May 24, 2016 | Summer 2016

Today, we visited the Chief Health Officers (CHOs) of Binkolo, Kapathe, and Kamabai Public Health Units (PHUs) in order to discuss our plans for Study 2. For each visit, we explained the scenario that applied to the specific PHU and provided a general walk-through of how the training would work. Each CHO shared meaningful insights and provided great feedback with respect to the considerations we need to make in our study. We are now preparing for our next visit with each PHU in order to train the CHO and other personnel on how to use and interpret the urine test strips and blood glucose tests. Currently, our study is being conducted across eight PHUs in Bombali District. Each PHU has been assigned a unique scenario, or mode of diabetes screening. Our goal for the study is to identify the optimal route to mass-screen individuals for a particular disease and see how the health care system responds to the introduction of diabetes screening test strips.

Aside from our PHU visits, we spent the day working on our GHTC papers. Additionally, we calculated the allocations that will be made for urine test strips, blood glucose tests, and cups for each PHU.

May 24, 2016 | Summer 2016

This morning we made many preparations for our first scenario meetings so that we have all the paperwork and posters ready to go. We printed out example posters, in black and white, to show the CHOs and CHAs at the PHUs. We met with the CHO of Kunsho and Makeri and the CHA of Kunsho to further explain their scenario, get their feedback and support. They were interested in doing the scenarios and we are planning to meet with them again.

When we showed the CHO and CHA the black and white version of the poster they told us it would be really hard for community members to interpret. They told us to look at the Ebola posters because they were very straight forward. When we showed them the color version, they thought that it was much better and would work well for its purpose.

We also introduced them to the screening questions they will record answers to for each patient and they also thought those were appropriate for any CHA or CHO doing the screening. More meetings were set up for the following few days and integrating the training into the next meetings is being considered.

This morning, we continued to work on our GHTC paper and completed to rearrange our posters to fit different scenarios. We made our posters to be printed in color to get them ready for Monday, which we will start to set up our scenarios. We met with M-Zed to finalize our scenario locations and transportation logistics for the second portion of our study. M-Zed took us to the CHO training session to meet with all the CHO for our study 2 scenarios. This meeting proved to be very helpful in the consideration of CHO schedules as well as other issues such as the number of participants and the spread of the information in ways we don’t want to disseminate.

Tomorrow the GHTC papers will be almost complete and we will finalize all other plans for Study 2. Be on the look out for pictures from the top of a mountain (if we make it).

We spent our day in the WHI office working on the GHTC papers.

May 19, 2016 | Summer 2016

Our first goal of the day was to talk to two Chief Medical Officers (CHOs) about their work at their PHUs as it relates to diabetes as well as the general practices of PHUs. We met them early in the day before their training began and got the opportunity to interview one more CHO than anticipated, all from different rural areas. A few of the CHOs had the means to screen for diabetes at their own PHU but still sent their patients with diabetes symptoms and positive tests to the local hospital. Some even travel to the urban area, Makeni, to stock Metformin at their PHU.

Next, our team went to the diabetes day in the Holy Spirit Hospital to finalize our understanding of health care with a specific aim on diabetes. We talked with many individuals with diabetes about their experiences with the disease. In particular, although testing is free at the hospital every Wednesday, many people were complaining about how expensive treatments tend to be and how having to buy specific vegetables and drugs can strain individuals financially. We learned about the clinic and its process and, in addition, we were introduced to a separate entity called the Diabetes Association: a group that meets to share experiences, diets, and exercises between members and collect funds for financial support of those in need and the families of those that pass away. With all these information, our diabetes pathway map was completed.

Our final goal was to establish a plan to implement for Study 2. We met with Bernadette about each of our specific scenarios and created a protocol for the final phase. Our current plan is three different groups, one with a paid and unpaid scenario each. We are in the process of creating a list of all possible options and then eliminating options that don’t fit into our results from Study 1.

 

The bracelet on one of the diabetic patient we interviewed at the Holy Spirit Hospital. 

Our team with the patient we interviewed at the Diabetes Day in Holy Spirit Hospital.

Our interview with the CHOs before their training begins.

May 17, 2016 | Summer 2016

This morning, the Ukweli test strip team visited Amara, the District Pharmacist. Today we visited two of five PHUs, Kamabai and Binkolo, classified as CHCs.

At Kamabai, we met the Chief Health Office (CHO) who we were able to interview. It became obvious that the CHC did not see many cases of diabetes. There was still no stigma sensed with diabetes. If they were to see a case, they would refer the individual to a regional hospital, where they would be tested and treated. At the clinic, they had one medication for the treatment of diabetes, but rarely use the drug.

Later, at Binkolo, we interviewed four clinic employees as a group and found a scenario similar to that of Kamabai. The employees we interviewed had never seen a case of diabetes in their clinic; they also don’t typically carry diabetes medication or a regular supply of screening devices. Having the opportunity to talk to multiple employees at once was a great chance to learn about the clinic from several perspectives at once and provided a comprehensive look at how the clinic functions.

To round out the day, we met with Khanjan, Bernadette, and two World Hope employees to schedule interviews with PHUs and CHWs for the next few days. Through these interviews, we’ll be creating a composite view of diabetes in Sierra Leone, in relation to the local health system. This diabetes map that we’ll be making is the product of our first study of our trip; using the map, we’ll structure our second, final study.

Our team member interviewing CHO at the Kamabai CHC.

The map and plan for the national measles marklate campaign at Binkolo CHC.

 

May 15, 2016 | Summer 2016

Today, the team was able to meet with a diabetic patient thanks to the help of Hassan, a local translator who became particularly interested in the Ukweli team project. Hassan introduced us to his friend who was diagnosed a month ago with type 2 diabetes. The man explained that he experienced diabetes symptoms for a long time but he never attributed them to the disease (before his diagnosis) and preferred to avoid hospital visits. Only when he decided to visit the local hospital due to a swollen foot, he discovered he had diabetes. Based on the testimony of various doctors that we interviewed in the previous days, this is a repeating trend in Makeni which makes the disease very dangerous and potentially lethal for local individuals.

The man continued the interview describing his visits to the Wednesday clinic at the Holy Spirit Hospital, his treatment, and his struggle with being able to only eat low-sugar or sugar-free foods. In order to give additional help to diabetes patients, a Diabetes Group was formed which meets the final Sunday of each month, sharing stories and advice about diabetes medications and diet. Thanks to this visit, the team was able to further understand the obstacles that prevent individuals from getting diagnosed and treated, which include the far distance from hospitals, the lack of money to purchase prescriptions and care, and the lack of awareness of the population about diseases such as diabetes.

During our meeting with Hassan’s friend, we took the opportunity to get some more insight on the posters we will be using in the hospitals and clinics to advertise our second study. When we asked about our current text-based poster, he told us that pictures are preferred as illiteracy rates are high. We are working with a Graphic Design Assistance Professor from Penn State, Peter, who is developing images, similar to those on posters found around Sierra Leone for our test strip advertisement. Hassan’s friend also had a pamphlet from the hospital on Diabetes, which proved to be helpful in our image development. In addition, he provided helpful clarifications on the rough draft pictures, such as using a big glass of water to represent excessive thirst.

The team worked at World Hope International office to digitalize the notes from filed work, to complete progress on GHTC papers, and further develop our posters.

 

Professor Peter showing the idea and design of our future poster about diabetes symptoms to the patient and asking for advice. The man also pointed out the ulcer on his foot as he saw the drawing.

The man showing our team the diabetes symptoms flyer provided from the hospital.

A closer look of the patient’s diabetes symptoms flyer from the hospital.

May 15, 2016 | Summer 2016

To further clarify our perceptions of Sierra Leonean health care and the local knowledge and treatment of diabetes, one of our group members visited a public hospital today with professors and World Hope employees. After speaking with the hospital’s Medical Superintendent, the head of the hospital, it was clear that the Medical Superintendent was very excited about Ukweli’s purpose and goals and sees a definite need for the project. The hospital currently uses ten parameter urinalysis test strips to diagnose diabetes because blood glucose test strips cost 15,000 Leones (about $2.50), which is too expensive for most to afford; our strips can save the hospitals and patients money, making diabetes screening more accessible and potentially allow more people with diabetes to eventually be diagnosed. This change would be extremely beneficial because most people are currently only diagnosed once they come to the hospital in a coma or with other life threatening diabetes-associated complications.

In addition, we compiled the information gathered yesterday in order to obtain more readily available data, which could be used in our future discussion course and in development of later study and article papers.

With the help of Professor Sarah Ritter, we focused on progressing and advancing on our Global Health Technology Conference (GHTC) papers. We also worked on redesigning our venture’s posters intending to be able to reprint colored posters by Sunday in order to receive feedback on them by Wednesday. These posters will later be hung in the hospitals so that it can catch the attention of patients, enabling them to know more information about diabetes screening. Our translator, Hassan, has a friend with diabetes. We plan to meet Hassan’s friend tomorrow in order to more clearly understand the daily life of an individual with diabetes. We also hope to visit a weekly diabetes association meeting that Hassan’s friend is a part of.

 

May 14, 2016 | Summer 2016

This morning, we met with Dr. Kamara, Bombali District Medical Officer (DMO), in Makeni to receive approval for our venture. We shared both the OEM and hand-stamped test strips with the DMO, and discussed the logistics regarding each of our scenarios for test strip distribution. Upon support of the DMO, we were introduced to Amara Baugali Sesay, the Bombali District Pharmacist. Amara explained the hierarchy of the healthcare system in Sierra Leone and pointed us to private hospitals, public hospitals, pharmacies, and public health units (PHUs) that we could contact in order to identify the diagnosis and treatment pathways for diabetes. Today, we visited one pharmacy and two private hospitals alongside Amara, who was very kind to travel with us and get us connected with each respective entity.

We first visited a pharmacist at MK Pharmacy located at a busy intersection in Makeni. The pharmacist provided valuable information regarding the number of individuals who walk in with diabetes, how individuals get diagnosed for diabetes, what kind of medication is used to treat diabetes, and how much such medication costs for the average consumer. The pharmacist also described the challenges surrounding diabetes screenings such as misinterpretation of tests, unsteady insulin supply, and short lifespan of insulin (i.e., it expires quickly, especially in hot and humid conditions).

After MK Pharmacy, we visited Dr. P. Turay, the medical coordinator at Holy Spirit Catholic Hospital. Dr. Turay described diabetes as a “silent killer” and commented that the frequency of diabetes in patients has been steadily increasing over the past few years. Five years ago, Dr. Turay saw 1 case of diabetes for every 10 patients. Now, Dr. Turay sees 2 to 3 cases of diabetes for every 10 patients. We also learned that the Holy Spirit Hospital hosts both a Diabetes Clinic and a Diabetes Association, which tells us there is a large need for diabetes screening and treatment in Sierra Leone. Dr. Turay was very welcoming and invited us to speak with members of the Diabetes Association in the upcoming weeks, which we can use to further investigate diabetes treatment pathways and identify the optimal way to distribute our test strips.

In our last trip for the day, we visited Dr. S. Turay, a general physician at Magbenteh Community Hospital. Dr. Turay remarked that diabetes is a serious and growing problem in Sierra Leone, but not given utmost priority. Dr. Turay also described challenges facing diabetes treatment in Sierra Leone, which included getting patients to visit clinics regularly, making medication affordable, and treating patients with Type I diabetes (which is especially difficult due to limited insulin supply). Dr. Turay was very open about diabetes being a large yet unsolved problem in Sierra Leone, and hosts weekly radio sessions, called “Talk to the Doctor,” in order to raise awareness for common health problems and encouraging individuals to visit clinics regularly. Dr. Turay was very helpful in describing the obstacles facing diabetes treatment pathways in Sierra Leone, and gave us valuable recommendations regarding the future designs of our test strips.

Our visit to the pharmacist and two doctors provided valuable information on the current state of diabetes diagnosis and treatment pathways in Sierra Leone. Both the private hospitals we visited appear to be strong candidates for our study, which involves studying the outcomes and responses of community members getting screened using our test strips. In particular, the Holy Spirit Catholic Hospital provides diabetes screening for free, while the Magbenteh Community Hospital does not provide diabetes screening for free. As a result, both hospitals provide an excellent foundation to conduct paid and unpaid scenarios of study. We would like to give much thanks to Amara for connecting us with several pharmacists and doctors in Makeni, in addition to Dr. P. Turay and Dr. S. Turay for their time and consideration in answering each of our questions. Moving forward, our game plan is to visit a couple of public hospitals and PHUs over the next few days, where we hope to connect with Community Health Workers (CHWs) and further expand our venture into the different communities of Sierra Leone.