"Some people see the cup as half empty. Some people see the cup as half full. I see the cup as too large."George Carlin.
As more and more people get diagnosed with some type of non-communicable disease (NCD), the more one realizes just how insidious these diseases can crop up. At this point in my life, I am of the opinion that each of us has a disease or a group of diseases that are personal to us. One may be living with it/them or slowly or rapidly you have witnessed NCDs impact people close to you. The WHO estimates that NCDs account for 41 million deaths each year and that yearly, 17 million people die from NCDs before turning 70 (World Health Organization, 2022). In comparison with different geographical regions, low and middle-income countries are more affected (World Health Organization, 2022).
Extensive research studies have concluded that early disease detection, health screening and treatment plans that encompass palliative care are essential for NCD management (World Health Organization, 2022). Among my list of personal experiences with NCDs, my greatest one is stroke. Stroke forms my earliest memories of how vastly a disease can impact someone's life. In my formative years, I could quickly identify something that was different about my grandfather. I remember visiting my grandparents and wondering why my granddad had a different gait? My earliest concerns were; why was he using a walking cane? Why did he need that extra hand to perform his daily activities? Well, it turns out that before my birth he had suffered from a stroke and it had left him with hemiparesis (partial weakness of one side). Looking back, I am grateful that he was well cared for and this was evidenced by adjustments made even around his home to make life better for him. Several years later I learnt that the stroke was a result of Hypertension and that shook me. In my still-developing mind, I concluded that HTN and Stroke were synonymous. I am happy to report that I am better informed now but this experience made me realize of how valuable it is to ensure patients and patients' families need to be educated appropriately and guided on how to provide economic, social, psychological and any other form of support needed. To you my reader which disease prompted you to seek more information
In 2022 we have vast access to knowledge on these diseases. However, it is still a worrying trend to see it loosely translated to most patient groups and families. This has a direct impact as we see it result in frequent unnecessary hospitalizations.
I believe we can do better by emphasising improving care delivery in the most basic of ways such as
1. Formulate standard procedures and protocols and actually apply them.
It is sad to realize that GOK generates a lot of materials that end up in the archives. few institutions apply them yet a lot of funding had been directed towards their development. For example, (Division of Non-Communicable Diseases Ministry of Health, 2018). For more advanced institutions there are several resources available and of course, the oldest model of all clinical experience that's backed by feasible outcomes is applicable in those resource-limited areas.
2. Family and patient education
It is prudent to have an honest discussion on the impact of the disease. Practice empathy instead of sympathy otherwise, you may end up having discussions and communicating nothing. Do not approach it alone utilize a multidisciplinary approach. Reinforce the information repeatedly. You also did not understand all concepts on the first encounter so stop expecting too much from them. Any diseases that need long-term treatment or lifestyle modifications are already a source of stress and may hinder comprehension in some people (Traeger et al., 2019).
Key points often missed out include:
- Impact of the medication on their daily activities/ need to modify nutrition due to food & drug interactions, duration of medication use, when to go back for review even if on medication
- Rehabilitation- Details on how it impacts their health, breakdown of the details on the type of adjustments that may be needed around their homes eg including handlebars, cost of said therapies and how they can access them at an affordable cost but not compromising on quality
- Impact of the disease on their current roles- Roles could be within the family, income generation, societal etc
3. Make appropriate information accessible and available
Stop limiting patients by not recommending reputable sites or resources to them. For those conversant with the world wide web guide them on the selection of online forums, apps etc (Correia et al., 2022). Employing educators is needed, being an educator is among our core roles however it's not viable for staff to deliver when overwhelmed beyond their capacity.
4. Build or encourage patients to develop support groups
There have been several studies around the role of support groups 1)improved patient outcomes and 2) increased caregiver support. These studies show that patients and families benefit more from recommended therapies if they can identify themselves in others (Enriquez & Conn, 2016). They may be virtual or involve patients' or caregivers' physical attendance. Within them, I would encourage the involvement of a clinical psychologist he/she can cater to their mental wellness when the need arises.
To sum up, there is greater urgency to a well-thought-out multidimensional approach within our different setups. Duplicating without modifying certain elements of patient care is clearly not providing the results needed. If the current situation is unchanged we will still be witnessing an exponential increase in NCDs. Honestly, aside from our clinical roles; factors like environmental influences on disease are still beyond us and what we can do at this time is improve on what is within our control. Hopefully, in this way, we can make the transition through the wellness continuum bearable.
References
Correia, J. C., Waqas, A., Aujoulat, I., Davies, M. J., Assal, J. P., Golay, A., & Pataky, Z. (2022). Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis. International journal of environmental research and public health, 19(10). https://doi.org/https://doi.org/10.3390%2Fijerph19106128
Division of Non-Communicable Diseases Ministry of Health. (2018). Kenya National Guidelines for Cardiovascular Disease Management. https://www.health.go.ke/wp- content/uploads/2018/06/Cardiovascular-guidelines-2018_A4_Final.pdf
Enriquez, M., & Conn, V. S. (2016, Jan). Peers as Facilitators of Medication Adherence Interventions: A Review. J Prim Care Community Health, 7(1), 44-55. https://doi.org/10.1177/2150131915601794 Givler, D. N., & Givler, A. (2022). Health Screening.
Traeger, A. C., Lee, H., Hübscher, M., Skinner, I. W., Moseley, G. L., Nicholas, M. K., Henschke, N., Refshauge, K. M., Blyth, F. M., Main, C. J., Hush, J. M., Lo, S., & McAuley, J. H. (2019). Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain: A Randomized Clinical Trial. JAMA neurology, 76(2), 161-169. https://doi.org/10.1001/jamaneurol.2018.3376
World Health Organization. (2011). NCD Global Monitoring Framework. https://www.who.int/publications/i/item/ncd-surveillance-global-monitoring-framework
World Health Organization. (2022). Noncommunicable diseases. https://www.who.int/news-room/fact- sheets/detail/noncommunicable-diseases
