OPINION

By Terence Kalule

The thrill of the chase, while fighting to restore the pathway of a blocked coronary artery (blood vessel of the heart) - lies in how fast the clinical team is; to destroy the blockage before this heart attack kills someone! Common warning symptoms preceding this impromptu experience come in forms of a stabbing chest pain - which often times radiates towards one’s left arm, shortness of breath, intense anxiety, among others.

This adrenaline filled procedure can only be performed in a catheterization lab, a special lab well equipped to execute a life-saving intervention.

In Uganda, we currently have only four fully functional Cardiac Catheterization laboratories - all located within the central region. One at the Uganda Heart institute (Mulago Hospital) - a government facility; the other three in Nakasero, Case and Kisubi hospitals - all three being private facilities!

What are the chances a random Ugandan suffering a heart attack can afford undergoing this nature of procedure, worse still accessing these facilities in a short time - considering their distribution across the nation, alongside other factors like the efficiency of our country’s emergency-response-program and roads-network? 

Science, on this budding chronic killer of a condition; has been kind enough to reveal to us the common risk factors fueling the development of a heart attack. Obesity, High blood pressure, elevated Cholesterol levels (high levels of fat in the blood), Smoking and Diabetes mellitus (high blood sugar levels); collectively maintain the ranks - being the top five risk factors for ending up with a heart attack! If for personality, a heart attack is one being that stealthily develops over a handful of decades! Walls of the coronary arteries change unnoticed, with fatty plaque deposits accumulating in and on these arteries - narrowing their pathways. The peak of this stealthy blood-flow heist comes to be, when this narrowing segment of the arteries blocks off completely. The plaque can burst, advancing into a blood clot!

Studies on the causes of coronary heart disease (damage or disease to the heart’s major blood vessels) - prior to the 1950s, had considered it such an uphill task for Africans to be diagnosed with coronary heart disease (CHD). A particular study performed in colonial Uganda (Davies, J.N.P., 1948) regarded Ugandans of African descent to be “ethnically immune”, to the development of CHD; in comparison to the Ugandans of Asian descent - in whom this disease was a sore challenge!

What informed this sanctimonious opinion about Africans; was often times their lifestyles, physical activity characterized with digging, brick laying, etc., and a mediterranean diet that comprised of mostly organic local food. This way of living decreased greatly the risks Africans would ever develop CHD.

It was not until Sharper and Jones – in 1959; a few years following the former study; also chose to study the same population.  The duo really had a yearning of sinking their fangs into this so called “ethnic immunity” Ugandans of African descent had, towards CHD! Much to their surprise, the African race was not all gold as the glitter had predicted! Having considered other risk factors such as cholesterol levels as a contribution from the diet; whilst refraining for the “racial profiling” which was somewhat common at the time; Sharper and Jones found - that much as both Ugandans of African and Asian descent differed distinctly in their levels of cholesterol; both groups were very pre-disposed to the same exact risks of being diagnosed with coronary heart disease (Shaper, A.G. and Jones, K.W., 1959)! Noteworthy, at the time of this study, the then Kampala Health Department reported 43% of male deaths and 9% female deaths over 30 years of age - among Asians, to be attributed to CHD over a period of three years, from 1956 - 1958.

If Sharper and Jones followed up on this project of theirs today, considering the current trends in the Ugandan population, they’d be astonished - but not surprised! The notable STEPS survey, conducted by the World Health Organisation & Ministry of Health on Ugandans in 2014 – revealed disturbing statistics. Their target population were adults aged 18 - 69 years; surveying the disease risk factors liable for these communicable beings, catching non-communicable diseases. (This same study cohort should be aged in the ranges of 27 - 78 years, as of today).

Over 70% of the participants had never had their blood pressure measurements taken! While collecting data, it was found that 1 in 4 participants had quite an elevated blood pressure reading (or had been taking treatment for the raised blood pressure). Consequently, majority of Ugandans with hypertension were not aware of their hypertension status. Only 7.7% of the participants knew about their hypertensive status; and even then; an immense 76.1% of the participants with raised blood pressure were not on treatment or any kind of management to lower down the raised blood pressures!

Furthermore, participants who lived in urban areas were found - much more; to have elevated blood sugar levels – in comparison to those that lived in rural areas. When asked, 94.9% of the participants had never had their blood sugar levels measured! Overall, 1.3% of the participants were found to have raised blood glucose levels (or were on medication for diabetes),  with the highest portion in the age-group of 50-69 years. A huge portion of participants was found naïve of their elevated blood sugar levels and neither were they on treatment or any kind of management to control them!

98.8% of the study participants had never had their Cholesterol levels measured! Prevalence of raised cholesterol was high in the urban setting, compared to the rural setting – with females having higher levels than males, in both rural and urban settings!

The idea of BMI (Body Mass Index), much as is commonly talked about in lots of wellness spaces – still lacks the firm ground, where people can appreciate how their body weight interacts with their body height, so as to ascertain whether one is underweight, normal weight, overweight, or Obese - and what actions to implement in gearing towards healthy body weight. As was the case with Cholesterol levels, the study found females to be more overweight and obese compared to males; in both rural and urban settings!

In a switch, males who participated in the study were found to exceedingly consume way much more alcohol than the females did – this time with the rural category being the high-end consumers - compared to the urban setting! Noteworthy; much as recent WHO’s reports on the status of alcohol and health - report a general decline (improvement) in the consumption of alcohol globally, Uganda still remains the highest alcohol consuming country in Africa, vibing with an annual per capita alcohol consumption of 12.21 liters (World health statistics 2023: monitoring health for the SDGs: WHO). Considering the low prices of alcohol, there has been evidence of authorities having an eye for revenue - through the manufacture, importation, sale and consumption of alcohol; rather than aiming at its regulation. The Alcoholic Drinks Control Bill - regulating the stewardship of alcohol within the country is said to be underway.

When it came to smoking, most participants who used tobacco (both smoking and smokeless - such as chewing & snuffing) reported it taking them for a ride on cloud nine! To some it was refreshing, to others - an insatiable appetite, taking away all the nausea they felt.  Some (especially those who worked at night) reported tobacco to have been an efficient antidote to the cold spells, filling their souls with relief and warmth. Tobacco gave people strength to dig in gardens. In Arua, the same tobacco in question was mentioned to be a home remedy; not only treating stomach ailments and worms, but also casting all sorts of evil spirits! With peer pressure as the most identified reason most people started smoking tobacco; the overall average age at which most Ugandans started smoking was identified as 22 years. Notably, a portion of Ugandans was identified to be exposed to second-hand (passive) smoking either at home or at workplaces! All in all, males consumed way much more tobacco than their female counterparts, with prevalence being higher in the rural regions compared to the urban regions.

As mentioned earlier, Obesity, High blood pressure, elevated Cholesterol levels, Smoking and Diabetes mellitus – happen to be the top five risk factors for ending up with a heart attack; an attack that also happens to be a consequence of heart disease - a member of the NCD fraternity. What’s a random Ugandan left to do, amidst the roaming, silent, steady and determined killer combo of NCDs; in a country challenged with scarcity of resources? It’s true that a great deal of us have heard the word “NCDs” thrown here and there in conversations (with some misperceptions and myths), but how many of us actually decipher what these Non-Communicable Diseases are; and what are one’s risks in ending up being diagnosed with one? The aforementioned STEPS survey revealed an approximation of 1 in every 10 Ugandans having more than three risk factors for being diagnosed with an NCD; and 1 in every 4 Ugandans suffering a Non-Communicable Disease, unknowingly! Could you be the 1 in the many?

If not addressed ahead of time, NCDs are life threatening and painfully expensive to treat and manage. Our healthcare system makes it even more agonizing for persons battling with NCDs, as their chances of surviving these diseases is somewhat dependent on their ability to pay for care out of their own pocket! As the state alongside the health ministry strengthen efforts towards this brutal fight against NCDs; through a multi-sectoral approach by ensuring citizens are equipped with knowledge on prevention, early detection and early treatment - all you need is the simple recipe of NEEDS (N. Nutrition, E. Education, E. Exercise, D. Drugs, S. Screening). Prevention is, as always has been – better than cure; especially if there’s no cure for disease.

Nutrition: The old saying, “Let food be thy medicine and medicine be thy food”, has never been more relevant today! What we eat feeds directly into the body’s engine as fuel, supporting its daily functioning of other activities within the body. By calling it a balanced diet; it strikes a balance, providing all the nutrients you require generally; with caution on consuming just the rightful amounts of each nutrient, every day. Let’s get back to the basics. Let’s embrace the organic/local foods, ones who’s calorific and nutritional value hasn’t been tampered with extremely. We ought to avoid processed foods, cut down on salt, reduce as much as possible fat diet; while hydrating and eating as much fruit and vegetable as possible. Spread this out in a diet plan and notice how food is medicine. What fuel are you putting in your engine? How durable will this engine last?

Education: In this age of information, as Don Miller says; Ignorance is a choice. Unfortunately, disease knows no boundaries, when it comes to finding people that suit its taste. Unless you know of its shady mode of contact and how it can be prevented; best believe, you suit its taste. For as long as you’re predisposed to it (the risk factors) - it’s definitely bound to catch up with you! Get informed with the basics. Know the facts. What are the NCDs? What causes them? How can they be prevented? What’s the impact of too much alcohol to one’s body? What secret ingredients lie in the tobacco – that even make the manufacturers issue a disclaimer of its lethality ahead of sales? What does each ingredient do to the body? By educating ourselves with all this knowledge, we get to make informed decisions, so that in the event something happens, we’re not taken by surprise. It's true, “we only live once; but if well lived; that once is enough” - Mae West.

Exercise: The lay understanding of exercise varies from environment to environment. The gold standard for exercise, lies in the amount of physical activity with which we engage our bodies! In settings where activities partake roles with routine and extreme body movement; people are quite involved physically. On the contrary - settings where people spend most of their time seated while being physically inactive not by choice; one ought to make an effort to compensate for this inactivity with some physical exercise! Hit the gym, do some cardio, take a stroll daily. If not in a hurry, do not take that boda-boda where you can walk. Keep the blood flowing within those vessels. “Exercise should be regarded as a tribute to the heart” - Gene Tunney

Drugs: As most Non-Communicable Diseases require life-long treatment, it is a common occurrence for persons battling with them to be burdened by the various prescribed drugs and treatments. The adherence rates to these treatments being low has often times been explained by the anticipated or real adverse effects of the drugs, the hefty costs of the treatments, mere inconvenience or even confusion! And even so, poor adherence has been associated with an increased risk of hospitalization, let alone decreased healthcare outcomes which eventually increases the costs of overall care! Not only does good treatment-adherence come along with lower medical costs, it also betters one’s quality of life! If you have an NCD, embrace your treatment religiously, and the same treatment will owe you one, in taking care of you in return, religiously.

Screening: A great deal of us have a particular interest in something, in which we have this in-depth knowledge about. Could be music, soccer, farming, business, philosophy, science, name it. But how well do you know your body? When was the last time you had a thorough wellness check up from a professional? What’s your blood group? What is your BMI? What is your body weight? At what levels are your Blood pressure and blood glucose?

If you can save for a trip, or car, or whatever; then you definitely can put aside some money to undergo a thorough preventive health checkup.  Once every year is a good start. The core of the wellness approach is the kind that embraces healing before the need for repair. It’s unfortunate that most of us seek for help when we’re at the repair stage, worse still - beyond repair! Take that breast cancer screening exam, check your prostate if you’re nearing the ripe age for it to become stubborn. Plan that wellness health check-up today; and receive advice from professionals on how to adjust your life, in an all-round healthy direction.

Of all diseases in the NCD family, heart diseases remain the leading cause of death; responsible for one third of all deaths globally, followed by cancers in the second place.

In the African region, cardiovascular diseases account for 9.2% of deaths, also happening to be the leading cause of death to persons over the age of 45. Noteworthy, is that a huge percentage of these heart related deaths are preventable. With 54 countries comprising Africa, only 20 countries were found to have Cardiac Catheterisation laboratories as of last year; which if excluding South Africa and the North African countries - exposes the huge gap there is, in Sub-Saharan Africa!

“Use Heart, Know Heart”; has been the theme for the recently commemorated world heart day - on September 29. This theme meant to remind each of us to take care of our hearts, by building a strong foundation of knowledge in knowing our own hearts first. It’s only then that we’ll protect what we know! Now, with all cards on the table; and taking into consideration your risk profile for getting diagnosed with a cardiovascular disease; your lifestyle, your diet, name it - What are the odds you’d survive a heart attack, in Uganda? What is it you’re doing to increase these odds?  

 The writer is a Cardiac Nurse  terencekalule@gmail.com