Emily Nero lived in Sandy Bay a town very near the volcano and has hypertension. Emily recalls that day “as soon as I heard that the volcano was erupting, I packed up to leave. I have three children (26-year-old disabled female, a 17 and a 12-year-old). My husband works in the Grenadines, so I was alone with the three children. The Government sent assistance to help me leave with the disabled child. When leaving I forgot to grab my medication”.
After a couple days in the shelter, my head began hurting. My pressure was elevated, I had no medication. The Principal of the school (shelter) sent for two limes, but it was still hurting and the pressure was still high. The Principal’s daughter was a doctor and she sent me to her. I was then sent to the hospital and was given more tablets under my tongue. I could not remember the name of my tablets, so I was given a new set when I left the hospital. I am now staying in a house that the government provided, a shelter. The house is isolated, not close to the road, and it will be difficult for me to leave my disabled child. I do not know where I am to go to get my blood pressure checked. I was very concerned that a vessel burst in my head (stroke). I then thought what will happen to my children”.
Emily´s case is not unique. Dr. Zeon Byron-Clarke, from Milton Cato Hospital explains:
During the care of patients immediately after the volcano eruption we noted more persons being hospitalized because of decompensation. When displaced, a lot of persons fled to the shelters without their medicines. A lot of my colleagues went to the shelters to give meds. I felt overwhelmed, resources were not sufficient. A lot of clinics were closed and persons with NCDs did not have access to clinics. In the shelters the Glucose Metabolic Rates (GMR) were extremely high due to non-compliance with medicine intake or patients were going hypoglycemic because they were undergoing stress and not eating properly. It was a trying experience”, says Dr. Byron-Clarke.
Collaboration to ensure displaced persons receive essential NCD medicines
When the volcano erupted, PAHO in collaboration with Yale University School of Medicine and Primary Care International (PCI) worked with the Ministry of Health to deploy the World Health Organization (WHO) NCD kits to ensure displaced persons would receive essential NCD medicines. The NCD kit is a pre-packed set of essential medicines and medical devices to meet priority NCD health needs of 10,000 people for three months in emergencies, when medical facilities and regular supply have been disrupted. The basic NCD kit is intended for outpatient care in mobile clinics and primary health care units, particularly to refill ongoing treatment regimens. It contains oral medicines, basic diagnostic equipment, and additional products needing cold chain, such as insulin, accompanied with NCD treatment guidelines. Dr. Byron-Clarke explains the importance of including NCD care during disasters:
"When an emergency strikes, sometimes health facilities located in disaster areas must be closed temporarily if affected severely enough and referrals are made to the nearest health facilities where services are relocated for continuation of services. Where possible, mobile health teams are dispatched to areas serving as shelters for displaced persons. These mobile units comprise of first line healthcare providers and supporting staff. Resources are provided mostly from the government consolidated fund through the Ministry, as well as by donors and other partners. A major concern is the inadequacy of resources to meet the demands. Improving stock availability and distribution, strengthening of our main procurement department, Central Medical Stores (human resources, financing, storage capacity), is urgently needed”, he adds.
Prior to the arrival of the WHO NCD kits in the country, PCI delivered a series of five virtual trainings on the use of the Kits, with approximately 40 physicians, nurses and pharmacists, in addition to delivering 2 refresher virtual courses after the NCD kits arrived in country. Theoretical information was provided to participants on NCD management, case scenarios of persons living with an NCD were discussed to stimulate clinical reasoning, and information was provided on the contents of the NCD Kit Modules and how to use the medicines in the kits with the national clinical guidelines, including medication substitutions. The training covered clinical management of people with diabetes, hypertension, cardiovascular disease, chronic respiratory disease (asthma and chronic obstructive pulmonary disease), seizures and epilepsy, and mental health conditions.
Dr. Desawe Walker, junior doctor at one of the shelters shared his insights on the training and WHO NCD kits:
Patient education is key. There should also be the preparing of care kits with one month supply that the patient keeps and utilizes in similar situations. This would be helpful during disasters where it is more or less predicted. At the end of the hurricane season, the patient can utilize the medicines”
Upon arrival of the 3 full emergency kits in the country, the Ministry of Health had a ceremony in which Mr. Levi Walker thanked PAHO/WHO, Yale University School of Medicine and PCI: “These supplies have been made available to us, in St. Vincent and the Grenadines, at an opportune time, considering the exacerbation of health challenges in the aftermath of our recent volcanic eruptions. While the emphasis initially would have been on meeting the medication needs of persons who were displaced, we acknowledge the fact, and it is a desirable fact, that a wider cross-section of our NCD population will in fact benefit from having access to the components of the NCD Kits”.
Using the WHO NCD Kits to improve NCD care in disasters
Based on their experience with training providers around the world in using the WHO NCD kits, PCI provided training to providers in St Vincent & the Grenadines on improving NCD care during and after disasters and highlighted important points as follows:
- Ensuring strong primary care to diagnose and adequately treat people with NCDs is important to prevent any health emergency from uncontrolled disease
- Standardized NCD management guidelines and protocols are necessary for quality care
- Planning, procurement and ensuring continuous supply of essential NCD medicines is needed, including as part of disaster preparedness
- Sharing and delegating clinical tasks with nurses and pharmacists is an important part of NCD care
- Ongoing supervision of personnel is an important part to ensure that appropriate interventions are being implemented
- Patient records, both clinic- based and hand-held by the patient are needed to monitor care
- Health education and lifestyle counseling are important aspects of clinical NCD care
