Silent killers

By Pearl Natamba

Deaths from high blood pressure, heart disease, diabetes go up in Mulago

The woman’s leg had rotted away and, from the foot up to just below the knee, it looked like it had been burnt and left as black as soot.

Dr Brian Kiggundu, a specialist in Internal Medicine was by her bedside in Ward 4C at the Mulago National Referral Hospital in Kampala. He had diagnosed her condition as Type 2 diabetes and was giving her the bad news.

“We have to cut off this leg,” he told her calmly.

The elderly woman, dressed in a brown gomessi, the flowing wrapper with wide pointed and pleated sleeves that women her age favour, looked at him helplessly.

“Doctor,” she said in her local vernacular, “I do not want my leg to be cut off. Isn’t there anyway my leg can be saved?”

Dr Kiggundu shook his head.

“No,” he told her, “If the leg is not cut off, the decomposition could affect the other parts of the body.”

Dr Kiggundu, whose specialty involved dealing with adult diseases, says Type 2 diabetes and other Non-communicable Diseases such as cancer, high blood pressure, and heart disease, are becoming more prevalent as more Ugandans become affluent, consume more fattening foods, and spend hours sitting in offices, in front of television, or driving and not walking.

A doctor on the same ward summed up the growing crisis:  “The very legs we misuse when still in good shape are the very ones we are eager to use when they are in a bad shape”.

The doctor explained that every time we deprive our legs and hands of physical activity, we increase the chances of losing them. According to research by World Health Organisation, physical inactivity is a big contributor to contraction of non-communicable diseases. In case of diabetes, sometimes the foot or arm has to be amputated.

Physical inactivity holds the 4th position as a leading risk factor for global mortality causing an estimated 3.2 million or 6% of deaths globally, according to research made by WHO. The same research recommends that regular and adequate levels of physical activity in adults helps reduce the risk of coronary heart disease, stroke, diabetes, hypertension and colon cancer where these diseases are rampant.

Sedentary lifestyles

“So many people in the corporate world live a sedentary lifestyle, meeting up with so many people in boardrooms and also seating on their computers the whole day which is unhealthy because there isn’t any physical activity done the whole day,” says Dr Hafisa Kasule of WHO in  Kampala.

Dr Kasule defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure. It includes exercise as well as other activities that involve bodily movement and are done as part of playing, working, active transportation, house chores and recreational activities. She recommends taking a walk for 30 minutes for every five days of the week for those who are not over weight and for those that are obese an hour of exercising for every five days of the week is recommended.

“The biggest mistake that most high blood pressure patients do is that when they come here and we treat them to a point where their pressure reduces, they get off medication and even relax on exercising and after a while they return suffering from heart disease,” says Dr Emma Okello, at the Heart Institute Uganda.

On any visit to Mulago’s Ward 4C and 4B, one finds it crowded with patients suffering from high blood pressure, diabetes. Some have suffered strokes.

“People have the knowledge but lack understanding and this has contributed to the increase in high blood pressure, diabetes, stroke, and heart failure,” says Dr. Nuwagaba Wallen Tumwiine. Apart from lack of physical inactivity, he lists causes like physical inactivity, smoking, alcoholism, obesity, and eating too much salt as things that most people know are health threatening but deliberately ignore warning, indulge in them , and regret after they are taken ill.

He says in six months since June 2012, Mulago has admitted 12,345 patients in ward 4B, of whom 11,831 were diabetic and hypertensive. He emphasized that the patients keep increasing and that the biggest number of people that suffer from high blood pressure and diabetes are among the adults. He says the death toll in this ward is high at about 21% of all admissions.

Often are times, young people think that they cannot suffer from diseases like high blood pressure and diabetes because it is a disease for adults. As a result, they consume a lot of unhealthy foods like chips, burgers, pizza and sit down all day watching television.  Such behavior is dangerous as it leads one to be obese and also acquire diseases like diabetes if one does not cut down the fats by exercising.

Exercising also improves heart and lungs functions, helps maintain weight, and has been shown to contribute to higher academic performance at school. Research shows that both physical and mental exercise help the brain by improving blood circulation, building new neural connections, boosting memory and offsetting the debilitating effects of age and disease.

Dr Kasule says a high blood pressure patient should never stop taking medication even if their pressure reduces. He pointed out also that some doctors wrongly advise patients to stop medication without observing the patient over a period and ascertaining that the patient can stop taking medication but continue using non-pharmacological methods like reducing on the consumption of salt and exercising more.

The WHO urges people to engage more in physical activities like walking, dancing, gardening, hiking, swimming, cycling, doing household chores and playing games, sports, or planned exercise, in the context of daily, family, and community activities.

For now, as a way of dealing with a growing problem, Dr Tumwiine says Mulago Hospital is planning a strong health care system that emphasizes prevention of non-communicable diseases. Although still in discussion stages, it is based on the understanding that investing physical activity is cheaper than treating a disease acquired because of physical inactivity.