Worldwide awareness of NCDs and the associated risk factors is growing, although it is still not consistently high. For people who have limited education or are living in situations such as refugee camps, the levels of awareness may be lower and resources for health information are scarce. This is why the Kenya Red Cross has initiated an NCD program in the two refugee camps of Dadaab and Kakuma. The ambition is to create awareness and the project is initiated in conjunction with national initiatives. In the last four years, the government launched the national strategy with a lot of support from the Red Cross and other partners to be able to come up with a strategy for non-communicable diseases and in that strategy, there's a very clear communication plan in terms of awareness creation. So, we have a lot of partners now who are looking at creating simple messages on risk factors; how do you do exercise? How do you eat well, you know, diet issues? How do you ensure that when you're having stress and depression what do you do? So, there's a lot of awareness now that is being packaged, of course, still a lot has to be done in terms of making it culturally sensitive, making it acceptable to people looking at how people can for example stop smoking or then have alternative ways of coping that would not be harmful to their health. So, there's already a lot that is going on, but still a lot more has to be done because it's about behavior change, communication. The picture of the disease burden in the refugee camp is similar to that of the host population where for example 30% to 40% are at risk of getting hypertension and around 27% of all deaths are related to NCDs. So far, we have seen a trend, a very high trend in terms of patients who are presenting with hypertension and diabetes. Those are the two leading causes of non-communicable diseases in the two camps, and the others being the other kind of cardiovascular diseases. To create awareness, health workers and social networks are involved in programs such as education in primary schools, home visits, and encouragement of patients to join local support groups. Often, they will meet people who have only little knowledge of symptoms and causes of disease and for the need for long-lasting self treatment. I think now people are taking it seriously, looking at the numbers of people that are now getting the condition and looking at if the condition is not taken care of, the after effects, the side effects of diabetes, things like amputations and people losing their limbs. What people are still yet to take seriously is cardiovascular conditions and hypertension. People take that for granted and people imagine "I must feel a pain somewhere to go to hospital". I know hypertension at times you may not feel any pain. You will feel a bit of discomfort but the pain is not there. But then, you just have people having cardiac arrest, just from nowhere. That is what people haven't taken seriously, because there is no physical manifestation for hypertension. But for diabetes, there is a physical manifestation. Health service providers play an important role in empowering patients, in collaboration with families, communities, and health professionals. Cultural differences related to NCDs, as well as, educational background and language should be taken into account. Although the Kenya Red Cross has launched an NCD program, far from all people in the camps are covered. In 2017, the Red Cross worked with around 40 community health workers, providing NCD drugs and services to over 450 people, and approximately 1700 people were reached through community-based sessions. That's just a fraction of the thousands of people living in the camps. So, what are the possible consequences of missing out on these NCD initiatives. I think consequence number one, of course, is looking at a population that would then silently suffer from these conditions, and maybe be treated for other conditions and not necessarily these ones. Therefore, we have a lot of misdiagnosis that would go on, we have a lot of populations that then would end up resorting to other forms of alternative treatment to take care of their conditions or for those ones that then can afford within the camp who very few, would then get services from the host community side, which would again be heavily overburdened, because in Kenya, we as a country we've also started doing seriously programming on NCDs, not very far, four years ago. So, you expect that a lot of the population from the camps would then seek services from the host community facilities, which will be overburdenig the host community facilities. So, it's been, I would say is a struggle, in short and it's a pity that as humanitarian actors we've not be able to address this early enough, but at least now there is hope now that there are more actors getting into this issue of NCDs in emergencies. There's a clear need for further awareness raising to minimize misunderstandings about causes and consequences. People need to be better informed on how to prevent or how to live with the disease. In Sylvia Khamati's opinion, there's a need for a new mindset. My biggest wish really would be to policymakers and decision makers is they should invest in health and not invest in the disease. What I mean by this is we need to look at how to support the communities to remain healthy and support them to live positively with the conditions they have, and not provide the last-mile treatment, because I think that is what at times happens, where you have medication available for you as you are very sick, but people don't look at you to be able to support you, prevent the condition, or be able to support you live positively with the condition. So, I think I would really look at policy-makers investing in Health and not investing in the diseases. Living positive with the disease means looking at a person who lives within non-communicable disease and enabling them to live healthy and being able to appreciate and accept that they have a condition and they shouldn't sentence themselves to death with the condition. This actually plays a very important role in terms of ensuring that the longevity of life for that person is made even much longer because if we make the person consider themselves as a patient who can only survive on tablets and that is it, then that becomes a very defeatist approach to it, but looking at positively living is encouraging them to live healthy, making sure that they're eating good diet, and of course they're taking their medication, but they shouldn't just rely on the tablet to live healthy. So, they should live a healthy life and appreciate that they have a condition that other people have and they can still live healthy with it.
