Project HOPE US Board Visit and Dinner

A couple of weeks ago now we had the privilege of hosting a delegation from our Project HOPE HQ in Millwood, VA as well as representatives from the Project HOPE Board.

This team led by Dr John Howe, President & CEO of Project HOPE did a three country two week intense visit with the aim of getting to understand the various programs that Project HOPE runs on the Africancontinent.

We had the privilege of hosting the delegation for a couple of days here in Johannesburg where they were able to come out to Zandspruit and visit our program, get to know our staff, take a tour of Zandspruit on foot to appreciate the complexities of township life as well and to meet with some of our patients at the HOPE Centre clinic. They were also able to visit the City of Joburg Masakane clinic and see some of the challenges that are faced there on a daily basis

The day was a wonderful success with the delegation leaving having a much better understanding of the scope and size of the program and the immense need for Project HOPE to work in Zandspruit and the surrounding area.

After a long day in the baking sun, we all went back to the Hyatt Hotel in Rosebank where Project HOPE hosted a dinner event attended by 100 senior executives who represented all but a couple of  international pharmaceutical companies working in South Africa, government, the NGO sector and academia. The aim of the evening was to highlight the work that Project HOPE is doing around the world in non communicable diseases as well as to specifically talk about our baseline survey findings from the HOPE Centre program here in South Africa.

Very rarely does an event like this occur, and as the diabetes world is fairly small and people usually move from one company to another it was like a big reunion for many attendees!

Dr Howe gave the opening address where he talked about our long history with working together with corporate organisations to improve the health of disadvantaged communities - some of those relationships are over 50 years old.

Ms. Sandhya Singh the Director for Chronic Diseases, disabilities and geriatrics at the National Department of Health shared with us the governments strategy for how they will go about tackling this growing problem of NCDs here in South Africa.

Professor Rheeder then came up and shared our baseline findings from our initial community survey and screening days. If you would like a copy of this then please contact me and I will be happy to post a copy to you.

I then closed off the evening sharing some of the real challenges that diabetic and hypertensive patients face living in a township like Zandspruit.

The dinner was a roaring success with many opportunities now to follow up with companies who would like to come and see our work in Zandspruit and potentially partner with us in the future.

If you would like to come and visit our site please do not hesitate to contact me at slawson@projecthope.org

Thanks for reading!

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Vegetable Gardens

Drew Wallace, a volunteer from the US posts his final blog before going back home...

Time goes by way to fast. It feels like I just got here in South Africa, and already its three weeks later and I’m leaving. I’ve learned so much while here, it’s been an experience completely unlike anything I have ever done before. My whole life has been spent inside the U.S. and this is the first time I have ever been outside that shell of American middle class comfort. As much as Project HOPE and South Africa has given me in terms of experience and unfailing hospitality, I hope I was able to give back just as much of my time and effort to help get the HOPE center ready to see patients, and start to make a positive impact in this community.

While here, I was able to finish up a few different types of gardens, and make instruction booklets for each one. With luck and a little sunshine, the plants will take root and grow, and start producing healthy foods, and maybe inspire some of the HOPE center’s patients to try making their own gardens, and be able to eat a little healthier, and manage their conditions a little better. I wish I could stay around just a few weeks longer, and get to see the fruits of our labor here in South Africa, see the first patients walk through the doors of the clinic, hopefully see the first vegetable gardens start to pop up in the township, but life and school gets in the way, as it so often does.

Anyways, so long South Africa, I hardly knew ya but you taught me so much, I hope I was able to give a little back. Maybe someday I can return, time willing. I know I certainly want to.

 Project HOPE is an amazing organization, and I’m proud and ever grateful that I got the opportunity to volunteer with them. I’m certain that they will make a gigantic impact for the better in this community and I wish them all the best in the future operations of the HOPE center.        

Thanks Drew for all your hard work! If anyone would like to come and volunteer with Project HOPE here in South Africa please contact me on slawson@projecthope.org

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Cosmo City Screening Day

Drew Wallace, a volunteer from the US, blogs about his first screening event in Cosmo City...

 One of the biggest problems with chronic disease care in Africa is the lack of diagnosis. Most people with diabetes don’t know they have it until they start to develop acute symptoms, blindness, foot ulcers, etc. What we are trying to accomplish with screening days is to identify people who are diabetic and pre-diabetic before they start to exhibit symptoms, so that they can then manage their condition, and never develop some of the problems that arise when diabetes and high blood pressure go too long undetected. At the screening day, people take about 5 minutes to get tested, and if their results show they have diabetes or high blood pressure, we can refer them to a free government clinic to receive treatment or to our  own HOPE Centre Clinic, which ever is closer for them to get to.

                                                                  

One of the great things about South African health care is that medicine is provided free by the government, but the diagnosis and management system is woefully underdeveloped. To highlight this of the 110 people we screened in Cosmo City we found over 50% of people were either overweight or obese which increases their risk of developing diabetes, and 70% of people had hypertension. We also were able to diagnose 7 people with diabetes who came to us with dangerously high blood glucose levels.

Hopefully, through screening events like this we can get more people to be aware of their conditions, and encourage them to stick with their treatment plans, to live healthy and full lives.

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First Impressions - Blog from Volunteer Drew Wallace

Drew Wallace, a volunteer from Virginia, USA is here in South Africa for the first time helping Project HOPE South Africa set up its nutrition program as part of the HOPE Centre project. Here is a blog about his first impressions....

So I guess it would be appropriate to start off with a bit about me. This August, I’m going to be a sophomore at The College of William and Mary (Go Tribe!), majoring in International Relations, with a minor in premed focused kinesiology.  I have always been interested in global health and wellness around the world, but in all my 19 years of life, I have never been outside of the continental United States. Sooner or later, this would need to change if I wanted to pursue my dream of helping people around the world lead healthy lives, so I jumped at the opportunity to volunteer with Project HOPE South Africa.

When people think of health problems in Africa, they generally think of infectious diseases, HIV, Malaria, etc. but in actuality, Africa, most specifically South Africa, has the world’s fastest growing diabetic population, and diabetes, as well as the heart conditions associated with diabetes and an unhealthy lifestyle, is the leading cause of death in South Africa. What Project HOPE South Africa is trying to do is establish comprehensive, across the board care for diabetic and hypertensive patients in Johannesburg’s poorest neighborhoods. My role more specifically, is to help develop a nutrition and exercise program, trying to get more people to grow their own vegetables to supplement their diet, and replace fried meats and starches, as well as get out and exercise in the very limited space they have.

Getting off the plane after a 15 hour flight, your mind really doesn’t register that you are now in South Africa, the airport could be in any metropolitan area in the United States, there are no giraffes, no zebras, no lions, just a typical airport terminal. Large parts of Johannesburg would fit in most anywhere in the first world, if not for the ever-present security fences and armed response signs, a constant reminder to this isn’t the suburban Virginia I’m so used to. The contrast becomes even more apparent when you get into the townships, informal settlements like the one the Project HOPE office is located in. South Africa, especially Johannesburg is a country with intense dichotomy, on one side of the road you could have a first world shopping center or a beautiful golf course, on the other side, a village of corrugated metal shacks crammed together along narrow unpaved allies.

The challenge now is to show families how they can grow healthy food in the limited space they have, in order to manage their diabetes. To do this we will be building a variety of demo gardens, and putting together instructions on how to build them, so that diabetic patients can better manage their condition with proper exercise and nutrition. I’m really excited for this opportunity to help out, and hope the new clinic can make a great positive impact on the community!   

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When is it OK for Chronic Illness to be normal?

When is it ok for chronic illness to be normal? This is something that I have been pondering for the last few days, but it first came up when I used to live in Mozambique. There are certain chronic illnesses which unfortunately result in people suffering pain and other disabilities with very little that can be done. However, there are other conditions where this does not have to be the case.

When I lived in Mozambique, I stayed in a Malaria endemic area, and over the course of a couple of years suffered from multiple bouts of the disease. The first time I got it I remember the crippling headache, fever, lethargy like an extreme case of the flu. After I had taken my medication for about a week I felt much better and continued on with life as normal. Yet I clearly remember the subsequent bouts of malaria were often not as crippling - yes there was a fever and a headache, but because of work and other commitments I often couldn't take time off and I would soldier on through. Then it began to hit me. What if everyone was feeling like this? What if the many people who had malaria, had a constant headache, felt tired, but because of pressures to just survive,  pushed on through without taking time off to go to a clinic and queue for a test and rest at home. Would this feeling over time become the new "normal" forgetting what it was like to live pre-malaria?

Fast forward almost 9 years and I am sitting in Zandspruit, South Africa wondering exactly the same thing. We are screening people of diabetes and hypertension. We've come across some patients with blood glucose of 37 mmol/l or 666mg/dl, another patient with 27 mmol/l or 486 mg/dl. Many patients had blood pressure of over 160/100 mmHg. In fact over 35% of patients have had an abnormally high blood sugar reading.  One of my first questions I ask these patients is, "How are you feeling?" Often the response is tired, headache, blurry vision, sweating a lot, having to use the bathroom frequently. My next question is "Are you aware that you have high blood or high blood sugar?" Some patients say yes, whilst others say no.

This one patient situation typifies most. He had a very high blood sugar and blood pressure level. He knows that he is diabetic and has high blood pressure. He used to take the tablets, but he doesn't anymore because he didn't think they worked, they ran out, and he couldn't take time off work to go to the clinic and queue all day to get another prescription.

So, when is ok for chronic illness to be normal? Have patients simply forgotten what it was like to "feel" energetic and headache free? Do people soldier on feeling like this because in their minds there is no other option, or is it because they don't know any better?

The answer is NEVER. It should not be acceptable. You and I would most likely do everything we possibly could to feel better again. But we are the lucky few, where barriers to quality healthcare are few and far between. 

 I suspect for the patients that I met in Zandspruit, the reason that chronic illness has become 'normal'  is a combination of living on the bread line trying to make end's meat, and the absurd inefficiencies, lack of care, education and other barriers that they face at government clinics that leads to a sense of hopelessness and acceptance of feeling ill.

My hope is that as we slowly break down the barriers in the community, reducing wait times at clinics, improving patient self care, reducing blood pressure and blood sugars to a manageable point, these patients will feel so much better, more productive, able to do things they haven't been able to do for years, that they will advocate for improved quality, improved access to preventative screenings like the ones we are doing.

Over the coming weeks Project HOPE in partnership with Eli Lilly, The University of Pretoria, Empilweni Nursing College, and other community stakeholders will continue to hold screening days to make people aware of these conditions, and then will be able to refer them to our HOPE Centre clinic where they will receive  proper care and attention and hopefully very quickly begin to see drastic improvements in their health.

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Diabetes and Hypertension Screening Day in Zandspruit

Setting up our testing station

Project HOPE South Africa as part of the HOPE Centre project, funded through the Lilly NCD partnership held its first diabetes and hypertension screening event in Zandspruit on Saturday 16th June 2012. Despite a freezing cold day and recent service protests in the community which shut down everything, we managed to screen over 150 people and generated a lot of interest in our project in Zandspruit. 

Nurses registering patients

Screening events like this one are part of our strategy to sensitize and make communities aware of the growing problem of (pre)diabetes, (pre)hypertension in these urbanising areas. In sub-Saharan Africa only 15% of people with diabetes have been diagnosed, meaning the vast majority of people are living with the disease and only presenting at the clinics when complications have set in. By offering free screening opportunities like this one, we are able to catch the diseases sooner, get people onto treatment when necessary quicker and improve patients quality of life.

Our team of volunteer nurses

We were supported by a wonderful team of 13 volunteer nurses provided to us by Empilweni Nursing College in Randburg who helped us weigh and measure patients so we could take their  BMI, prick fingers to get a random blood glucose value, take blood pressure and then provide counselling and referral services at the end. Teams of nurses from the college will be a regular part of these screening days ensuring that we can screen as many people as possible at one go

Patients queuing for the various tests

Homemed, a medical diagnostics company donated all our glucometers, strips and lancets and provided training to the nurses on how to use the glucometers.

Getting a finger pricked!

All the patients that we saw, received education material about the risks of diabetes and hypertension, were educated about their results, and where necessary were referred either to the government clinic for an immediate follow up, or to Project HOPE's clinic for a re-test in 3-6 months time. This is  a really important piece of the puzzle. Many times patients receive tests, but because nursing staff are over stretched they do not have the time to sit down with the patient and explain thoroughly what the numbers mean. Project HOPE is using a very simple, yet effective stop light system approach so the patients were able to see if they were in the 'Red' or danger zone, 'Yellow' or warning zone, and 'Green' or healthy zone. 

Project HOPE will be screening in Cosmo City this Saturday the 23rd June, and then again in Zandspruit in August. Over the next couple of years we will be repeating this on an regular basis.

Check back next week for pictures of our screening event in Cosmo City!

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Cosmo City Baseline Survey

Over the past four days a team of twenty community members, led by Project HOPE's Lebo Molete underwent training on how to conduct a community health knowledge survey and screen for risk factors such as blood pressure, weight, and waist circumference.

The team went through a day of training and then surveyed the community for three days. Each morning the team met and we distributed out bags full of survey forms, BP machines, scales and packed lunches! The whole family got up early each morning to make sandwiches!

 



It was an interesting experience, following on from our survey in Zandspruit which is a neighbouring township where the majority of people live in tin shacks. In Zandspruit there were a lot more people around during the week, as a high percentage of people who live there are unemployed. People were out on the dirt streets, talking with neighbours, wandering around but in Cosmo City the environment was quite different.

Cosmo City developed as a sort of social housing experiment where people from neighbouring townships were relocated into the area. It is designed to offer a mixture of government subsidised housing with low and medium cost traditional housing split up into various extensions, intermixed with schools, a business park and shops. The idea was to develop an economically diverse area for the emerging middle class.

While we were surveying we noticed a stark constrast in attitudes of people living in the different extensions. During the week, the traditional housing sections were virtually empty, with many people having gone to work. The people that were at home tended to be quite suspicious of us, many saying that they didnt want to be surveyed because they had medical insurance. Contrasting this was the government subsidised housing sections which were full of people due to high unemployment who were more than happy to get screened as for them with no health insurance access to medical services is a challenge.

Cosmo City unlike Zandspruit does not have a government clinic servicing its population so they have to travel either to Zandspruit or closer into Johannesburg to get primary care services. This makes it more challenging for people to get regular preventive health check ups.

Project HOPE picked Cosmo City to be part of the HOPE Centre Project because combined with Zandspruit it provides us with a nice socio-economic mix of people enabling us to see in terms of diabetes and other chronic diseases where the burden lies and if ones economic status changes a persons health behaviour.

More pictures can be found on our facebook page - click on the right hand tab to like it!

Thanks for reading!

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Project HOPE attends the first Healthcare in Africa Conference



The Conference Participants



I was privileged to attend the first Healthcare in Africa summit organised by the Economist in Cape Town in March. Leaders from across the healthcare field gathered together at the Cape Town Convention Centre for two days of interesting discussions looking at the many challenges that healthcare in Africa faces today.

Minster Motsoaledi

The first day was spent discussing how Zambia and South Africa are changing the way healthcare is delivered on the continent through the development and implementation of a National Health Insurance system to help reduce inequities in the system. The highlight was listening to the Ministers of Health from Zambia Joseph Kasonde and Aaron Motsoaledi from South Africa. These policy makers were then challenged by stakeholder representatives.

Day two looked at some of the practical challenges that healthcare systems on the continent face like the role of both the public and private sectors in healthcare delivery, what the best investment in public health infrastructure is and what the role can civil society play. We had interesting presentations from the President of Save the Children, the International President of Medecins Sans Frontieres and the CEO of Discovery.

Derek Yach and Adrian Gore

Later in the day the issue of chronic diseases came up which was of particular interest to me. We talked about how to tackle the double burden of disease that is now emerging on the continent as people are living longer and diets and lifestyles are changing, using new technology where healthcare workers are few and how can we in Africa prevent these chronic diseases such as diabetes and obesity from becoming the problem that they are today in the developed world. We had an excellent presentation on this from the SVP of Global Health and Agriculture at PepsiCo, Derek Yach, and from the CEO of Discovery, Adrian Gore.

The take home message of the conference was that the need is great and that there needs to be engagement from all sectors of society if we are ever going to be able to provide a level of healthcare that we can be proud of to our citizens on the continent. Project HOPE is well placed through our work in Johannesburg and across the region to help with this great mission.

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New Staff start with Project HOPE

 Project HOPE in South Africa welcomes two new staff to its senior management team to help with the HOPE Centre project:

Lebo Molete, our new Program Officer has an extensive background in social policy and health having previously worked in the UK and South Africa. He has a particular interest in non-communicable diseases and  was the founding member of a local NGO called PHELA (Public Health Education Liaison and Advocacy Project) which seeks to improve the quality of life of patients with chronic diseases through patient education and support groups.  Lebo is currently completing a Masters degree in Public Health.

Carol Diplock, our new Manager of Operations and Finance comes from having spent 15 years working for a leading UK charity called Voluntary Service Oversees (VSO) as their Office Manager having established their office in South Africa and assisting with the opening of their office in Mozambique.

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Its all go! The start of our baseline surveys in Zandspruit

The last couple of weeks have been hectically busy for Project HOPE South Africa. I have been looking forward to this for a long time – finally getting to dig down deeper into the community of Zandspruit and sit in people’s home and learn about what the community’s perception is on good health and barriers to good clinical care in the community.

The idea of our baseline survey is to get a good understanding of the community's awareness on the chronic diseases such as diabetes and to collect some prevalence data such as blood pressure and BMI before our activities launch. This will help us to measure the project's impact over time.

 Project HOPE South Africa has formalised a partnership with Project HOPE Mexico to provide technical assistance on this project and it was great to have Courtney Guthreau our Global Diabetes Specialist come and participate in this whole process her team will be helping us develop the training materials that we use in the future.

I was able to interview and hire 20 young residents from Zandspruit to help with this process. Hardly any of them had any real understanding of what diabetes and high blood pressure was, and few had done any sort of surveying before. We spent the first day training on how to undertake a survey and had great fun learning how to weigh each other and take each other’s blood pressure.

Each morning we assembled at our base at Emthonjeni Community Centre had a quick briefing and then armed with our Project HOPE bags full of survey forms, tape measure, scales and blood pressure machine and packed lunches we split into pairs and went to one of the 10 recognised sections in Zandspruit to begin surveying.

Because this is part of a formal research project that we are conducting with the University of Pretoria we had to take a random sample of the community so we used dice to choose which home we would visit!  We would go to a predetermined starting point, get our clip boards out and roll our dice to see if we would sample on the left or right side and then roll again to see which home we would stop at.

For me it was the first time that I had visited certain parts of the community and was taken aback with the numbers of people that are crammed into such a small area and the lack of any real infrastructure. The smell of sewage was in some places very strong running down the middle of dirt paths. A common complaint when talking to people was the issue of access to health care – having to wait for such a long time to be seen by a nurse puts a lot of people off from going to the clinic as well as the lack of money to buy healthier food due to high unemployment rates. Poor living conditions also came up lots.

Yet in the middle of these difficult living conditions you find a people that are very resilient, up-beat and wanting to improve themselves.

Although our results won’t be published for a few weeks, informally we can say that the vast majority of 400 people we interviewed were overweight (a key risk factor for developing diabetes) and many had high blood pressure. We found that a number of people were "tired" a symptom of poor diabetes control, some had lost strength in their hands and feet, some had eye problems and other headaches. All these are symptoms of diabetes and high blood pressure.

With only 15% of diabetes cases being diagnosed it is so important that the community becomes more aware of these diseases and empowered to make choices that improve their health and productivity.

Please check back for regular updates now. We still have our clinic assessment to undertake tomorrow and then another big survey in a neighbouring township this month to conclude all our baseline work.

Remember to like our facebook page (right hand side) to get regular shorter updates!



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