Raising awareness to reduce asthma burden

Catherine Mwauyakufa, CNS Correspondent, Zimbabwe
(First published at The Minica Post)
Since 1998 the world has recognised May 3 as World Asthma Day and this has helped in raising awareness. Asthma is not curable but through proper medication and appropriate management the disease burden can be reduced. The causes of asthma are not wholly understood but include a mix of genetic predisposition and exposure to triggers.

While short term medications are used to relieve symptoms during an asthma attack, long term regular use of inhaled steroids can prevent/control the progression of severe asthma. Growing up in Harare with an aunt, who had asthma, in the 80s was a difficult time for her and the family. Aunt Laura was my mother’s elder sister and each time she went back to her rural home of her in-laws in Hurungwe, she would fall ill. She would get better on returning to Harare. The village people called her a ‘lazy woman’ who did not want to till the land, fetch firewood and hew water from the stream. Just by sitting in a smoke filled kitchen and blowing the cinders to cook for a day, she would suddenly get a severe attack. She was nicknamed ‘mugara dzakasungwa’ (one who has bags packed ready to travel).

The rural folks taunted her that she faked her illness just to return to the bright lights of the city. Aunt looked and sounded ill. However she was not treated as an ill person, but was rather labelled as being lazy. As a woman who could not fulfil her expected chores in the rural home she was seen unfit to have had a man pay lobola (bride price in cash or kind, which a prospective husband undertakes to give to the prospective wife’s family in consideration of a customary marriage) for her. Poor Aunt Laura! By being sedentary most of the times she also became obese, which was a problem too. Being very young at that time, I did not understand her condition but her wheezing, coughing, shortness of breath and the heaving chest movements would disturb me greatly. Little did I realise then that all these were symptoms of asthma— a chronic non communicable disease that affects more than 300 million people globally. Aunt Laura used to drink water from a clay pot where a live frog was kept. This was believed to help her breathe better as the frog had an ability to breathe under water.

Her life improved dramatically when Bobo, one of her sons, took her to live with him permanently, when he started working as an accountant in Harare. There she was put on medication and used an inhaler and her asthma attacks became less frequent. Being educated, Bobo had understood that the rural environment was not suitable for his mother’s condition. Tilling the field, cooking on firewood, sleeping on the floor smoothed with cow dung and the dusty smoke filled  grass thatched kitchen— all this exacerbated her asthma and triggered the attacks. But aunt’s happiness was short-lived. Bobo had a fatal road accident. During the funeral, which, in our custom, sees mourners keeping vigil until the deceased is laid to rest, aunt had to stay for 72 hours in a room with over 20 other mourners. Her emotional distress at her son’s death, coupled with staying in a very congested room for 3 days, proved too much for her. She did not wake up on the day Bobo was to be laid to rest. She was pronounced dead on arrival at the clinic.

With the knowledge I have today, Aunt Laura’s death was avoidable. As much as people said that the pain of losing her son killed her, I see the real cause of death was being indoors and breathing polluted air for a long time. No one had bothered to check if she was taking her medication during the funeral. While speaking at a webinar hosted by CNS, Dr Jeremiah Chakaya Muhwa of  the Forum of International Respiratory Societies (FIRS) and Member, Board of Directors at the International Union against TB and Lung Disease (The Union) said that asthma worsens poverty because the sufferer misses work thereby enlarging the poverty loop. “People with persistent symptoms must take long term daily medication to control the underlying inflammation and prevent symptoms and exacerbations,” said Dr Chakaya. The World Health Organisation (WHO) states that though asthma does not kill on the scale of chronic obstructive pulmonary disease (COPD) or other chronic diseases, failure to use or adhere to appropriate medication can prove fatal at times.

A recent Cochrane Review announced that Yoga may have some beneficial effect on symptoms and quality of life of asthma patients. But its action on lung function and medication use are still uncertain, and more studies need to be done for it. Sustainable development goals (SDGs) 2030 target to reduce premature mortality from NCDs by one third by 2030. Taking life long quality medication and avoiding exposure to triggers can help reduce asthma-related deaths dramatically and also help patients lead a normal life. Creating awareness about proper management of asthma would go a long way in helping people better control this incurable disease. The Minister of Health and Child Care, Dr David Parirenyatwa said that asthma burden in Zimbabwe is high and flares up seasonally. “When spring comes, pollen in the air results in a high number of asthma attacks. So we have many people needing medical attention. August, when we have strong winds and there is too much of dust in the air, is another burden time. We are, however, working hard to have the required medication available in our hospitals nationwide,” he said.

What then can rural persons, living constantly under the trigger conditions in Zimbabwe, do to improve their quality of life, even as access to medication is constrained? I think one solution to the problem is harnessing the abundantly available sunshine for solar energy. A solar energy summit was held in Harare in 1997 but even after 19 years the government has not done anything concrete. For now solar projects are available on individual basis but the rural poor cannot afford the cost. Solar energy would see many ‘once thick forests now turned deserts’ getting lush green again. This will not only reduce pollution but would help in achieving the SDGs.

(First published at The Minica Post)

Catherine Mwauyakufa, Citizen News Service - CNS
May 15, 2016

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