Oda Nsabimana, 61, is a breast cancer survivor dealing with hypertension and diabetes. After five years of battling cancer, she started getting chronic headaches and upon medical checkup, she was told that she had hypertension.

Five years later, she developed diabetes as a result of treatment from pemphigus, an autoimmune disease that causes blistering of the skin.

"After receiving treatment in Brussels, I began feeling constantly dizzy and after visiting the doctor, I was diagnosed with type 2 diabetes,” she says.

As an NCD advocate, the biggest challenge she has noticed is that Rwandans fear testing and would rather live in unawareness. Most of them do so when they develop symptoms which could significantly affect their health as sometimes symptoms appear at later stages of the disease.

24-year-old Paladie Kampuhwe Mategeko, says she got to know she has type 1 diabetes two weeks after experiencing symptoms like fatigue, thirst, loss of weight and the need to use the bathroom often.

"At my age, we couldn’t connect those symptoms to diabetes, as people still believe diabetes is for older people, and I was only taken to hospital because they thought I was poisoned,” she says.

After taking her blood sample, they found out she had very high blood sugar, and since then she has been on medication for diabetes.

Creating awareness

Despite awareness put in place on NCDs, medics confirm that the number of people turning up for screening is still low. Although data shows some increase in the number of people turning up for screening, it has been observed that there is still a need for more people to get screened.

The available data from Rwanda Biomedical Center (RBC) indicates that there were 83 per cent eligible people who turned up for community screening this year.

Dr Simon Pierre Niyonsenga, the Diabetes, Renal, Respiratory and Other Metabolic Diseases Programs Director at RBC, says that if 83 per cent of people turn up for screening, they are supposed to see among this number how many made a follow-up regarding doing all the tests needed, especially those who tested positive for any of the NCDs.

On NCDs, he says the followed up cases are only 12 per cent, meaning that the percentage remaining are not followed up, which according to him indicates a huge number from what is expected. The big percentage of this is on both diabetes and hypertension.

He cites that there is still a gap as most of the people don’t show up for further testing as they presume to be okay, especially if they are not experiencing any pain.

"It’s quite challenging to know the exact number of those screened and those who need a follow-up because we have been using paper-based community checkup screening, which makes it hard to do a proper follow up across the country,” he says.

At the moment, they are expecting to do a clear and proper follow-up on the patients as they have introduced a digital system known as NCD tracker, which has been put in every health facility.

He says here, the data recorded is centralised to trace who tested positive for what and do a proper follow-up, to know who is coming and who is not, as the system is linked to case management.

Diabetes and hypertension

Dr Evariste Ntaganda, officer in charge of cardiovascular diseases at RBC, says diabetes and hypertension are among a group of four major NCDs worldwide, including Rwanda.

Hypertension is the most prevalent NCD in Rwanda with 16 per cent of the population having it. Three percent have diabetes according to the nationwide studies conducted recently.

From an expert’s point of view, 16 and 3 per cent out of 12 million people is an alarming number. The common complications of diabetes and hypertension are stroke, cardiovascular diseases and kidney failure.

Etienne Ingabire, director of Rwanda Diabetes Association (RDA), explains that the rationale behind this is that high blood pressure increases the force of blood through arteries and can damage artery walls. Having both high blood pressure and diabetes can greatly increase your risk for heart disease.

For stroke, he says, since the body can’t make insulin or can’t use insulin correctly, it causes glucose (sugar) to build up in the blood. Overtime, high glucose levels can damage the body’s blood vessels, increasing the chance of stroke.

Also, Ingabire adds that high blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons so they don’t work as well as they should.

"Getting treatment for hypertension and diabetes is important as they are also the risk factor for heart diseases, kidney failure and stroke. When you treat hypertension and diabetes well, you are delaying those complications (heart, kidney failure and stroke),” advises Dr Ntaganda.

People who do not have hypertension or diabetes, Dr Ntaganda says, should avoid abuse of alcohol, smoking, physical inactivity, obesity.

Solutions

Initiatives like car free day, which has been extended to all districts, are some of programmes to help people fight NCDs. All medical insurances in Rwanda starting from community-based health insurance (Mutuelle de santé) cover NCDs screening.

This is a good prevention method that has been validated in the country to help people fight NCDs.

Regarding diet, the government initiated a programme known as ‘akarima k’igikoni’ or ‘kitchen garden’, especially in rural areas for every family to have one for planting vegetables and fruits.

This is to respond to eating healthy, fighting malnutrition and stunting, and have all communities access nutritious vegetables and fruits.

Professor Joseph Mucumbitsi, a cardiologist and the president of Rwanda Heart Foundation and Rwanda NCD Alliance, says a lifestyle change is also the key prevention of NCDs.

In fact, he affirms that one can even reverse the trend of some of these NCDs after addressing lifestyle modification, especially when the conditions are in their early stages.

"This is the reason why screening and seeking medical attention early enough still plays a pivotal role in fighting NCDs,” he says.