A life on the road had caught up with Alphonce Wambua. Twenty-five years of transporting cargo between the Kenyan capital, Nairobi, and the coastal city of Mombasa, nine hours’ drive away, had resulted in long days, a poor diet and an irregular sleep routine for the trucker. Still, it came as a shock when doctors told him he had hypertension a few years ago.
“I wasn’t expecting it – I thought I just had serious fatigue,” says Wambua, who has stopped by the clinic where he was diagnosed to pick up his monthly prescription. “This job is high pressure. There’s not much rest: you either have a client waiting for you to drop cargo or pick it up.”
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
The health facility, based in Mlolongo, on the busy Nairobi-Mombasa highway, attracts a steady flow of patients. As well as workers and residents from the area, it also treats drivers from the truckers’ rest stop across the road, as one of 19 roadside health facilities run by the nonprofit North Star Alliance, offering priority healthcare to mobile populations.
The organisation, which constructs clinics out of shipping containers, has set up facilities along major transport routes, transit towns, and border crossings across east and southern Africa to increase mobile workers’ access to medical services.
“When governments do their health planning, they usually plan for communities, but no one plans for mobile workers,” says Jacob Okoth, a programmes manager at North Star Alliance. “Their operating hours are different, so you can’t reach them with the traditional 8am-5pm healthcare service delivery model, and many can only afford to queue for short wait times.”
North Star was founded in 2006 to tackle HIV and STD cases in the transport sector during the height of the Aids epidemic, when some transport companies were losing more than 50% of their drivers to the disease. It extended its services to cover broader health issues after identifying other recurring health concerns among mobile workers, including non-communicable diseases.
NCDs such as hypertension and diabetes are responsible for more than half of hospital admissions and deaths in Kenya. Health practitioners warn that the growing burden demands new approaches for prevention, diagnosis and treatment.
North Star’s clinics provided health services to more than 180,000 patients in the region in 2022, nearly third of whom were truck drivers. In 2023, its clinics treated 2,332 people for hypertension and diabetes, a relatively small number due to limited funding.
Many of the NGO’s health centres are along the northern corridor, one of east Africa’s busiest transport routes, which connects several countries in the region. Truck drivers who transport cargo along the corridor can travel for 12-hour stretches with short breaks in between, sometimes for weeks or months at a time. In some areas, the distances between hospitals are long; drivers often delay seeking care due to time pressures or irregular work cycles. Because people with illnesses such as hypertension may not show symptoms early on, a number stumble upon their diagnosis.
Billy Odhiambo, a clinician at North Star’s Mlolongo clinic, says: “They came for another condition and then discover that they have hypertension. Considering high blood pressure is a life threatening condition, detecting it early can save lives.”
Regular health checkups are essential for truckers, whose sedentary lifestyle predisposes them to weight gain and non-communicable diseases. Many rely on high-carbohydrate meals to keep them full on long drives, and they struggle to maintain a balanced diet due to time and cost pressures, says Wambua, whose go-to meal is the Kenyan staple ugali (boiled maize meal), which he eats with fermented milk. Having simple meals, he says, also helps him avoid stomach upsets. At rest stops, he usually grabs a snack or fizzy drink.
“You’re not focused on eating healthy food – you eat what you find and continue with the journey,” he says, while a clinician takes his blood pressure and writes him a new prescription. The clinics offer free medication when it is available, but shortfalls in funding mean they now mainly prescribe, rather than dispense medicine, and that their facilities are understaffed.
Each health centre tailors its opening hours to the needs of mobile workers in the area. Some, like the Mlolongo health centre, have regular 9am-6pm opening hours, but run outreach programmes in which clinicians and trained volunteers offer free health screenings to target groups, such as truckers, sex workers and informal traders. The volunteers visit key areas like truck stops carrying blood pressure cuffs and glucometers to check for hypertension and diabetes. Cases of concern are then referred to the clinic.
Medical staff can access patient information from any of North Star’s facilities in the region, which helps them keep track of how the workers are faring, but face some challenges when patients travel frequently outside their countries of operation.
“It makes it hard to follow up on their medication. One day, he’s here, the next he’s in Congo; you can’t be sure if he’s accessing the right care there,” says Odhiambo.
On his doctor’s recommendation, Wambua has made some lifestyle changes. Drastic diet changes are cost prohibitive, he says, but he now goes for short morning walks and tries to stay physically active on Sundays when he’s not working.
As NCDs become more prevalent, access to flexible health services and an early diagnosis can be a lifeline for mobile workers, Wambua says. “As a truck driver, you need to know your [health] condition – that’s the only way you can manage it.”
