Background
Methods
Research setting
Study design
Data collection
Patients | Approximate age | Gender |
P01 | 16 | male |
P02 | 70 | female |
P03 | 46 | male |
P04 | 54 | female |
P05 | 58 | male |
P06 | 60 | male |
P07 | 49 | male |
Staff | Role | Gender |
S01 | Consultation nurse | male |
S02 | Psycho-social support officer | male |
S03 | Information, education and counselling officer | male |
S04 | Local MoH doctor | male |
S05 | Nurse supervisor | male |
S06 | Mental health officer | male |
S07 | Nutritionist | male |
S08 | MSF doctor | male |
S09 | MSF doctor | male |
S10 | MSF doctor | male |
Analysis
Results
Theme | Category | Codes | |
---|---|---|---|
Undermine programme effectiveness | Promote programme effectiveness | ||
Community awareness, knowledge and family support | Acceptance of DM Adherence to DM treatment Knowledge Accessibility of treatment | Ignorance regarding DM Word-of-mouth only DM awareness Reliance on traditional healers Fear of diagnosis Feeling of emasculation among men relating to diagnosis Recommended foods difficult to obtain, expensive Transportation to clinic challenging in conflict Long distance to clinic Perception of traditional medicines as more effective | Acceptance of chronic nature of disease View of medicine as the difference between life and death Awareness of consequences of not treating Support of family in DM diet and treatment adherence Bonding with other DM patients Appreciation of importance of regular appointments Patient education as empowerment |
Sustainable treatment approach | Implementation of DM programme Staff investment and capacity Ownership and certainty of programme Maintenance of DM programme | Heavy workload for staff compromises quality Low expectations for programme capacity No dedicated programme resources Dependence on NGO to maintain programme Low institutional investment in programme | Staff pride in programme Motivation from increased skills and responsibility |
Community awareness, knowledge, and family support: empowerment, acceptance, and adherence to DM treatment
" I started feeling thirsty for water, then I started losing weight, people started saying that I have AIDS. So I started feeling scared, people were saying that I would die soon.....I didn’t know what was affecting me and I would have just died. They saw the symptoms because I lost a lot of weight and many people were confused. If nobody would have told me I would have continued the same way until death." (P01, male)
"I was home then I started feeling bad. I was passing urine frequently and felt weak.I went to seek help from herbalists and was given herbal medicine. I kept taking it but was not improving. Later I met a friend who advised me to come to Mweso." (P02, female)
"I thought I was going to die. I despaired and felt hopeless. They said it’s incurable. I just knew I would die." (P04, female)"There and then I felt fear. I had been told diabetes is for rich people. But now me, a poor man? I was afraid. I was afraid because diabetes is an expensive illness for the rich. What was I supposed to do in my poverty?" (P06, male)
"After diagnosis...they (the patients) do not want to accept that 'ok, this is the problem I have'. There is also a feeling of guilt, they will feel guilty 'where did I pick up this disease?'...Commonly, when we diagnosis a person, they exhibit these feelings. Either they will refuse, 'no this is not possible, how did I get this disease? Where did I get it? Did she give me this disease?' Because some patients say 'maybe it is someone who contaminated me with this disease.' Because, from the beginning, they do not have good information about the disease." (S06)"When they go back home, the patient may well be influenced by the traditional practitioners, by telling him that he will cure him. And then, he thinks he must be cured. Why wouldn’t he? He believes the healer. We say something different; we say it is an incurable disease yet it is a disease that you can control. It’s easier for him to listen to the other message that gives him hope for cure. This is his ultimate goal: cure. " (S02)"Unfortunately, there was a case who went for indigenous products... This is just one example we give to the other patients..He thought he was cured with indigenous products; we had screened him and started him on pharmaceutical medication and then he was sold some tradi-practitioners treat. He left and remained stable for around two years, I don’t know how, miraculously… But complications set in and when he came in, he had such bruises we had to amputate him. Now he is in the clinic. "(S08)
"At the beginning, it may frustrate the patient. But, with continued visits and because he meets other patients, at the second, third visit, he feels much better. He is not alone. The other patients are doing fine. This helps him continuing with what we provide in the programme." (S04)
Interviewer(I): "How about your wife, how do you think she is handling your condition?"Patient (P): "She gets discouraged. She wonders for how long this will continue. She figures I am already gone, living on medicines all my life. It brings her worry. But I cannot stop injecting myself....The diet, it brings a lot of strife. Because she has to prepare her food with the children, then prepare mine. It brings many quarrels. We just live by the grace of God." (P06, male)
"I would follow the diet happily, but unfortunately the foods I am asked to eat are very difficult to find. We have the red bananas which I can only eat a little of. The right food to eat is difficult to get. It’s not easily available where I come from." (PO3, male)P: "I do my best to get food so as to take my medicine. But, diabetes is a rich man’s disease"I: "Do you stop taking medication when you have no food? "P: "Yes, I sometimes stop. This disease is expensive. "(P04, female)
" It (this disease) is difficult because it requires two meals in the family. Sometimes you have no money to afford the meals. It’s more expensive and the income is less. Because they have to separate my meals. People who inject, they need to eat; they need to have certainty of meals. When they get home they worry, thinking they may die due to lack of food. Majority of us are very poor, sometime you find you have nothing, you get discouraged because you have medicines but not the food, especially the ones who inject. You must eat before injecting" (P05, male)
"I: How do you find coming here for every appointment to collect medicines? Is it easy for you? Do you encounter any difficulties?P: It’s difficult, every day selling bitter vegetables and paying the fare to this place regularly. It’s not easy. It’s tiring. You need flour and vegetables for food, yet you are forced to have money for your fare here." (P02, female)"I come for appointments from (place name). When I have money, I pay for a ride. Like today, I walked to Kichanga then found someone assisted me with some money and I took transport to here. When I have money I pay fare and come, otherwise I walk...Walking from (place name) to Mweso takes four hours. It takes will power to come because of the expenses. It’s a long distance. It takes sacrifice because I never want to miss my appointment. " (P06, male)
"Some of us come from very far where you need transport here, for example (place name). Is it possible for you (MSF) to arrange for us to collect medicine close to where we come from? Because sometime the roads are blocked by fighting and medicine is finished and you have an appointment to come to Mweso and you have no way of coming. Is there a way you can help us? Because there is a dispensary at (place name)." (P03, male)“If they could bring the medicines to (place name of home village) it would make it easier (collecting medicines). Because sometimes the roads are bad and people can get attacked. Like when some people were attached that time in Au Baibe.” (P02, female)
Sustainable treatment approach
" Regarding the support, it has improved a lot. Because before, when we did not have this clinic, there were diabetic patients who would arrive either in hypo/hyperglycaemia, we took them up only within the boundaries of the little bits of medication we had available within the ward. There were some of these drugs that were not available at the big pharmacy. But since we started this support, we have seen, I saw, that there is a follow-up and by the way we are very happy....I am thankful also because we follow-up diabetic pregnant women! Really, with the support, I can see that it is really, 100%, something good. " (S01)" The quality of care is the best here. When each patient arrives to the hospital, first of all, he is well welcomed. We try to test his glucose; we check his weight, his blood pressure. We try to do a nurse consultation, ask the patient if he has any particular complaint during his stay at home. Then....once we see that there a positive aspect that allows us to judge that the patient can see the physician for a medical consultation, we guide him and transfer him to a medical consultation for an appropriate management. And if we see that the patient has a stable glucose rate, no particular problem, we the nurses, we try to conduct the treatment of the patient and then we provide him with the next appointment of the Diabetic clinic. (S05)
S: "With regards to diet, if the partner (MSF) could help us with a nutrition programme and nutritionists available to follow up the patients with us and help them become more disciplined with their diet, it would be helpful...Of course, we have the economic problem because the diet we propose is pricy for the patients. It is an additional obstacle. "I:" Thank you very much. Do you have anything to add or suggest anything to improve the programme?"S:" OK. It is about our development and continued education. The activity is quite new and we do need an on-going training....We need regular updates. If you (MSF)are conducting such programmes in other provinces or countries, it would be helpful for us to see them....The problem we have is that we are not always confident about what we do. We feel sometimes that we have a limited knowledge or experience....We have no clue about our weaknesses when it comes to stabilising the patient. We still have no solution to that." (S04)"Thankfully we have the doctors who are here and helping us try to change...you know, in scientific life, man cannot stay immobile. Man needs to change. Needs to get information. And these pieces of information will help improve the quality of care both from a staff and a patient's point of view...when man limit ourselves to only routine, routine, routine, the consequence will not only be suffered by him, but also by the patient. We are trying to alter the system! " (S01)
"For example, we need to know specifically that the programme will last one or two years, or more… If we have this guarantee, we have visibility and we can come up with a plan to control and manage the patients. We would know what to share with the patients. Sometimes we have reserves regarding the education, because we project things in the future. We say, for example: “next year or the next six months you will be this and that and you will have to do this and that… “ While even us, we don’t have the guarantee that the programme will be there to help the patient and do a proper follow-up. "(S02)