Instant diabetes care and benefits for people in Cape Town

A fundraising project in Cape Town, South Africa started in May 2006 has already had an impact on people with diabetes.

The project activities have been divided in two parts. One part is addressing the immediate need for eye screening. If the pilot is successful the intention is to increase the service to the whole Cape Town metropole in more than 40 Community Health Care Centres and make it a part of the service in the long term. A second part of the project is training, which will benefit on a longer term too.

 “With the initial funds we hope to equip and train staff in clinics located around Cape Town Metropole. Our target is fifty clinics but we will start with three”, explains Dr Timmy Kedijang, who is one of the coordinators of the project and Medical & Corporate Affairs Director in Novo Nordisk South Africa.

So far a fundus camera has been purchased and is used for eye screening in three community health centres in poor black socio-economic areas of Cape Town; Khayelitsha is an African Xhosa speaking area and Retreat and Elsies River that are so-called coloured area with Afrikaans and English.

The camera can determine whether symptoms of retinopathy are starting to show. The patient may need treatment or follow up, and can avoid blindness.

Eye examinations were nonexistent

Until project start, the level of detection of retinopathy in these clinics has been less than 1% which is mainly due to lack of appropriate equipment and trained personnel. The project responsible Prof Bob Mash from Stellenbosch University, Family Medicine and Primary Care Department explains the impact achieved: “Most of these diabetic patients - approximately 95% - have never had their eyes examined which explains why so many were referred for cataract surgery and other problems even before they had the retinal photograph taken”.
Approximately 20-30 patients are screened at each visit. So a total of 60-90 patients are assessed each week in all 3 centres. Each of these centres has several hundred regular diabetic patients.

Nurses gain knowledge in the screening process

At each of the three sites the screening of diabetes patients has been an ongoing process running from end July to end October. An opthalmic nurse and a young community health worker from Khayelitsha, training as an ophthalmic technician, are seeing patients at each site on one day every week.

For the patients screened and referred the project has an instant effect, but it will also have a impact in the quality of care as the project also has been trying to support the clinic staff, mostly nurses, in performing accurate visual acuities.

Identifying the needs before starting the training

The first workshop for nurses and doctors involved in diabetic care to assess their needs for training has already been held, a second will follow up and help each health centre plan their specific actions to move towards their vision.
At the first workshop health centres were facilitated in an inquiry process that evoked from them a vision of how they would like to see diabetic care performed in their health centres.

Dr. Bob Mash noted that the health centres could differ in their responses; “for example Khayelitsha, which is the poorest and most chaotic setting, came up with the need to care for the nursing staff themselves who feel overwhelmed by the task facing them, while this was not mentioned elsewhere”, he says. Others emphasised for example the need for more effective teamwork or better structuring of the care process.

Training will also focus on diabetic foot problems

Currently feet are rarely assessed, so in addition the project will be training each health centre team in the screening and assessment of the diabetic foot using a nylon monofilament. This will be a new skill, and the need for this was widely identified by the staff during the initial workshop.

Donations from international managers makes it all possible

The funds for this project were raised by people in Novo Nordisk. At the International Managers Meeting held in January 2006, managers donated money for the project and the company doubled the amount. With additional donations from Ireland and Hungary a total of 42,000 USD was reached.

Official inauguration of the project is scheduled for 14th November 2006 on World Diabetes Day. Prof. Bob Mash anticipates that the health minister for the Western Cape Province will participate in the function.