The EKFS (Else Kröner Fresenius Stiftung) medical-humanitarian funding was established in September 2016 in Nakaseke district of Uganda to promote patient-centered care for non-communicable diseases (NCDs), in order to foster the development of a Center of Excellence for NCDs in rural Uganda. A full report of our activities from September 2017 to September 2018 has been compiled and presented separately. Major events in the past year have been the training of 27 health care workers (HCWs); establishment of a rural NCD clinic at Nakaseke General Hospital; development of NCD charts approved by the Uganda Ministry of Health (MoH), training of 20 Community
Health Workers (CHWs), integration of CHW model into NCD care program; testing the feasibility of NCD Pocket Doktor booklets on 100 selected participants with NCDs in Nakaseke. We have developed, translated and field-tested Pocket Doktor booklets for hypertension, diabetes mellitus and chronic kidney disease.
We currently provide chronic care to over 300 patients through the newly established NCD clinics at Nakaseke and Life care center. We have trained 7 students in global health from Uganda, USA and Germany. We set up the NCD fellowship program in collaboration with the Uganda Ministry of Health and our first candidate is finishing in this year. We continue to offer scholarships to nursing students with 3 new candidates selected for the awards. As a way of reaching out to the community, we have adopted this CHW model to disseminate NCD-related health education, screen for NCDs and refer community members diagnosed with NCDs to Nakaseke NCD clinic and ACCESS life care center. In addition, the program has also strengthened NCD global health education component through supporting both local and international fellows. Recently we hosted three medical students from Makerere University College
of Health Sciences through Makerere University-Yale University collaboration (MUYU) programme. We also hosted one student from Yale School of Medicine, USA and one student from Germany.
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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.