Yeshihoseg is 30 and has had insulin-dependent diabetes since she was 21 years old. Life is hard as she is divorced, supporting two teenage children. For a living she sells the local beer, Talla. Managing her diabetes is an additional burden and although it is made easier by being able to attend the health centre, she finds it difficult to control and as a result her blood sugar levels are often very high. Most recently, she attended the clinic because she had frequent headaches and some swelling of her legs and face and was found to have raised blood pressure. She also said that she had been taking traditional (usually herbal) medicine which is common in Ethiopia but difficult for the clinic staff as the active ingredients of these medicines are frequently not known.
Yasume is 63 years old and has high blood pressure, which she was diagnosed with two years ago. At the time, her symptoms which included headaches, palpitations and swollen ankles badly affected her and made day-to-day tasks very challenging.
When Yasume began attending the health clinic two years ago, her blood pressure was measured and found to be high and she was started on medication straight away. Now, Yasume attends the clinic every month to collect her medication and see the chronic disease health officer, who checks her blood pressure, asks about symptoms and prescribes another month of drug treatment. Her symptoms no longer cause her trouble and Yasume says she’s feeling a lot better.
Yasim is a weaver who lives in the small town of Maksegnit, around 40 km south of the city of Gondar, Ethiopia. He was diagnosed with insulin-dependent diabetes 7 years ago. As he has no means of transport he is unable to travel to the local hospital and therefore has been regularly attending the health centre in Maksenit. The nurses and health officers have received training and can therefore confidently help to manage his diabetes and provide him with insulin. He cannot read or write and finds giving himself the right dose of insulin a challenge. To help him the staff at the health centre mark the insulin syringe with a piece of tape to show him the right amount of insulin to take. Recently the nurses in the health centre found he also has high blood pressure, common in patients with diabetes. They have been able to successfully start treatment for this too. Thankfully, there are no other complications for Yasim and he can continue to work as normal.
A 35-year-old young man arrived at Gondar University hospital after a wound in his right foot had failed to heal after being injured more than 2 weeks ago. It had been dressed and treated with antibiotics but was still open and painful.
Due to the high level of training on diabetes the nurse had received, she was able to confidently refer the patient for further investigation. The patient had previously not experienced any symptoms of diabetes even thought it would later come to light that he was a type 2 diabetic.
After further examination of his eyes it was evident that the patient had retinopathy, a chronic complication of diabetes which can result in loss of vision. Because the nurse was able to spot the potential signs of diabetes and refer him to a doctor, he had had the opportunity to have his eyes examined where this abnormality was discovered. He was immediately referred to the ophthalmology department for laser therapy which would go on to save his eyesight.
A 20 year old lady named Z.A. arrived at Asendabohealth centre (Jimma) with complaints of right flank pain which was spreading to the inguinal area. The nurse, while trying to check for RBC or crystals in the urine, found that the sugar levels were +3 and ketone bodies were +2. Her random blood sugar which was 400mg/dl. Going back to the history, it showed that the patient had 2 years of increased thirstiness and urine. Her father had died 12 years earlier at the age of 39 from chronic renal failure diagnosed in Jima hospital and who had beenreferred for dialysis. Her mother is fine.
She had been crying all day as she had been told that she will need to take medication for the rest of her life and would die of diabetes.She told a sad story about how her father had been well but then passed away within a few months of being diagnosised with renal failure. The patient needed reassurance and was told that early diagnosis would help to prevent complications,which otherwise could cause a premature death like her father.Many patients suffer from shock when they are told of their diagnosis of a chronic disease. Some also become depressed when they consider the implications of having to take medication for the rest of their lives. Learning that the disease is incurable also causes worry.
Later in the day, she was referred by a nurse in the health centre to inpatient care. This was because it became clear that this was a diabetic emergency (Diabetic ketoacidosis) and the patient needed insulin treatment immediately. As there was no insulin available at Asendabo, the nurse put an IV line into the youg lady and referred her to Jima Hospital.This is another clear example of how the role of nurses in rural health care facilities in early detection of chronic disease is essential. Without this, Z.A could have potentially needlessly died like her father or been subjected to a limited life.
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