Awaiting the last heartbeat

Photo credit: CNS
Alice Tembe, CNS Correspondent, Swaziland
“I need to enjoy the last days of my life now, and live like as if today is my last day on earth. Life is too short.” These were the words of 35 years old Mr. Brown (name changed) face down, with tears flowing on his cheeks, when Dr. Dlamini had explained that his heart was operating at 25%. Unfortunately in most cardiovascular disease patients, the complications of cardio health are discovered by accident. In low and middle income countries, like the Kingdom of Swaziland, routine medical check-ups are a luxury for a majority of people.

It is not typical for a healthy individual to stand in a long queue for most of the day, just to have a routine medical check-up. Even the medical officers may not tolerate such ‘interruptions’  while really sick patients wait in the queue.

Dr. Dlamini, a general practitioner who examined Mr Brown, explained that the diagnosis of this middle aged man is loaded with harsh realities. In the absence of a heart specialist in his country, Mr. Brown was referred to seek consultation in neighboring South Africa. Regardless of the urgency of his clinical condition, he had to stay in his country and at work for another week before mobilizing enough out-of-pocket funds to finance his seven hour long round trip to Johannesburg in South Africa, (including money for accommodation and meals, and more importantly fess for medical consultation).

This is but the story of one man. It is known according to the World Health Organization statistics that more than three quarters of deaths caused by cardiovascular diseases take place in low and middle income countries. As Dr. Dlamini said, the patients have to fund the expenses that come with late diagnosis of heart diseases out of their pocket, and most of these patients cannot afford it. Hence they have no other alternative than to settle for living the days they have left fully, be comfortable and wait for their last heartbeat.

According to WHO’s latest fact sheet, 17.5 million people die from cardiovascular diseases worldwide, representing 31% of all global deaths. Prof. Rishi Sethi, of the Department of Cardiology at King George’s Medical University in India, says that cardiovascular diseases account for 34% of all deaths in women and 28% in men. As the world is set to adopt the Sustainable Development Goals, it is essential to note the wide gap and distance that cardiovascular disease patients have to cross, just to get a diagnosis. The importance of public health education for patients to appreciate the preventative measures and management of cardiovascular diseases, advancement of medical care in low to middle income countries as well as increased access to routine medical assessments, cannot be over-emphasized.

Cardiovascular diseases are a group of disorders of the heart and blood vessels, that include (i) coronary heart disease (disease of the blood vessels supplying the heart muscle); (ii) cerebrovascular disease (disease of the blood vessels supplying the brain); (iii) peripheral arterial disease (disease of the blood vessels supplying the arms and legs); (iv) rheumatic heart disease (damage to the heart muscle and heart valves); (v) congenital heart disease ( malformations of the heart structure since birth); and (vi) deep vein thrombosis and pulmonary embolism (blood clots in the leg veins).

Unfortunately, there are often no early symptoms of the underlying disease of the blood vessels, and a heart attack or stroke may be the first warning sign of the underlying disease. However, pain or discomfort in the centre of the chest, arms, elbows, jaw or back are symptoms of a heart attack.

Stroke is usually indicated by numbness in the face, arm or leg; confusion and difficulty in speaking or understanding speech; difficulty in seeing and/or walking; severe headache; fainting or unconsciousness. These symptoms require immediate medical attention. While commemorating World Heart Day (that is held on September 29, every year), it is essential to remember that most deaths related to cardiovascular diseases can be prevented. Prof  Rishi Sethi advice that by making small changes for a positive and healthy lifestyles in our day to day lives—eating healthy diets, doing physical activity and quitting smoking--the last heartbeat may be a long way away.

Alice Tembe, Citizen News Service - CNS
October 3, 2015