By Shehu Olaitan Mohammed FCA
June 19th of every year has been designated as world sickle cell day by the United Nations Organizationsince 2008 to raise global awareness about the disease as a public health concern. This year’s Global theme is, “Closing the Survival Gap: Equity in sickle cell Disease”. The theme emphasizes addressing disparities and ensuring equal access to quality care.
As a sickle cell survivor, I examine the effect of collaboration between the community, policy makers and innovators in enhancing sustainable sickle cell care, thus helping in closing the survival gap among sickle cell warriors.
For all stakeholders in the Sickle Cell Disease Care ecosystem, one of our key concerns at each point of our discuss should be, what can we do to improve the situation of the Sickle Cell patients thus ensuring their total wellbeing?
Sickle Cell Disease has been variously referred to as a multi-system Disorder, hence the care will also require multifaceted approach. Beyond the acute manifestation of SCD in the form of bone pain crisis, it also affects the psychological well-being, social-economic participation and family dynamics of the patients. A Sustainable collaborative effort is therefore needed for the effective care of people living with the Disease.
Sustainable Sickle Cell Care will include the following.
• Early genotype and newborn screening. When the Sickle Cell statue of a child is detected early, its helps in the early commencement of necessary care, especially various immunization required, which can help prevent complication in later years. This will also ensure the commencement of early monitoring of the child and the administration of necessary medical care continuously.
• Public Awareness and Information Dissemination. The general public still lack the basic information about the causes, symptoms, manifestations and management of SCD. We must therefore develop a sustainable information sharing model in simple English and local languages which will provide basic information about the disorder.
• Emotional and social support: having identified the fact the SCD goes beyond bone pain crisis to include psychological and economic dynamics, our focus in ensuring a sustainable care must include plans that take cognizance of patient psychological wellbeing and efforts geared towards improving their ability to earn income to sustain their lives with less dependence on others.
• Long Term patient follow-up: A sustainable Care should be one that gives the Sickle Cell Disease patient access to health right from birth to old age. A structured health policy is therefore required to achieve this.
For a sustainable care to be achieved, a collaborative effort is therefore required as no single institution can do it alone. Strategies to achieve these collaborative efforts will include
1. Community Based Strategies: communities are foundational to sustainability, and could be engage by:
• Mass Education and Awareness campaign targeting the grassroots about SCD causes, signs, crisis prevention and screening. Such campaign should be in simple language understandable to the targeted community preferably in the language of the community.
• Information in the awareness campaign should also focus on reducing stigma and myths associated with SCD and promote genotype testing before marriage so that would–be couple can make informed decisions before marriage.
• Religion is an important area of people’s lives hence collaboration with faith-based organizations will go a long way in promoting awarenessespecially in a country like Nigeria, where we are deeply religious.
• The Basic SCD Care and Management should be included in the training of our community health workers and counselors and they should be well equipped to effectively discharge this responsibility at the grassroot.
• Support Groups: In recent years many of us living with Sickle Cell Disease have decided to take our destiny in our own hands. This singular decision has been responsible for many support groups in the form of various Sickle Cell Foundations and Initiatives. From my personal experience some of these foundations have been responsible for enrolling indigent SCD patients on the NHIS scheme, providing free medications to SCD patients and going as far as running free Sickle Cell Clinics. In many instances they have helped inraising funds for critical surgeries and other treatment of complication associated with SCD. These support groups need to be assisted by the government for them to even do more within the sickle cell community.
• Supporting affected Children in Schools: Our schools should be a safe place where children with SCD can be supported and their confidence built to have self-esteem despite their SCD challenges.Our teachers therefore need to have knowledge about SCD they should not be part of the problems but the solutions to preventing negative stereotypes and myths about Sickle Cell Disease.
2. Policy Based Strategies: Strong policies make care accessible and affordable. Our policy makers must therefore develop a process that ensures:
• National Guidelines: Our policy makers must develop and implement a national guideline on SCD management protocol. Such guideline should be well articulated and implemented at the primary health units to the tertiary care units. Such protocol must include newborn screening and access to affordable and subsidised treatment for SCD patient and training of health personnel on the management of SCD.
• An Effective and Efficient Blood Donation Systems: We must have an elaborate system that encourages voluntary donation, a good storage and retrieval process so that blood is made available when needed considering the fact that blood transfusion is a major treatment option for SCD patients. This will go a long way in improving the survival rate of patients.
• Our health policy must include affordable health insurance for Sickle Cell Disease patients, such health insurance policy should be one that have no restriction as to coverage, subsidised medicines and social support services.
• School and Workplace support guidelines should be put in place to ensure that SCD patients in the workplace are not place at a disadvantage position in their workplace due to their health status, as this will constitute discrimination. Policies should ensure that our children in school are protected from stigma and discrimination.
3. Innovation Based Strategies: While innovation improves reach and quality of care for the SCD patients, such innovations should be available, accessible and affordable to the patients. An example of innovations in the care of SCD is bonemarrow transplant, which is though available and accessible is not affordable to the majority of SCD patients in our country. Innovations must therefore be accomplished with accessibility and affordability to ensure sustainability.
Examples of other area of innovations that we could explore are:
• Integrated Sickle Cell Clinics: Since we have agreed that SCD also involves psychological challenges, it won’t be out of place to have a counselling unit or clinical psychology department within the SCD clinics so that patients could be attended to the same way they see their hearmatologists.
• Mobile Health Education Tools could be developed and made available through mobile phones; this will help in enlightenment and education on SCD.
• Primary Health Care as presently run should be expanded to include SCD care and community health workers program should also include basic care for SCD patients.
CONCLUSION
➢ Real Impact for Sustainable SCD Care happens when all players in the SCD care ecosystem work together: communities provide awareness and support, policy makers provide structures and funding, Health Care providers offer quality treatment and personalised services, innovators innovate solutions that are efficient, affordable and easily accessible.
➢ Sustainable SCD Care is not achievable through isolated efforts. It requires collaborative framework that unify community action, government policy, and health providers with the SCD patients.
Together, we can build a system where people living with SCD receive consistent, dignified and effective care that enhance their chance of survival and living a fulfilled life.
Shehu, is a sickle cell survivor and can be reached at shehuolaitan@yahoo.com
