For the final post in our National Nurses’ Week series on nursing and the Sustainable Development Goals, Seed Global Health Chief Nursing Officer Eileen Stuart-Shor and UMass Boston PhD student James Muchira, RN, BSN respond to the following prompt:
“The wealth of our nations depends on the health of our populations, and the health of our populations depends on nursing.” How does nursing lift up entire communities, in addition to the essential health care nurses provide?
In Kenya and across sub-Saharan Africa (SSA), the prevalence of non-communicable diseases (NCDs) is rapidly rising. The emerging threat of NCDs defies a commonly-held belief that African countries are dominated by infectious diseases, malnutrition and maternal and child deaths: today, hypertension and diabetes are the leading cause of death in the Africa, with 10 to 20 million people estimated to have hypertension and 10 million people estimated to have diabetes.
These figures are astounding and an important threat to the health of SSA. In 2008, at the Kaiyaba clinic in Kenya’s Nyeri County, nurses were most concerned about maternal and child health, malnutrition, HIV, TB and malaria; screening for hypertension or diabetes was not even on their radar. In fact, at that time, the facility did not have a blood pressure cuff, a glucometer to test for blood sugars, or even a stock of essential medicines to treat these conditions.
But in 2008, all of that changed. The Kenya Heart and Sole project – a partnership with the Kaiyaba clinic, the Tumutumu Hospital School of Nursing and UMass Boston – began screenings for these before-underdiagnosed conditions at Kaiyaba. Local nurses were stunned to learn that 45% of those they screened had high blood pressure, and more than 12% had diabetes. And they decided to act.
In partnership, the Kaiyaba nurses (led by Lucy Gakage) and Tumutumu nurses (led by James Muturi Muchira and Irene Ndigirigi) created a system for following up with individuals found to have hypertension and diabetes. They worked with the ministry to get essential medicines to treat hypertension and diabetes stocked at the clinic. They talked to the community about how best to serve the influx of people who now needed follow-up and treatment for hypertension and diabetes and they worked as a group to create a system of care that would fit the local needs and resources.
The result was the new Kaiyaba Hypertension and Diabetes Program, a peer-led/nurse-directed initative. The community organizes a monthly meeting at the clinic which has evolved to be a group medical visit. Tumutumu sends faculty and staff to assist the clinic nurses to provide care (measuring blood pressure and glucose, examining patients) and a group education initiative. The clinic nurses refill medications from the government provided stock and provide individual counseling. The peer leader collects a small fee to help members offset unexpected medical expenses (this is totally community run) and created a community garden for indigenous healthy greens to support a more healthy diet.
Eight years later, more than 50 patients continue to be seen and receive care on a monthly basis and the Kaiyaba/Tumutumu partnership continues to be strong. They work together day-by-day to address the dual epidemics of hypertension and diabetes: one student, one nurse and one patient at a time.
An important lesson was demonstrated: nurses are present in every primary care facility and are the primary provider of care at the community level. Nurses, in partnership with the community can innovate to create effective and culturally-sensitive approaches to manage NCDs and lift up entre communities in rural Africa.