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Rwandans Trained to Conduct 'Verbal' Autopsy

Godfrey Ngoboka, HBCP program Manager at RBC

Abdallah Wendo 63, a resident of Kiyovu Cell, Nyarugenge district was paralyzed in 2012 following a car accident from which he broke his spine.

The accident was an addition to the existing problem he had of goiter. When he went to see the doctor, he was told that it was too late for cure.

“We have to see him every day for physiotherapy, massage and make sure he is taking his medicine and eating well,” Pacifique Kwitonda, a home based care practitioner said.

Kwitonda works day and night to make sure that patients with incurable non communicable diseases (NCDs) from Kiyovu Cell are properly cared for.

The incurable NCDs include cardiovascular diseases, diabetes, cancer, respiratory diseases and fatal injuries.

Kwitonda is among 206 youth from 100 Cells across the country trained by the Workforce Development Authority (WDA) in partnership with Ministry of Health and National Institute of Statistics.

The initiative is called ‘Home Based Care Practitioners (HBCP) Program’ that started in May this year.

HBCP program offers free special treatment and companionship to NCDs patients especially those in their last days, clinically known as ‘palliative care’.

“Even if we can’t cure someone, the pain can be appeased. That’s why the HBCPs are equipped with sufficient pain killers like morphine,” said Diane Mukasahaha, National Coordinator of palliative care at Rwanda Biomedical Center.

HBCPs underwent a six months training (From May to November 2015) on clinical courses including wounds dressing, pain management, physiotherapy, massage as well as psychological behaviours to assist patients.

“They were selected based on their age (21-35), level of education as well as their integrity,” Godfrey Ngoboka, HBCP program Manager at RBC said.

Autopsy, Not by a Doctor

According to Ngoboka, HBCPs on top of home based care; they also conduct awareness campaigns on NCD’s prevention.

They also practice ‘verbal autopsy’ on deaths that happened outside hospital premises.

This according to Ngoboka helps the Ministry of health to determine the likely causes of death in the community which figures indicate 60%.

“We have given them tablets equipped with a software questionnaire called ‘smart autopsy’ whereby families of the deceased answers to the questions related to the conditions of the deceased before death,” Ngoboka said.

So far, 459 verbal autopsies have been conducted since May, according to RBC records.

Ngoboka also said HBCP program is helping the country to save money that was spent on chronicle disease patients before.

For example Kigali University Teaching Hospital (CHUK), receives between 20-30 patients with complicated NCD’s cases annually. A hospitalized diabetic pays at least Rfw 100 000 per day including consultation and treatment fees.

This means if he uses insurance that pays 85% of the total cost, the country spends more than Rwf 2.5 million per patient monthly.

Ngoboka says the program is also assisting the National Employment Program (NEP) to create 200, 000 off-farm jobs.

“In the first phase 206 were trained and they are paid Rwf65, 000. We are planning to train other 2,148 to cover the whole country because we started with 100 cells that surround district and referral hospitals. This is reducing the number of youth unemployed,” said Ngoboka.

The World Health Organization (WHO) indicate that NCDs are responsible for 70% of deaths worldwide.

These NCDs share key risk factors like tobacco use, unhealthy diet, lack of physical activity, and the harmful use of alcohol, which in turn lead to overweight and obesity, blood pressure, cholesterol, and other diseases.

In 2016 alone 3,656 people died due to NCDs and injuries. Of this 2,052 equivalent to 56% were due to injuries and disabilities, while 655 (18%) were due to cardiovascular diseases and 315(9%) due to diabetes.

Cancer caused 172(5%) deaths

As the world celebrated ‘World Heart Day’ on September 29th, the Ministry of health under the theme ‘share the power to prevent heart diseases ‘has started an awareness campaigns from September 24th to October 1stto sensitize Rwandans to prevent NCD’s.

In the one week campaign, Health Ministry is testing NCDs especially cardiovascular diseases that are killing a big number of people according to RBC.