Kenya Heart and Sole Afya Njema Program is a transnational service-learning, research and advocacy project that partners faculty, students and clinicians from UMass Boston with the Tumutumu and Kijabe Hospital Schools of Nursing, The University of Nairobi School of Nursing and the Kenyan Ministry of Health. Each year KHAS carries out cardiovascular-metabolic screenings in six MOH community health centers intended to improve the prevention, detection and treatment of individuals at risk for or with cardiovascular-metabolic disease (CVD). Over the past six years protocols have been implemented for standardizing CVD data collection, screening and treatment protocols have been implemented and innovative projects have evolved. While the full team is only together twice a year, the Kenyan clinicians, faculty and students continue to work throughout the year and have done some extraordinary advocacy on behalf of patients with CVD. The report below is an example of how the faculty from the Tumutumu Hospital School of Nursing and nurses from the Kaiyaba clinic collaborated to implement a patient-centered CVD self management program. It’s an inspiring story of how nurses can take the initiative to implement innovation and advocate for new approaches to patient care on the national level.

Eileen Stuart-Shor, PhD, ANP, FAAN. Associate Professor UMass Boston, Nurse Practitioner Beth Israel Deaconess Medical Center

According to WHO estimates, non-communicable diseases (NCDs) contributed to 36 million deaths globally in 2008, accounting for 63% of 57 million total deaths. This staggering toll of NCDs and premature mortality in low- and middle income countries sometimes surprises those who suppose that mortality in these countries is still dominated by maternal and child deaths and deaths due to infectious diseases (The New England Journal of Medicine October 3, 2013 )

To be comprehensive, a program for the prevention and control of noncommunicable diseases must integrate policies designed to foster a societal environment in which people are encouraged to make and maintain healthy living choices, promote health literacy so that people can protect and improve their health, and provide health services focused on early detection and cost-effective management of noncommunicable diseases and their risk factors (N E J M October 3, 2013). Of concern, there is a lack of local NCD data to guide community health providers to plan services.

According to a study done by Kenya Heart and Sole: Afya Njema project June 2012, communities served by Kaiyaba clinic has high prevalence of CVMD, but the typical Western risk factors usually associated with CVMD were not observed. These results demonstrated a need for locally- tailored approaches to treating CVMD. In this line, Tumutumu School of Nursing and Kayaiba clinic, initiated a peer-led, nurse-directed, diabetes/hypertension support group that meets monthly at Kaiyaba dispensary. The purpose of the group was to maximize the ability of patients living with CVMD to self-manage their illness and optimize their quality of life.

Kaiyaba dispensary is one of the rural health facilities in Kenya under the Ministry of Health and owned by the Government of Kenya. It is located in Nyeri County off Nyeri Nairobi highway. It is headed by a Kenya registered community health nurse, offering both curative and preventive health services to the community around Kiayaba.

The peer-led support group has 17 registered members with majority aged above 45 years, with both diabetes and hypertension. Of special interest is a 14 year student with type I DM. The group is purely nurse directed in that the nursing officer in charge and District health promotion Nursing officer oversee the activities of the group.

The main activities of the group include health education on cardio-metabolic diseases, risk factor reduction, screening and testing for DM/HTN. The members have their own way of keeping themselves “together” by having a demonstration kitchen garden at the facility for teaching/enhancing on indigenous heart healthy foods.

This intervention was presented during the National Nurses Association of Kenya Annual Scientific Conference in October 2013. The presentation largely focused on the application of innovative methods in approaching the health challenge in the rural Kenya to fight the rising rates of NCDs. The nurse leaders, clinicians and the policy makers were very interested in this model. On the ground, we now see the model being adopted by various health facilities in Kenya.

The groups’ challenges include high cost of drugs, high cost of equipment (glucometer and glucosticks), and lack of established support for the NCD support groups in the Kenyan health system. As a result, KHAS supported the group and the clinic with three glucometers and some glucosticks. We believe this noble health intervention will have a great impact in cardiometabolic health and results will be presented later.

James Muturi Muchira, RN, BS. Tutor, Tumutumu Hospital School of Nursing.