28 October 2019
Zimbabwe Manicaland NCD project
MSF’s Dr Brian Nyagadza consults an adolescent patient at Mutare Provincial Hospital in Manicaland province in Zimbabwe during a diabetes clinic. MSF is supporting Mutare provincial hospital to provide quality treatment and care to patients with diabetes. Photo: MSF

Dr Brian Nyagadza is a medical doctor at the Doctors Without Borders (MSF) Manicaland non-communicable diseases (NCD) project.

He shares his experience working with NCD patients in Mutare where MSF is supporting the Ministry of Health and Child Care (MoHCC) to provide treatment and care to patients with diabetes and hypertension.

“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 very 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 the 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 a 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 they do not do anything about it, they will enter a phase, which is called ‘hypoglycemia unawareness’, where they will lose the ability to perceive that they have low sugar.

Manicaland NCD project in Zimbabwe
MSF is supporting the Ministry of Health and Child Care with diabetes medication (insulin and tablets). Photo: MSF

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.

“As we are managing chronic diseases, we notice that patients have half-baked information and that is very dangerous. We try as much as possible to educate patients so that they understand.

“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.

Zimbabwe Manicaland NCD project
Diabetic patients on insulin are supposed to monitor their blood sugar regularly using a glucometer. Photo: MSF

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 utilization of glucose in the blood. If insulin is not there, there will not be energy production.

The glucose will be accumulating in the blood but because of lack of 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. Therefore, patients need to be managed optimally to avoid complications.

Counselling

“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.

After they start, we 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 glucometers and glucose strips so that patients can monitor themselves at home.

Zimbabwe Manicaland NCD project
MSF in collaboration with the Ministry of Health and Child Care is providing treatment and care for patients with diabetes and hypertension in Manicaland. Photo: MSF

Management of NCDs

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. Health care professionals are few and the patient should be the one demanding services.

NCDs are fast becoming a pandemic in developing countries. The donor community should do more, to support NCDs. Type 1 diabetes affects the productive generation, explains Dr Myagadza.”


MSF has been providing treatment, care and support for patients with non-communicable diseases such as diabetes and hypertension in Manicaland province, mainly in Chipinge and Mutare using a nurse-led model, introducing differentiated service delivery (DSD) models Since 2016.

Read about MSF's activities in Zimbabwe