instead instituted treatment for high blood pressure, gave an antibiotic and counselled the patient on healthy lifestyle including reduction on salt intake. Janet has been attending care at ACCESS for the last six months. She reports that her general health has improved drastically.
Four out of five people who die from cardiovascular diseases (CVD) are killed by either a heart attack or a stroke according to world health organization. When the community is empowered through taking charge of their health, the impact can be enormous. This story illustrates how learning and putting into practice skills of assessing patients with suspected CVD by lower health care cadres can have long lasting impact on the health status of peasants who can’t afford care from tertiary centers or highly specialised personnel (cardiologists). Many thanks to Else Kröner-Fresenius Stiftung medical-humanitarian funding which aided the pilot phase of the HEARTS protocol training in February 2018 at Nakaseke General Hospital. Through continued support, we plan on continuing with the HEARTS training targeting low cadre health workers and Village health Team (VHTs) to increase awareness of CVD in the community. We hope that our efforts will curb the raising prevalence of CVDs in rural communities of Nakaseke. Let’s all work together to achieve the 25 by 25 goal of reducing premature mortality from NCDs by 25% by 2025.
Alex Kayongo, MD. Post graduate Research fellow.
A community that stays together will grow together! This saying is quite true for ACCESS (African Community Center for Social Sustainability) which is now its 15th year of operation. ACCESS is a community-based organisation in the rural district of Uganda called Nakaseke. It was founded on the premise that everyone has a right to a healthy life. Our mission is to work with vulnerable groups in resource limited settings through medical care, education and economic empowerment to create long lasting change that is owned by the entire community.
At its inception, we worked with the community elders to identify key people from the community who volunteered their time to support people living with HIV-AIDS. There being no major care for such patients, death was an inevitable end. We thus had to devise means of supporting the orphans who were left in the wake of the AIDS epidemic. One simple solution was to work with the community volunteers who later trained to become community health workers (CHWs). CHWs are elected by the community and are then equipped with the different skills required to carry out the different programs of ACCESS. Since we began, over 150 CHWs have been trained who now provide services to 6 sub-counties of Nakaseke. In addition to providing follow-up and care to our patients, the CHWs work closely with the ACCESS team members to identify and oversee the care of over 270 orphans and vulnerable children. Over 500 OVC’s have been identified from within the community we serve and our hope is to one day be able to support them all. For the first fortunate 30 families, we have been able to provide income generation projects with the hope that these families will develop the financial muscle to independently sustain themselves in the future. This will allow us to carry on the support to other families in need. ACCESS is dedicated to providing care over the continuum of life with the support of our CHWs.
Our contact begins with the child while in the womb of its mother, through our Clinic (the Lifecare center) where we provide antenatal care to pregnant mothers and support the delivery of health babies. Once the babies are born we ensure that they attend the early childhood development program that enables them to read, write and play in the presence of their parents/guardians. Working with our social worker and the CHWs, we identify and follow up vulnerable children who would have otherwise been unable to attend school, and we then support them with school fees, scholastic materials and medical care services. This puts them on a path of recovery and social well-being. For those who are not able to continue with formal education as well as for those who dropped out of school, ACCESS has partnered with other local institutions to provide hair dressing and tailoring skills. We have so far enrolled 60 young girls selected by the CHWs. Thirty have completed their studies and the majority are now employed, while a few have set up their own salons and tailoring shops.
Over the course of several years, ACCESS has grown from a nursing assistant training program to an accredited Nurses and Midwifery School whose goal is to improve access to medical services in underserved areas of Uganda. The ACCESS School of Nursing and Midwifery. currently has 212 students with 52 in their final year of study. Given the current hardship of getting nurses to work in rural areas, our students have a mandatory community rotation where they work with trained CHWs in order to appreciate first hand the challenges faced by the common man. This is not restricted to medical issues but encompasses the day to day challenges of families, such as poverty, lack of food, and various social injustices among others. Our students are trained from Nakaseke District Hospital where they see the common medical challenges and learn how to best nurse their patients. In addition, students are encouraged to visit lower health level facilities so that they gain a deeper understanding of the health care system. Most of our CHWs are now linked to the health units within the district where they refer and follow up the patients referred from the community. The interaction between the nursing students and the common man further enhances their appreciation of health in the fullest sense of the word and not just the mere absence of disease. In addition, the students work with the youth in and out of school providing them with key health messages as well as peer mentorship.
Most of our OVCs are cared for by the elderly, locally called ‘jaajas’. Working with the CHWs, jaajas have been identified from within the community and have been supported with social services, medical care and income generating activities (IGA). Those looking after school-going OVCs have been facilitated with solar systems that help them to read their books by providing light in the dark.
Deeply rooted in the community of Nakaseke, ACCESS does not shy away from making friends from far and near. In fact, most of the current success we are most proud of would not have been possible without the support of our local and international partners. We have organizational and individual supporters that have helped us grow tremendously. At the forefront is our US based team, Partners for ACCESS, who have coordinated efforts to see that we access the much needed funding to support our programs. We have collaborators from USA, Canada, Germany, Spain as well as Uganda.
Through their support, we have been able to set up programs that have tackled issues of family planning and womens’ health (Edith and Erik Bergstrom’s Foundation, University of Vermont, Preston-Werner Ventures, Kyetume Home Based Care and the John Gould Foundation), medical access (Barcelo’ Foundation, Western Connecticut Health Network and IMEC), care for OVCs (the ELMA Philanthropies-EP, the Segal Family Foundation-SFF, One World Children’s Fund the Grace Henrik support and KLM) and infrastructure development (SFF, EP, UVM, Carpenters’ Union). We have also had support from academic institutions that have helped to build our international program as well as research for medical care (University of British Columbia, Yale University, Charity University with the Else Kröner-Fresenius-Stiftung-EKFS, Johns Hopkins University, Touro University, Sacred Heart University, Makerere University and the University of Vermont). We have screened over 16,000 participants from the 3 sub-counties in Nakaseke for non-communicable diseases such as hypertension, diabetes mellitus, chronic airway diseases and chronic kidney disease. We have now established an integrated NCD care clinic in collaboration with the Ministry of Health and Nakaseke Hospital where patients with NCDs can receive all of their services from under one roof. International partners, students and faculty have played a pivotal role in ensuring the constant growth of ACCESS.
The ACCESS board of directors provides leadership and governance oversight for all of our programs. In the spirit of partnership, and with the help of all these resources we are surely headed for greater heights. With ACCESS, we are ready to serve one village at a time through our well trained and grounded CHWs who provide an indispensible link to our communities and who complement all aspects of the work we do.
Throughout this year we are going to be sharing with you details from each of our projects, highlighting the impact they have had on our community. All of our programs originate from the felt needs of the community with whom we are constantly in touch through our CHWs.
As we aspire to grow, we invite you to join us in this journey of empowering rural communities to be the best that they can be.
Dr. Robert Kalyesubula, President ACCESS Uganda