Clinicians and Peer Educators Share Tools for Diabetes Self-Management
Allen Nabisere, a clinical officer for the Sonia Nabeta Foundation in Jinja, Uganda, presents a certificate of completion for peer support training to Lilian Kube Philipe, a clinical officer at the PEN-Plus clinic at Koidu Government Hospital in Sierra Leone. Christine Nabatanzi, warrior coordinator for the Sonia Nabeta Foundation, stands at left, beaming.
A peer education event in May brought clinicians and community advocates from three countries to Kono District, Sierra Leone, for training on type 1 diabetes management and symptoms, leadership, and…building towers out of spaghetti.
Dr. Remy Bitwayiki, the NCDI Poverty Network’s regional advisor for West Africa, said the May 14–17 event at Kono District Hospital focused primarily on diabetes-related topics such as managing hyperglycemia and handling insulin. But for the more than a dozen participants, who included clinicians and peer educators from Liberia, Uganda, and the Pujehun and Kono districts of Sierra Leone, there also was a focus on leadership styles and collaboration. That meant team-building games, such as a challenge to work with a partner and build the tallest tower possible out of uncooked spaghetti.
“It required a lot of communication and discussion,” Dr. Bitwayiki said of the challenge. “People really got involved with the construction.”
They also got involved with the purpose behind the challenge, which was communication. For peer educators and clinicians who support care in low-resource settings for type 1 diabetes and other severe, chronic noncommunicable diseases, communication skills are crucial. Treatment for type 1 diabetes can extend far beyond clinical care, to also include support for mental health, well-being, and skills such as organization and responsibility, to be able to independently check blood sugar levels, for example. All of that requires collaboration—and help from others.
“Peer support groups are a key instrument in diabetes self-management,” said Dr. Bitwayiki, who also serves as the West African regional advisor for the Network’s U.S. co-secretariat, the Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital in Boston. “We are trying to train our patients on self-management, while also teaching them to give each other psychosocial support.”
Along with clinicians, Dr. Bitwayiki said, some of the participants in the Kono peer education event were teenagers active in their communities and with an aptitude for leadership.
Participants were selected because of their involvement with clinics that provide PEN-Plus, a package of clinical services that enables frontline providers in low-income health systems to provide high-quality care for people living with severe, chronic NCDs, such as type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease.
Peer support groups are a vital foundation for NCD education and advocacy, Dr. Bitwayiki said. The Network facilitates peer support groups in many places served by PEN-Plus clinics, including the Kono and Pujehun districts in Sierra Leone, and locations in Liberia and Uganda.
The Network and the Center for Integration Science hosted the May training event in Kono District along with the Sonia Nabeta Foundation, which provides resources, advocacy, training, education, and events for children and adolescents with type 1 diabetes across Africa.
Lilian Kumba Phillie, a nurse at the PEN-Plus clinic at Koidu Government Hospital in Kono District, said the peer education training will directly affect how she provides care.
“As a clinical officer in Sierra Leone, I have received only limited training on type 1 diabetes, so learning comprehensively and directly, from a Uganda sister clinician working in the same clinic setting, was a powerful experience,” she said. “Her teaching on insulin management, sick day management, and psychosocial care gave me practical tools I can immediately use in my clinic.”
Dr. Bitwayiki said the training also covered social topics for peer educators.
“You cannot talk about type 1 diabetes education,” Dr. Bitwayiki said, “without talking about the stigma in communities, especially in schools.”
He added that stigma can have an impact on young people’s school performance and their mental health in daily activities. Without support, some will drop out of school and face depression or anxiety.
“The best way to deal with this stigma is to talk with someone you trust,” Dr. Bitwayiki said. “In clinics, it can be valuable to talk with a mental health officer or, if that’s not an option, a community leader or family member.”
One such leader is Christine Nabatanzi, a warrior coordinator for the Sonia Nabeta Foundation in Uganda. Children and young people living with severe NCDs often refer to each other as warriors, because of the strength and spirit needed to handle daily challenges from their conditions.
Nabatanzi said she is an example of how peer education can have exponential impacts across communities, regions, and nations.
“Going to Sierra Leone to train other warriors felt like a full-circle moment,” Nabatanzi said of the May event. “I was part of the very first Warrior Educator Training at the Sonia Nabeta Foundation and now, just months later, I was sharing what I have learned with peers from another country. It showed me how powerful this training really is and how it is multiplying impact with neighbors in Africa."
Dr. Bitwayiki said more peer education trainings are planned next year, in several countries served by PEN-Plus clinics. He hopes the energy from the May event will continue.
“I’ve participated in many trainings,” he said, “but I have rarely seen one where everyone was this excited and enthusiastic.”