For four months, I had the pleasure to be a part of the medical staff at Nemba District Hospital, in Rwanda’s Northern Province. The aim of my stay as a General Practitioner was working in the Service of Internal Medicine (IM) and fighting Non Communicable Diseases (NCDs).
Rwanda is one of the world’s poorest countries, devastated by the 1994 genocide. Since that time, major improvements in life expectancy have been observed. This was possible due to the development of a well organised health system based on district hospitals surrounded by health centres, and a big number of community health workers. With an additional structure of health insurance available, access to basic care was also given to the poorest inhabitants.
Back to my work: What were the patients hospitalised for in Internal Medicine? Half of them were diagnosed with infectious diseases such as malaria, typhoid fever and diarrhoeal diseases. Medications for those were widely available and treatment protocols were followed with ease by local doctors. The other half were hospitalised for NCDs such as hypertension, cardiac insufficiency, asthma, diabetes and neoplasms. This is basically what I’d have to deal with everyday as a doctor back in my country, Poland. But in Rwanda I observed a lack of knowledge about these diseases. I focused on this topic in my educational program, training doctors and nurses to provide efficient health care for NCDs patients.
As a young doctor, coming for the first time to Rwanda, I didn’t expect such a high burden of NCDs. Looking at the World Health Organisation (WHO) statistics – more than 40% of the population over the age of 20 is affected with hypertension or other cardiovascular diseases. Such a big number does not have an accurate answer in foreign aid. Still most of the programs in low-income countries (LICs), such as Rwanda, are focused on infectious diseases and maternal and child health challenges.
What are NCDs patients struggling with in Rwanda?
First, access to a NCDs Clinic located in a district hospital or in a health centre is not always easy as they might be located far from their residence.
When suffering from asthma, patients might temporarily deal with lack of access to medications. For a long time, special sprays for asthmatic patients were not available in the country which puts their life in danger and can lead to frequent hospitalisations.
In the case of Hypertension (HT), it is difficult to achieve a compliance with patients, since HT doesn’t cause any pain or other symptoms. The discontinuation of treatment leads to a high risk of stroke which means being paralysed and thus, being dependent on care by family members.
Regarding Cardiac Insufficiency, there is a high burden of underdiagnosed young patients with rheumatic heart disease who could live longer if there was an access to basic echocardiography with trained staff.
Finally Diabetes is a condition that is easily manageable in Europe with the appropriate medical support. However, in Rwanda it is a death sentence. There is no access to the resources needed to treat this disease. 1$ to measure glycaemia once per day? No way. This is crazy.
A patient told me once: “I would rather have HIV instead of diabetes”. A shocking statement, but, after analyzing the situation, totally understandable. Rwanda’s HIV infected patients have a lifespan comparable to Europeans. Their medication is refunded by the government. Whereas with diabetes, people are left behind, dealing with complications such as blindness just after first years of illness onset. It leads to disability and social stigma. Diabetes is a lifelong condition and buying the essential insulin and additional supplies required can represent a significant proportion of the family’s income.
My conclusions: There is an urgent need to educate patients and medical staff in developing countries about non communicable diseases as the problem will be constantly growing.
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Volunteers go from Poland to Africa
to help the most needy and poorest
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| Operating since 1992 in Poznan, Western Poland, the Foundation of Humanitarian Aid “Redemptoris Missio” has created professional back-up facilities for Polish missionaries engaged in medical activities among patients in the poorest countries of the world, mainly in Africa. To support their work, the Foundation sent shipments of medical equipment, medications, hygiene and school materials. In addition, the Foundation has enabled nearly two hundred volunteers to go to the missions.
The aim of the Foundation is the professional preparation for the work in the tropics, primarily in terms of prevention of tropical and parasitic diseases. Together with the Department of Tropical Diseases and Parasitic Diseases, the Poznan University of Medical Sciences organizes training courses and conferences on health issues in African countries. The Foundation has considerable achievements in promoting humanitarian and charitable activities. Volunteers – not only doctors and dentists, nurses and midwives but also students of medicine, nursing and midwifery – go from Poland to Africa, enthusiastic to help the most needy and poorest. The volunteers are the driving force of the Foundation, because they are the basis of our operations and the ambassadors of the Foundation in their surroundings. The Foundation of Humanitarian Aid “Redemptoris Missio” supports mission hospitals and clinics in some of the poorest countries with regular shipment of medicines, dressing materials and medical equipment. In Poland, volunteers help with: – package packing, – preparation of promotional materials of the Foundation, – assistance in obtaining funds to meet the requests of the missionaries. In 2017, the Foundation is celebrating its 25th anniversary. Over that time, it has incessantly fulfilled the purposes for which it was established. Its help included countries in Africa (Tanzania, Cameroon, Zambia, Ethiopia, Uganda, Rwanda, Kenya, Chad, Madagascar, Central African Republic), Latin America (Guatemala, Bolivia, Jamaica), Asia (India, Nepal, Kazakhstan, Afghanistan) Oceania (Papua New Guinea) and Europe (Belarus, Serbia, Bosnia and Herzegovina, Kosovo). More information: http://www.medicus.ump.edu.pl/ |
- Author: Małgorzata Osmola
- Photo: Doctor Adrien and young interns during medical visit in Nemba Hospital
- Info box on Redemptoris Missio: Contributed by Jerzy T. Marcinkowski
- Contribution by Redemptoris Missio to the Annual Report 2016 of the MMI Network