Medcan initiative empowers global frontline health workers

Medcan Naweza supports community health workers address non-communicable disease in Kenya and Uganda

Community Health Worker Helen walks between empty homes in her village

Three hundred kilometers north-west of Nairobi, on the edge of a lush acacia forest, is the village of Simit where Helen wakes with the morning mist. The middle-aged, petite woman heats masala tea on a charcoal hearth in a tin hut. Chirps of herons pierce the silence. No other voices can be heard now that her neighbours moved closer to the fluorspar mine and her two daughters are away studying. So Helen’s day begins undisturbed and she can focus on her two jobs: farming and community health screening.

After she’s checked the state of her greens and pumpkins, Helen prepares for her community visits under the papaya tree. The path to neighbouring villages can be treacherous, especially after a rainfall, so she packs her bag carefully: a kit, pen, notebook and her cell phone. The community health worker kit contains tools to educate the community on diabetes, hypertension and other non-communicable diseases. Medcan Naweza created the contents of the kit developed based on community health worker feedback on what would best help them educate their community.   Helen is one of the five Medcan Naweza community health workers (CHWs) leading a mobile health screening program.

In poor rural communities, where there are not enough resources or skilled health workers, trusted members of the community like Helen have emerged as super heroes. The CHWs counsel people and refer them, if necessary, to the clinic.  They offer a vital link between underserved populations and the primary health care system.  That’s why Medcan Naweza, the humanitarian initiative dedicated to helping improve the health of individuals, families and global communities since 2013 supports CHWs.

Educational tools that save lives

This is how it works: the CHW collects five simple data points from an individual living in their community. She enters this data into a cell phone and sends it via SMS to a laptop, which resides at one of our partner clinics.  Within 30 seconds the CHW receives via SMS a risk score in colour form (green, yellow or red) on the patients’ chance of a cardiovascular disease within the next 10 years. This enables the CHW to advise the person whether they should go to the clinic for management.

In just a few months, Helen collected data on 450 people over the age of 40, which represents about 90% of her community. She also trained two other community health workers.

Helen’s next step is to follow up with all of the patients who had non-green scores. The ultimate goal is to find those people at risk of chronic disease and provide the treatment to them before a cardiac event occurs – these are patients who are asymptomatic and have no idea they are at an elevated risk.

A sustainable way to counter heart disease

“Naweza means “I can” in Swahili, and that belief in education and self-sustaining programs is behind everything we do. We provide the initial infrastructure, training, protocols, and on-going medical advisory support,” says Stacy Francis, Team Lead, Medcan Naweza. “It is a program that can be ongoing after the team from Canada leaves.  Together we are hoping this will allow us to find the people at risk and then manage their treatment strategy from a non-green to green status.”

“This simple tool empowers previously under-served communities. Almost 3,000 patients have been screened this way, and more than 80 patients have been identified as a heightened risk for a cardiovascular event,” says Dr. James Aw, Chief Medical Officer at Medcan and the co-founder of Medcan Naweza. “Through early detection the patient will more effectively manage their health issue resulting in a higher quality of life at a lower cost to the health system.”

A young patient with asthma learning to use a makeshift spacer made by Dr. Hawkes to be used with the inhaler prescribed at the outreach clinic in Isiolo, Kenya.

Members of the Medcan Naweza team visit two rural Kenyan clinics throughout the year – where they check in and conduct training with nurses, doctors and CHWs including Helen. Back in Toronto, Medcan doctors and nurses review complex cases during bi-weekly video conferences with clinic employees. The most recent outreach included a visit to a public hospital in Uganda.

Specialty and emergency clinics address urgent cases, build trust

To ensure the communities stay engaged, however, Medcan Naweza services extend beyond chronic disease prevention. Every outreach trip has included specialists who conduct clinics or awareness sessions (such as pediatrics, nutrition, musculoskeletal, women’s health and dermatology) in order to address acute, urgent or other conditions requiring day-to-day care.

Optometry has been the most extensive specialty clinic run by Medcan Naweza. An optometrist has joined 5 out of 7 trips to host vision clinics so the community can prescribe glasses on an on-going basis (with glasses funded largely by Naweza at this point). The optometry clinics have also completed around 75 cataract surgeries at the two clinics in Kenya.

On a particularly busy outreach in October 2015, four specialty clinics were taking place: a pediatric clinic to conduct examinations on local children; cervical cancer screening for women; cataract surgeries and nutritional assessments. The most recent trip also included urology surgery at a clinic in Uganda.

Word gets around fast when the clinic is open. One day, a 26-year-old man came into the clinic suffering from ulcers on his face, a result of his poorly managed diabetes. He admitted that he wasn’t taking his insulin injections because he wasn’t comfortable doing it himself. The clinic introduced the patient to Alfred, a CHW, who helped educate and train the patient. Alfred visited with the patient until he improved his ability to manage his diabetes, and continues to check in with the young man to ensure continuity of care.  The patient remains on the Medcan Naweza bi-weekly video conference call, when Alfred provides updates.

Community Health Workers: a vital link in rural health delivery

Doctors may prescribe the medicine, but it’s the community health workers who ensure the guidance and medicines are followed through. The CHWs provide continuity of care and access to regular health care.

“During our last trip, Alfred and I had the chance to join Helen during her door-to-door visits,” remembers Vanessa Churchill, a registered nurse at Medcan. “Once we arrived at the village, I said the familiar ‘jambo’ and was greeted with handshakes and smiling faces. The CHWs began to chat and translate. One woman praised Helen. She spoke about how much Helen has helped her with education and connecting her to services such as the TB clinic. The woman was complaining of a chronic cough. She had TB testing done a couple of days ago and is just waiting on the results. Earlier that day, I had done an education session with the CHWs on respiratory disease and reviewed practices that could help reduce the risk of lung damage due to cooking in the house which is a common practice in Kenya. Timing was perfect, the CHWs could now educate this lady on the importance of good ventilation in the home when cooking. They spoke to her about how to prevent respiratory disease and dry eyes. Illness and accidents were averted, and the woman went on living her life and supporting her family disease and pain free.”

You can read entries from the field on the Medcan Naweza blog.

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