Dr. Bernard Gitura is one of Kenya’s leading Cardiologists and the President of the Kenya Cardiac Society. Throughout his career, Dr. Gitura has worked to ensure that everyone has access to the heart care they need.

The burden of non-communicable diseases (NCDs) and, in particular, cardiovascular diseases (CVD) is significant in Kenya. Heart diseases cause 25 percent of hospital admissions and 13 percent of deaths per year, according to the Ministry of Health. Despite this high prevalence, research shows over 50 percent of adult Kenyans have never had their blood pressure measured – a key indicator of an underlying heart condition.

The advent of COVID-19 has brought additional difficulties for people living with NCDs. People with cardiovascular disease in particular are more vulnerable to the effects of the virus – and at greater risk of complications or long-term health effects. It is important to keep the needs of people who are more vulnerable to COVID-19 at the forefront of the pandemic response, and to continue building momentum for long-term, sustainable solutions that create system-wide changes that can accelerate access to care for NCDs and infectious disease alike.

As the world continues to adjust to new challenges raised by COVID-19, we got in touch with Dr. Gitura, one of the many NCD champions working on the front line to provide care and treatment to people living with NCDs in Kenya. We asked Dr. Gitura to share his experience on how the pandemic has impacted people with CVD and how he’s having to adapt his work to respond.

To begin, how are you doing during this time of uncertainty? How are conditions in Kenya?
We are doing well considering the prevailing circumstances. We have begun to see a reduction in the number of confirmed COVID-19 cases and things are slowly going back to normal. There is still strong caution from the government for people to continue adhering to the recommended measures to avoid a resurgence.

What promising solutions or initiatives have you seen in Kenya for advancing NCD prevention, treatment and care during the pandemic?
One of the promising solutions is the use of digital health platforms such as telemedicine and mobile applications. There was an increase in use of these platforms during the pandemic, though not to a large scale. A significant proportion of Kenyans have mobile phones though the majority still don’t have ready access to internet enabled smart phones. We are yet to see if use of these digital platforms will continue beyond the pandemic. We have also seen increased use of digital platforms to train health professionals on different diseases including NCDs. At the Kenya Cardiac Society, we have conducted several webinars targeting health professionals across the country on different cardiovascular disease topics. I believe the use of digital platforms provides a cost-effective approach to building capacity of health professionals on NCDs.

When it comes to the public health response, we know that there isn’t a “one-size fits all” approach. What makes Kenya unique in terms of NCD response and what challenges have COVID-19 brought to light or exacerbated?
COVID-19 has exposed the glaring gaps in our health system. We were aware of many of these challenges but the pandemic brought them to light and prompted the much-needed action to address them. Some of these challenges include shortage of health workers. The government was able to support the recruitment of health workers across the counties to ensure we were able to manage the pandemic as well as the other infectious and NCDs. The facilities across the country were also equipped with intensive care unit facilities in anticipation of the increase in COVID-19 patients with severe disease. Last but not least, health workers, including community health volunteers across the country, were trained using both physical and virtual platforms on how to manage the Coronavirus.

I was pleased to see how NCDs received more attention when we realized that patients with underlying conditions such as cardiovascular diseases and diabetes were at higher risk of severe disease and death. Civil society organizations, as well patient-led organizations, took advantage of this opportunity to advocate for prioritization of NCDs.

What is the greatest lesson that Kenya is learning during COVID-19, particularly with regard to managing chronic conditions?
One of the greatest lessons we have learned as a country is the need to have an integrated approach. For a long time, infectious diseases have been looked at as being separate entities from NCDs. Many of these diseases such as HIV, malaria and tuberculosis are still heavily donor-funded and many times these funds only benefit patients with these conditions as opposed to addressing the health system issues holistically. It is high time we realize that the patient with malaria today is the same patient who will be diagnosed with hypertension tomorrow. We therefore have to focus on health system strengthening and not disease-specific programs. We also need to identify ways of integrating NCD management in to the existing health programs.

Have there been any real success stories or best practices when it comes to your work in the time of COVID-19 that you can share with us?
During the time of COVID-19, especially early on in the pandemic, our cardiovascular services almost came to a halt with very few patients visiting the hospitals due to the countrywide lockdown and travel restrictions. Many of my patients could not come to the clinic. A lot of patients started calling me, sharing their fears with me and asking me what to do so they could continue their medicine. I found myself spending a lot of time discussing patient’s change of conditions, their fears and their treatment plans – all over the phone. After some time, I realized it would be better to free up an hour after work to answer patient queries. I directed all patients calls regarding prescriptions and consultations to this period after work. This hour became so popular with my patients that, even now as patients come back to the clinics, many are still calling me during this hour. I am now wondering if I should continue this session moving forward and I am working with my digital team to see if this hour can be utilized as a much talked about telemedicine session.