Thursday, 21 June 2012

‘Dangerous lifestyles contribute to poverty of health in Nigeria’

Dr. Abimbola Silva is a Family Medicine Fellow. The best graduating student at the West African College of Physicians in her set, Abimbola is currently campaigning for a healthy lifestyle among Nigerians, as a way of raising the low life expectancy in the country to an appreciable level. She speaks more on the project.
You are a Family Medicine Fellow, what does that mean?
  Being a Fellow of the West African College of Physicians (WACP) in Family Medicine means that I am trained to be able to cater for the health needs of all family members irrespective of their age, sex or nature of illness. It means I am qualified to treat a baby, teenagers, mummies, daddies, grandpas and grandmas. Included in that training is the ability to recognise my limitations (no one doctor knows everything) and refer promptly and appropriately to other specialists when required. This is what particularly differentiates me from a ‘General Practitioner’ (GP) who may want to do all, for everyone, to please all. Of course, some GPs are also learning to know their limits in these days of litigation.
  My specific roles to the family include information and education to promote their good health and prevent illness as much as possible, prompt and effective management of acute illnesses including emergency, life-saving operations, management of long term illnesses to prevent or reduce complications as well as continued support and palliative care in cases of terminal illnesses.   

How healthy would you say the Nigerian family is?
  To answer that, I’d like to use the term ‘life expectancy’. It is an estimate of the average number of years a human being is expected to live in a particular society. It has been said to be associated with available opportunities in the society, the public health as well as diet. It varies in every society and it changes as these indicators change. In Japan, in 2011, life expectancy was estimated to be 82.6 years while in a country like Nigeria it was said to be 51 years in 2010 but now 47.8 years in 2011.
  It is no secret that the Nigerian society is more ‘Westernized’ today than 20 or 30 years ago. This is more so in the urban areas than in the rural areas. So while people would normally have eaten pounded yam and vegetable soup for breakfast, lunch and dinner, today, eating friend rice and fried chicken is more fashionable. People who would have walked 10 kilometres to the farm in the morning, would now be driven in cars, take a bus or okada to work or school. Instead of taking a stroll in the evening to fetch water in the stream, now we would pump water from our well while watching our favorite programme on a television that we would not even get up to tune, thanks to the remote control!
  Today, it is generally fashionable for our children to snack on biscuits and chocolates rather than oranges, pawpaws, bananas and tangerines. So, our healthy, fibre-rich vegetable and fruit-rich diets are being replaced by oil-laden, low fibre meals with little or no fruits. Also, our exercise or physical activity levels are reduced to the barest minimum.
  In the absence of strict laws against tobacco and alcohol use in Nigeria, advertising companies have tried very hard (and are still trying) to make cigarette smoking and alcohol use as attractive as can be to our youth.  
  They desperately need to get the children and youth ‘hooked’ on these harmful substances so that even in the face of reasonable evidence to declare the harm that the use of tobacco and excessive alcohol cause, these youth may find it difficult to say ‘no’. All these contribute to the poverty of health in the Nigerian family today.
  If I were to say what is lacking and the remedy, it would be that we must return to those fibre rich, low salt, low oil, vegetable and fruit-rich diets. This was the diet and lifestyle that kept some of our old people alive till up to 100 years in those days. This is also the type of diet that keeps the life expectancy so high in a civilised society like Japan.   
  They have somehow remained traditional in their lifestyle irrespective of the so-called civilization and development. They are known to walk, exercise and cycle a lot of times.
  We (Nigeria) must take a cue from them and learn to ignore as a matter of choice some of these machines that are supposed to make life ‘easier’ for us.
  Many of them make us more laid back and the lack of exercise promotes ill health. In addition, our laws on use of tobacco and alcohol as well as how they are advertised, must be much tougher so that people are well informed about what they are exposing themselves to.

You are campaigning about healthy lifestyles. What exactly does that mean?
  A person’s lifestyle determines his state of health. If culture is the way of life of a people as we were taught to define it in primary school, then we can definitely say a person’s culture determines their state of health.
  A healthy lifestyle is one that in totality would enhance good health. It would include eating a healthy diet, which contains the following: Carbohydrates, especially a lot of fibre, which aids digestion of food so that food passes along the food canal freely. 
  Proteins should be mainly plant-based as in beans and its products. For animal based protein, we should choose more of white meat such as chicken and turkey (without the skin) as well as fish over and above red meat (such as beef, pork or goat meat).
  Scaly fish are generally better as they have less oil but fish oil also contains Omega H-3, which contains the ‘good cholesterol’ that helps to remove ‘bad cholesterol’ from the body. Fats and oils should be those with low cholesterol such as sunflower oil, soybean oil or olive oil.
  These contain more of the good cholesterol that is needed to remove bad cholesterol from the body. The bad cholesterol is tagged ‘bad’ because it helps to form clogs inside the small tubes that carry blood around the body.
  As we all know, the heart is the organ that pumps blood around the body. Most of the tubes that carry clean blood all carry clean nourishing blood away from the heart to nourish the body. Only very few tiny tubes carry clean nourishing blood to nourish the heart itself. A major problem occurs when the tiny tubes that supply blood to nourish the heart become clogged up because of this bad cholesterol. Portions of the heart may become technically ‘dead’ and the person then may have a heart attack.
  Fruits and vegetables consumption should be encouraged among our growing children and adults alike. If eaten fresh, vegetables provide vitamins that help the body to fight illnesses. Eating at least one type of fruit a day is a good way to start.
  It is good to note that the nourishment in vegetables are only available to us if the vegetable is eaten fresh or raw in the case of some that can be eaten raw like cucumbers, carrots, lettuce.
  If vegetables have to be cooked, we should try to cook it in a way that any water that comes out of it remains inside the meal. This is because many vitamins inside the vegetable are water-soluble.
 This means that if you boil your vegetable and throw away the water you used to boil it, then you are only eating useless leaves. So you should either boil with little water that you can add to the soup or not at all, or steam it.
  This further means that you must wash the vegetables very well many times under running water if possible to make sure that it is free of germs once you put it in the soup. 
  Minerals are usually needed in only small amount and are found in many different types of foods in the small proportions the body needs. One important mineral is salt (Sodium chloride). It is advised that we eat this in very small amounts and to never add extra salt to the meal on the table.
 A healthy lifestyle apart from the healthy diet must include regular physical activity. Regular physical activity means healthy exercise that would cause you to sweat like walking, running, swimming etc. This should be done for at least thirty minutes a day for three to four times in a week. Some other activities can make one sweat e.g. carrying heavy loads, but it is usually those ones that are not done on the same spot that are more beneficial to the heart.
  Exercise helps the heart to get used to pumping well under pressure so it helps to reduce blood pressure. It also helps to maintain proper weight and to lose weight for those already overweight and obese. Obesity generally is very dangerous to health. Unfortunately, some people ignorantly see it as a ‘sign of good living’ when they become pot-bellied or fat. Obesity worsens a person’s chance of having hypertension or diabetes. It increases the chance of heart failure. It also increases the risk for Osteoarthritis, which is a disease that causes pain in the joints. These joint pains reduce the ability to move around well.
  Also habits like taking alcohol should be reduced to the acceptable minimum. For men 2 units of alcohol and for women one unit of alcohol per day is said to be acceptable. One unit of alcohol is about a small glass (125mls) of ordinary strength wine while a large glass of red wine is about 3 units. About 250mls or half a pint of beer is one unit while one pint or 500mls of lager beer is about 2.5 units.
  Smoking must generally be stopped without any negotiation. Its effects are too harmful for negotiation. It is not only harmful to the smoker but also to anyone around them. Third-hand smoke, which is the smoke from the end of a cigarette stick, that people around a smoker are exposed to, is known to cause lung cancer in non-smokers. Even when they are not smoking, the residue or left over particles on the hands and clothes of smokers are dangerous to people’s health especially children.
So this is what I mean by healthy lifestyle.
  I believe the increasing number of people who are dying ‘suddenly’ nowadays drives my passion for this. WHO reports that the incidence of death from non- communicable diseases (that is diseases that are not contacted from person to person) is increasing at an epidemic rate. It was found in 2010 that worldwide, 17 million people died from heart-related diseases (or cardiovascular diseases), 7.6 million died from cancers, 4.2 million from chest (respiratory) diseases and 1.3 million died from diabetes mellitus.
  The very important part of the story is that all these four groups of diseases have the same things that ‘cause’ them make people likely to have them. The things that make people likely to die from these diseases - cigarette smoking of any quantity at all, not having enough physical activity, harmful use of alcohol and poor diets. To make matters worse, so many things have been discovered and written about these diseases and how they can be prevented but the average Nigerian would not go about reading all those wonderful researches. So there is a great gap between available information that can help people make responsible decisions about their health and the common man. This is the thrust of our campaign. We hope to help break down information to a level that everyone can understand and appreciate. We hope to express the most recent and beneficial research findings in the simplest terms that the common man can identify with.
How can the culture of medical check-up be enhanced in the country?
  The most important thing that may enhance a culture of medical check-up in this country, I believe, is when medical care becomes readily available and relatively free to the masses. I’m inclined to think like this because of the exposure I have to clients on the National Health Insurance Scheme (NHIS). I’ve noticed that it is mostly people who do not have to pay cash for their health care (like NHIS clients), are those who would come to hospital when they have no particular symptoms or illness. This is really the idea behind ‘Medical Check-up’. It is when people come to hospital when they don’t have a disease so that they can be checked or screened for risk factors (things that increase a person’s chance of having a disease).
  They may not yet have the disease but they may develop it later in life if they continue a bad lifestyle or if they fail to adopt a healthy lifestyle. Presently in Nigeria, coming to hospital has mainly been on account of illness and many times when the disease has already gone far with many complications. Very few come for medical check-up before they become sick. It goes without saying that the best time for a medical check-up is when there are no signs of the illness yet. Unfortunately that is rarely the case in Nigeria  For men especially those above 45 years, they should do Prostate Specific Antigen (PSA) and a scan of the Kidney, Urethra, Bladder and Prostate. Everyone should do their HIV screening especially young people engaged in risky sexual behaviour. Everyone should do their blood pressure check regularly, diabetes screening and cholesterol checks. People who have hypertension and those who have diabetes should have regular checks for their kidney function (a blood test), their cholesterol levels as well as their heart function (an electrocardiograph). Anyone who passes blood in their stool or who passes out black faeces without taking iron tablets should come to hospital to be properly checked for colon cancer. Anyone coughing for over three weeks should come to hospital for a proper check up.    
  Also, when there are certain types of illnesses in the family, like hypertension, diabetes, breast cancer, nose and throat cancer children and siblings in that family should check themselves for these things as much as possible. These are just a few examples of screening tests as well as some symptoms that may be pointers to some diseases.

How can awareness be generated for such people?
  It is not only illiterate members of the society that go to hospital when it’s too late. Literate people also do so and I think literacy may not be the only reason for this unfortunate occurrence. A person’s beliefs or ideas of the possible cause of their problems affects where they would go to first when they find themselves in trouble. The spiritual or religious nature of the average Nigeria causes him to usually try to deal with his medical problems first on the ‘spiritual’ level before coming to hospital as the last resort. 

What approaches are you adopting to drive awareness for your project? Whose help might enlist to get to your target audience?
  Well, the approaches we’re adopting to drive awareness include this type of newspaper interview, which we hope would go a long way for those who read. We would also have jingles on the radio describing in simple terms some of the things we have been discussing about diet, physical activity etc. We give health talks in religious houses, association meetings of market women, motor parks, engineers, mechanics etc. We are making arrangements with authorities of some companies to deliver lectures to their staff. Also, we are in the process of making comic books on this topic so as to attract the youth and the young at heart. We need the help of journalists, media people, artists and the heads of the various groups described to make all these possible.

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