Six Months at Tshemba: Tackling Chronic Disease and Cultural Challenges

I came to Tshemba for 6 months during a year out of my GP training in the UK.

I was working mostly in Primary Health Care clinics in satellite villages surrounding Tintswalo hospital. I would see mostly uncontrolled type 2 diabetic and hypertensive patients. South Africa has the highest rate of obesity in Africa. Diabetes is the number one cause of death in South African women more than HIV and heart disease combined.

The work within the PHCs was very enjoyable, but most challenges came from cultural and social barriers. Differences in culture and language, even with nurse translators, meant that communication with patients was difficult.Understanding their symptoms and fears but also explaining their diagnosis or treatment could be easily misunderstood or missed altogether.

Health education is severely lacking in the population, and I often believe patients left without a grasp of the seriousness or their condition.Treatment compliance was a big issue, and I felt often we prescribed more and more pills that were not taken.

After having been working for three months and seeing these issues around health education, I worked with the nursing teams to address them.  Firstly, I provided diabetic education for nurses and community health workers within the clinics.  This was often well received and good discussions would come from it. Nurses have lots of training on HIV and TB, and their knowledge vastly outweighs mine, but they get limited further education on other topics.

To improve patient education, we organised awareness and screening days in 3 of the clinics. Clinics are encouraged to run their own campaigns on a large variety of health conditions, but I found it can be difficult for them to have the time and resources to do this. Amazingly, most mornings nurses will give health education to patients in the waiting room. This verbal teaching appeared to be the preferred method for education in the community.

The awareness day focused on combined screening for hypertension, diabetes and cervical cancer which are some of Tshemba main projects. The nurses provided health education with the aid of translated posters we created.  The days were a success with great collaboration between all staff members at the clinic, managers of neighbouring clinics and enthusiastic volunteers. I managed to gather data from 191 patients and 46 staff members. This however confirmed my suspicion of poor control of chronic disease in the community.

What I hope will continue on in the clinics is education, education, education! For patients, they need to have the power to take a positive role in their health. After speaking with nurses, local researchers and allied health staff, they agree that support groups for diabetic patients would be helpful.Educating patients more on mass and creating more dialogue than just written information would help.

Overall, I loved my time in Tshemba. What surprised me was that I learnt a lot of public health skills. I have a greater appreciation of working within different cultures and low-resource settings. I learnt that barriers to changing health can be very complicated but actually small changes every day are always worthwhile.

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Story by Dr Marcus Ball

Medical Doctor, United Kingdom

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