It’s late afternoon, and Dr Kaushik Ramaiya, Consultant Physician and CEO at Shree Hindu Mandal Hospital, is completing his rounds in the intensive care unit. There are six patients on respirators; one, he notes approvingly, will soon be able to breathe on his own. But there are other concerns: the need for more testing and protective equipment, a hotline to answer patients’ questions, a mobile unit to bring care to their homes. There is no lockdown here in Dar es Salaam, Tanzania, but people with diabetes and other non-communicable diseases (NCDs) need information and support – they are worried about coming to the hospitals because of possible infection with COVID-19. Measures need to be taken to ensure that they do not miss out on their medications and other commodities.
6000 km north, Hanin Odeh, Director General of the Royal Health Awareness Society, is working the phones. She, too, is trying to keep vulnerable people with diabetes and other NCDs safe. Jordan is under strict lockdown – so her priority has been getting information about health and how to get medications to people who need it. But she too has other concerns: access to healthcare, soap, and other measures needed to keep Jordan’s vulnerable residents - including its large refugee population - safe.
Dr Ramaiya leads a regional-level NGO hospital in Tanzania. Ms Odeh leads a civil society organisation in the Middle East. Yet they have much in common. Both are WDF partners working to improve diabetes prevention and care in their countries. Both of the organisations they lead collaborate with local health authorities, hospitals, civil society organisations and other partners to achieve their goals.
And both recently received, via WDF, grants of 5 million DKK from the Novo Nordisk Foundation to support their local COVID-19 responses, allowing them to roll out or scale up these efforts at a time when they are urgently needed.
“The Novo Nordisk Foundation’s support for Jordan is very appreciated, because COVID-19 is a new dimension that’s been added to NCDs, refugee hosting and other challenges we face,” Ms Odeh says. “We’re extremely happy to have received approval in such a short time – we can see what needs to be done, and now we are better able to deliver.”
In Tanzania, the grant will provide urgently needed support to the COVID-19 response, starting in the densely urbanised city of Dar Es Salaam with a population of more than six million. Activities to be funded will include awareness raising and access to care with a focus on people with diabetes, hypertension and other NCDs, but also on personal protective equipment (PPE) for health care providers and capacity building of the health system.
“We are probably seeing more patients in Dar es Salaam than in other parts of the country,” Dr Ramaiya says. “We are working with the Dar es Salaam Regional Medical Officer and his team covering the city, making efforts to provide training to various levels of health care providers, provide them with PPE and secure resources at the hospital level to provide care for the sick, and above all sensitise the community.”
One of the project’s priorities is to ensure optimum control for people with NCDs during the pandemic. The many efforts to inform and protect the population in general, and people with NCDs in particular, include training of community health workers, support for outreach services, and online and telephone medical and psycho-social support for people with NCDs.
A mobile component, which would bring healthcare services to patients unable to reach hospitals because of fear of infection, is under way. So are several options for safely isolating people who become infected with COVID-19.
“Some can’t self-isolate in their own residencies, because people here live in joint families – they don’t have a separate room, so where can we put them? There are two or three models we’re trying out through this grant,” Dr Ramaiya says.
He adds that various approaches are being tested, and that Tanzania will have to adopt its own model of care based on the available resources.
“We’re still in the early part of pandemic, learning what we should be doing, trying to adapt to what is right for us,” Dr Ramaiya says.
In Jordan, the grant from Novo Nordisk Foundation is intended to support the national COVID-19 response preparedness with a focus on NCDs, especially at the primary care and community levels. It also will address the NCD burden among refugee populations and Jordanian host communities.
Before the crisis, the Royal Health Awareness Society supported Jordan’s Ministry of Health, focusing on diabetes prevention and self-management programmes at the primary level. This was already an urgent priority, Ms Odeh says, noting that in Jordan, NCDs account for 78% of deaths every year.
When the pandemic hit, Jordan responded with a strict lockdown. People older than 60 and younger than 16 were confined to their homes. Primary health centres closed, and people served by diabetes management programmes contacted RHAS for help.
“I remember one lady in her 60s – she couldn’t leave her house at all and asked if we know ways to get her medications. Our volunteers sought ways to help,” Ms Odeh says.
Quickly, in collaboration with the Ministry of Health, RHAS announced the distribution of NCD medications from selected health centres, where patients could call in prescriptions and request delivery from volunteers.
Communication has been another focus of Jordan’s COVID response. RHAS set up a new government website dedicated to corona health information and is now developing ideas including chatbots and What’s App groups, in close collaboration of the government.
“People with NCDs are suffering from a different type of anxiety – they are told they are at high risk: if you get this, you might die. It’s very important we develop materials addressing their well-being, and we continue to work with the government on this,” Ms Odeh says.
Jordan hosts more than 2 million refugees from Palestine, Syria and other countries, and understanding their unique needs during the pandemic is a priority, Ms Odeh says.
“It’s very important to engage with the populations we are serving - to ask their ideas, test messaging, and listen,” she says. “When the lockdown happened, many refugees lost the ability to put bread on the table. We need to be sensitive to these contexts when communicating about healthy lifestyles and positive coping mechanisms.”
As challenging as it is, the pandemic also offers a unique opportunity to learn and experiment, she says.
“We’re developing sustainable tools that we can build on as we go forward – developing content, building capacity, setting up mechanisms and strengthening community health as the need arises.”
These learnings will leave Jordan better equipped to deal with future crises that could emerge, she says. The same is true of Tanzania, Dr Ramaiya says.
“We are actually making the health system responsive to crises – today it is COVID, tomorrow it might be something else,” he says. “How do we respond to something unexpected? With the help of this grant, we are preparing for the future.”