One day if I get the platform, this is an address I’ll love to give to the Ghanaian public. The topic will be on the issue of Chronic Diseases.
It’ll probably be in the evening and I’ll probably start like this…
Good evening, ladies and gentleman. Thanks for tuning in. Tonight, I want to talk to you about the issue of Chronic Diseases.
Everyone knows what a disease is and what it entails. It makes you sick and forces you to seek treatment. Some of you go to see a doctor. Others opt to see a traditional healer or herbalist. A few may do the unthinkable and just hope the disease goes away by itself. Whatever the measure taken, the hope is that the doctor, traditional healer, herbalist or time heals the body of the disease and brings back normalcy and good health. That is the general expectation.
However, what if the disease is such that no matter what the doctor or herbalist does, it does not go away or keeps coming back? There is a chance that the condition is not being treated well. However, there is also the possibility the disease is chronic.
Chronic diseases are long-term medical conditions that are generally progressive or persistent. They last longer than three months. Examples of chronic diseases are high blood pressure, diabetes, end-stage kidney disease, asthma, hepatitis C and cancer.
It used to be thought that the most important health issue in sub-Saharan Africa (SSA) was that of the infectious disease e.g. malaria, tuberculosis, cholera. Infectious diseases are still a major health risk in SSA but I contend that a few chronic conditions also are exacting a heavy toll on the populations in the region. I further seek to explain why the mentality of the population might affect how these chronic diseases are managed.
Of the examples on chronic diseases stated above, the two most common in Ghana seem to be high blood pressure (HTN) and diabetes.
In 2004, a study of the Greater Accra area found an urban prevalence of HTN to be 32.9% and a rural prevalence of HTN to be 24.1%. Similar studies in the Ashanti Region yielded prevalences of 33.4% and 27% respectively. A review of about seven studies by Addo has the rural prevalence at about 19% and the urban at about 55%
Diabetes on the other hand has a prevalence of about 6 – 9%, that is over 2 million people.
The mean age of diagnosis for both diabetes and high blood pressure seems to be in the mid-thirties.
Now both high blood pressure and diabetes can lead to very serious healthcare problems down the line if not managed well.
High blood pressure can lead to stroke, congestive heart failure and to loss of kidney function and even death.
Diabetes can lead to loss of limbs, blindness, loss of kidney function and death.
So it is of utmost importance for these diseases to be managed well. That is where the problem of the mentality comes in.
If a disease is always seen as a condition that can be treated away (acute), then getting patients to accept the fact that a disease can be chronic presents a problem.
Patients may not believe the diagnosis and seek a second opinion from another physician or traditional healer of even worse, do nothing about it. The fact that some diseases cannot be cured can be a bitter pill to swallow.
Then is what I call the “The Falsehood of Eternal Youth and Health”. Excuses like “I’m too young to have high blood pressure or too active to have heart disease” are common. Well, youth passes, even if slowly and good health is not always assured. Besides black people seem to have a propensity for certain ailments, one of them being high blood pressure.
The other issue is that chronic diseases demand a much higher level of patient involvement in managing the disease. Insulin must be injected, tablets taken daily for that high blood pressure, diets, exercise….it gets overwhelming and the onus is totally on the patient. Further, managing chronic diseases can be a financial as well as time drain. Consider having to undergo hemodialysis three times a week or the cost of medications to manage high blood pressure.
It is not at all surprising that faced with these prospects, some patients seek another way out – a cure from, say, a traditional healer or herbalist or just denial. In our Ghanaian culture, the rush to attribute a chronic ailment to a supernatural cause is ever present. That unfortunately leads down a path of figuring out the supernatural cause instead of treating the disease.
The Swiss psychiatrist, Elisabeth Kübler-Ross describes in her 1989 book, On Death and Dying, five stages that patients go through when faced with the diagnosis of severe illness. They are Denial, Anger, Bargaining, Depression and Acceptance. One is supposed to move from one stage to the next and finally end up accepting the diagnosis. It is in the acceptance of the diagnosis that propels a patient to deal and live with it. If one never gets to the acceptance stage, the results are the early end-stage effects of a disease.
This can be devastating if the patient is young, say, in their thirties.
If diseases like diabetes and high blood pressure, diagnosed when one is thirty are mismanaged or neglected, then by the time one is in his forties, the end effects of these diseases are apparent and lead to early morbidity and mortality.
These diseases need to be taken seriously and managed well, the minute a diagnosis is made, irrespective of the age.
The great thing is that, with all the advances in modern medicine, chronic diseases can be so managed as to ensure a long life. It however takes an active, very active participation of the patient.
Diabetes and high blood pressure are not the only chronic diseases. Like I mentioned earlier, I used them since they are the most common. There are of course people dealing with diseases like HIV, Parkinson’s, cancer, arthritis, asthma, kidney failure and congestive heart disease. Whatever the disease is, the same principle applies – acceptance.
So to summarize, not all diseases are acute e.g. malaria, and can be treated away. There are the class of diseases that persist and are chronic. Recognizing them for their severity and accepting them as manageable conditions si the first step and avoiding the late term effects of these diseases.
Thank you for listening and take good care of yourselves. You deserve that. Have a good night.