CVD: The silent but avoidable killer

Catherine Mwauyakufa, CNS Correspondent, Zimbabwe
Photo credit: CNS
In Zimbabwe sudden death is still treated with suspicion and fingers are pointed that someone has been bewitched. How else can someone, who has been fit as a fiddle, go to bed and fail to rise up the next morning? Visits to sangomas (witch doctors) and some self-proclaimed prophets bring in more confusion as in most such instances of cardiac arrest no post mortem is done. Hence the belief that the deceased was bewitched. A common phenomena in my country is paralytic stroke. A visit to even a primary health care facility can confirm if one has high blood pressure. Yet there are many cases, where even educated people have refused to be placed on hypertension medication, since it would have to be taken for life.

“I have been told by the clinic, where I go to collect family planning tablets, that I have high blood pressure. But I am not even ill, so this issue of high blood pressure comes as a surprise. I have been told that I must start eating those small white tablets, but I refused. I will be okay,” say many women who refuse to have their hyper tension controlled by medication.

Not surprisingly then, a few months down the line, the person gets a stroke, giving rise to further speculations of witchcraft. Education on what causes a stroke is lacking and is not addressed, making it a major killer in my country. Right now main admissions in hospitals are due to TB-HIV coinfections with the majority only getting tested for HIV/TB when very sick.

Blood glucose test is not widely available in public institutions but only from private doctors and private facilities. With the majority using public facilities, it is therefore not unusual that many people have never been tested for diabetes and only get to know about their diabetes status after a stroke or recurrent attackes of dizziness, nausea, failure to comprehend issues, and numbness in fingers or legs.

NCDs - namely cancer, cardiovascular disease, diabetes, chronic lung diseases, and mental and neurological disorders - are today responsible for the majority of the global disease burden, killing approximately 38 million people every year. While all countries are affected, developing countries are hit the hardest.

Jose L Castro, the newly appointed Chair of the NCD Alliance and Executive Director of the International Union Agianst Tuberculosis and Lung Disease (the Union) hit the nail on the wall when he cautioned that even as NCDs cause 2/3rd of the global mortality, low & middle income countries are ill prepared & ill equipped to deal with them, and so it becomes imperative for the health authorities in these countries to prioritize the resources & political commitment to address the issue of non-communicable diseases. Obesity and a sedentary life style lacking in physical activity is to blame for some of the CVDs.

Dr Iris Shiripinda, a lecturer at The Health Sciences Faculty of Africa University believes that lack of exercise is one of the main causes for CVDs. “I am a lecturer and my job entails talking and standing, but not using any energy at all. I have therefore ensured that I need to cycle every day. I lived in Holland for more than a decade and there people cycle to work, to the market and even to social events. Here, in Zimbabwe it is the opposite. One even drives to a shopping centre, which may be just 1 km away. I therefore cycle as much as I can. I drive only when going to Harare which is 300 km from my university. In this way I try to keep myself healthy. People think that I am mean with my money and so I cycle. They identify driving to having made it, but for me, my health comes first. I cycle everywhere and will do so for as long as my legs carry me,” said Dr Shiripinda who is in her late forties.

A disturbing factor is that of babies born with congenital heart diseases- malformations of the heart that exist at birth. Medical correction of these defects at the local level is a mammoth task and there have been appeals for funding in local newspapers as parents seek funding to have the deformity corrected in India.

Deep vein thrombosis and pulmonary embolism have also been noted in Zimbabwe. A friend from school has had the problem and has been hospitalised three times as doctors intend to remove the clot.

“I have a clot and this is the second time I am in hospital in two years. The first time I stayed for a month as they tracked the clot and removed it. Sadly, I collapsed at home last week only to be diagnosed with another clot, which doctors say is approaching my organs. Hence the need to be admitted again in hospital,” said my former college mate from her hospital bed.

As Prof Rishi Sethi, of King George’s Medical University, India rightly said in a webinar organized by CNS, a healthy diet can contribute to a healthy body weight, a desirable lipid profile and a desirable blood pressure, and thus go a long way in preventing cardio vascular diseases. He recommends a diet that is high on intake of fruits, vegetables and fish; and low on saturated fat and transfat, salt and sugar. He cautioned against high dietary intakes of saturated fat, trans fat and salt to keep the heart in good health.

Some people in Zimbabwe have meat as the main dish that is overly salted which is not recommended. For me on a personal level, I lost my dad to heart failure. For 40 years he had worked as a messenger at a doctor’s surgery. His work involved cycling as he delivered letters and took samples to laboratories and medical aid societies.

His first stroke came 6 years after retirement, but luckily he was then at my house in the city. We rushed him to an emergency centre where his heart beat was kick started. He was with me for 6 months after which he went back to his rural home. Soon after, one day he took a nap around 6pm only to be found dead an hour later.

A post mortem confirmed heart failure. For someone who had led an active life for 40 years, his heart gave way when he suddenly become sedentary. I now know that the secret to keep my heart ticking and alive is to living with a correct diet and physical activity.

Now the world leaders have already met in New York and agreed to respect the post 2015 Sustainable Development Goals and said that non communicable diseases (NCDs) have to be halved before 2030. These promises have to be transformed to genuine action as they will go a long way in lowering the risks of CVDs. As for countries like my homeland Zimbabwe, it all begins with literacy, awareness and how to handle CVDs, as these are still treated with suspicion in a country like Zimbabwe.

Catherine Mwauyakufa, Citizen News service - CNS
October 4, 2015