21. May 2015

In West Bank and Gaza Strip, comprehensive care gets results

Gwendolyn Carleton
The World Diabetes Foundation and its partners are improving diabetes care, despite huge obstacles and growing need.
A nurse conducts a foot exam in Southern Hebron, during the WDF field visit in April.
Worldwide, about 8% of people suffer from diabetes. In the Middle East, more than 10% have the disease. Residents of the Gaza Strip and West Bank, with diabetes rates approaching 15-20%, are in an unhealthy class of their own.
One reason is lack of awareness on how to treat and how to prevent the disease from occurring, according to Ahmad Abu Al Halaweh, Director of The Diabetes Care Center at Augusta Victoria Hospital. Another is high levels of obesity, a major risk factor for diabetes.
In 2003, the World Diabetes Foundation began working with DanChurchAid and Augusta Victoria Hospital in East Jerusalem to improve the situation. Their focus was on capacity building: providing training, upgrading clinics, and expanding awareness. A mobile clinic was established in 2014, in partnership with Palestinian Ministry of Health, to bring care to more Palestinians in need.
In late April, WDF Managing Director Anders Dejgaard and programme coordinator Jakob Sloth Yigen Madsen visited the WDF’s five active and four completed projects in the region. It was the first Foundation field visit to the area since 2012, and they were impressed with what they saw.
“It’s very stimulating to see that the recently terminated projects, both in the West Bank and Gaza, demonstrated very sustainable effects in the healthcare services provided for patients suffering from diabetes,” says Anders Dejgaard.  
“There are huge challenges,” he adds. “But the Diabetes Comprehensive Care Model is being implemented efficiently – and is lifting diabetes care for Palestinians to a new level.”
DCCM gets results
The Diabetes Comprehensive Care Model – DCCM for short – is an approach that builds on learnings from early WDF projects in the area, which found that patients benefitted from having all diabetes services collected in one place. DCCM clinics offer foot care, eye care, gestational diabetes screening, and nutritional counselling. Standard diabetes lab tests and patient, family and community education are also provided.
DCCM clinics were established first in East Jerusalem by Augusta Victoria Hospital, and subsequently in Doura by the Ministry of Health, in Bethlehem by the United Nations Relief and Works Agency, and in Gaza by the Union of Health Work Committees.
Before the DCCM model was implemented, none of the diabetes patients or nurses at his clinic knew about the importance of eye and foot care, says Ahlam Abu Kubayta, a nurse at a DCCM clinic. 
Now, he says “doctors advise patients on how to measure their blood sugar. Nutritionists guide them on how to eat healthy and exercise. Specialised nurses take care of the patients’ eyes and feet. The diabetics now are fully aware of how to take care of themselves. Consequently, the dangerous complications of diabetes will decrease significantly.” 
In 2014, the new mobile clinic began bringing DCCM to Palestinians who had difficulty reaching Augusta Victoria Hospital and other diabetes centres.
“More than 30 patients, on average, benefit from the mobile clinic daily, and for me the most important service we provide is education, as education can prevent an amputation of a leg,” says Rena Abu Snena, a foot care specialist with Augusta Victoria Hospital. 
Learning for life
The mobile clinic and four DCCM clinics reach 10,500 Palestinians every year. Diabetes awareness campaigns related to the WDF projects reach about 1 million Palestinians annually.
Hussein Shoan is one of them. Before visiting the DCCM clinic in Southern Hebron, he lived with leg pain and double vision. After receiving nutritional counselling, he lost 29 kg, and began controlling his diabetes through lifestyle changes and medication. 
“I was given instructions and guidelines," he says. "I learned about nutrition, and how essential is to exercise. Now I suffer less pain in my legs, and I have clearer vision - before, I used to see one person as two."