Bwindi National Park is a beautiful part of the world. Known as the Impenetrable Forest it houses some of the last families of mountain gorillas. Bordering the Democratic Republic of Congo and Rwanda, the forest is under constant threat from pillaging and poaching as a result of civil war.
There is little industry in the area and some of the local community is involved in tourism associated with gorilla trekking. Most families undertake subsistence farming to feed their families or provide services for the community. One particular tribe, the Batwa, were the forest dwelling people who, when the forest was annexed 15 years ago, were rehoused in the town and farming community. With the loss of their ancestral lands and their purpose, many turned to drinking alcohol and were seen as a nuisance to other more established tribes.
Over the last 20 years particularly, the deluge of aid into African countries has improved access to healthcare and reduced the incidence of communicable disease. With increasing life expectancy and increasing access to western products different disease patterns were emerging.
I spent four weeks in the small communities around the Bwindi National Park area. I decided to use my time to educate people about hypertension and what they could do to reduce high blood pressure, an increasingly common issue in Sub-Saharan Africa
After spending a few days acclimatising and understanding the local eating habits, I created a very low-tech communication device – with five key messages.
On the back of a motorbike and with a translator, I moved from village to village talking with people about what they liked to eat and drink. We ran blood pressure drop-ins at the local market, with crowd of people wanting to have their blood pressure taken and see it being taken. I went to a women’s weaving group to talk with them about blood pressure and dietary changes that they could make.
The majority of people received the messages with interest. Most were interested in their numbers; some had incredibly high diastolic pressure. Many just wanted a drug that would solve the problem.
We visited one older woman. Her husband and oldest children had elevated blood pressure. We talked through a brief diagnostic considering the use of salt and oil in cooking and how much water they were drinking. We agreed some changes that she would make.
When we returned after two weeks, she told us that she was very grateful we visited her. She had made the changes we discussed and her family were eating a greater variety of food, less salt and drinking more water.
With a motorbike, some great translators and a rolled up flipchart paper we managed to directly access about 80 people, 180 indirectly. The methodology was based on resources available rather than using any particular rigour. However, there hadn’t previously been any information provided to members of the public on how to eat healthily to improve health.
As a healthcare manager, I have specialised in chronic health conditions and how they can be prevented; particularly through the innovative use of contracting and financial incentives.
I wanted to take the problems that I was trying to solve in the UK to rural Uganda. The solution was simple and in a community without electricity and limited public communication there was a dearth of such information. People were receptive and with a restricted range of food and drink products, arguably change would be easier to sustain.
However, my experience in Uganda as well as the UK has taught me that trying to get people to change their behaviour is a challenge in whichever community you live. There is no one answer, there will always be issues with rigorous cost effectiveness evaluation and the intervention is often as good as the individual delivering it.
When working or volunteering in developing countries, healthcare professionals could have a great impact in communities around the world, talking about the conditions we know well from our UK health system.
The knowledge that we have, even non-clinical knowledge, is vast in comparison to the impending problem of growth in non-communicable disease in developing countries. Getting out of the clinic or hospital and to the root cause of future issues can have a significant impact on small, vulnerable communities.
Gemma is Director at Reimagine Health Ltd, a small consultancy focused on redesigning incentives in healthcare to focus on patient outcomes and prevention. She is an alumna of the NHS Graduate Management Training Scheme and has held a variety of leadership and implementation roles within healthcare. She has volunteered in health promotion roles in Uganda and Zambia.
Gemma volunteered with Big Beyond in Uganda.
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