After a long day at work, Brenda Mirabeau loves to put on her favourite music and dance around the house. So, six years ago, when her toes went numb and she could no longer walk around at home, her family was alarmed. “I was so cold that I was shivering… that’s when they rushed me to the hospital,” she says. After emergency care, Mirabeau was diagnosed with diabetes, a condition that runs in her family.

Everything has changed in the six years since. It has been a long road back to health and mobility that Mirabeau has walked with health care professionals trained to help Seychelles address the country’s significant burden of noncommunicable diseases (NCDs).

NCDs accounted for more than half of the total number of deaths in Seychelles in 2022 and more than half of those (52%) were due to diseases of the circulatory system, such as heart disease and stroke. Cardiovascular diseases are the leading cause of death, accounting for 58% of all NCD-related mortality.

“It is often difficult for us to witness the practices and behaviours among the population that are contributing to the crisis, but we are working hard towards early detection and ensuring compliance with treatment,” says Jourdanne Letourdie, a nursing officer at Anse Aux Pins clinic in the country’s capital, Victoria.

In 2019, the WHO Package of Essential NCDs in Primary Health Care (PEN) was adapted for Seychelles, christened SEY-PEN, and piloted at the Anse Aux Pins and Beau Vallon health centres. Implementation then had to be put on hold because of the COVID-19 pandemic. Finally, in late 2022, 165 health care workers across the three main islands were given comprehensive training to effectively implement SEY-PEN. Full implementation in public health facilities began in January 2023.

In the first half of 2023, 134 health care workers were given further practical training on how to provide information and counselling on risk factors and how to to support lifestyle changes to prevent complications. Eight nurses have also been trained on correct procedures for monthly submission of NCD data, which is critical for programmatic decision-making.

Today all 15 public health facilities have a nurse who is the focal person for NCDs in the facility.

For Letourdie, it was a big shift from general nursing to overseeing chronic care. But she has found her stride and enjoys working with clients like Mirabeau. She runs two information sessions a week for people with chronic conditions. “I give them information about their condition and its management, the complications, potential treatments, while the nutritionist discusses food choices. There is so much that people can do, and I am doing my best to share all the information possible,” she says.

Due to an increase in screening, 75 new cases of hypertension and 34 new cases of diabetes were detected in the first quarter of 2024, compared with 35 and 17 during the same period in 2023.

“Although it is too early to note significant improvements, we have been heartened by notable increases in the number of patients undergoing blood pressure and diabetes screenings,” says Dr Vivianne Camille, a senior medical officer with Seychelles’ Ministry of Health and SEY-PEN chairperson. “With a focus on patient education this year, we look forward to empowering more people to take control of their health and reduce the prevalence and impact of these diseases.”

SEY-PEN has high-level commitment from the Ministry of Health’s senior management, ensuring smooth implementation, and, in 2023, President Wavel Ramkalawan launched the “Stop Obesity” campaign to counter one of the leading causes of chronic diseases in the country.

“With the implementation of SEY-PEN in full swing, we look forward to the time when no one will be diagnosed late as was the case with Brenda Mirabeau,” says Dr Camille.

WHO has been closely involved in the implementation of SEY-PEN. The Organization deployed an international expert to support with the adaptation of the WHO PEN standards to the local context, training of health workers and provides updated guidelines and essential tools for detection and management of diabetes mellitus and hypertension to support to programme implementation at the primary health care.

“We are proud of the work we have done with the government of Seychelles,” says Dr Rex Mpazanje, WHO Representative in Seychelles. “We understand that every interaction with a health care provider is a valuable opportunity to provide screening, management and counselling, so health worker training is a key element of the response,” he says.

Mirabeau’s zest for life is back. She watches what she eats, takes her medication and dances to maintain an active lifestyle. “I visit the clinic every four months for a check-up,” she says. “I am thankful to the health workers for helping me get my condition under control.”