The fear factor: How Kenya’s prevention campaigns miss the mark
Non-communicable diseases (NCDs), also known as chronic diseases, are illnesses that are not transmissible from person to person and tend to be of long duration.
What you need to know:
- For many people in middle age, caring for elderly parents is now the norm rather than the exception. It is a clear demonstration of the increased life expectancy as our survival rate improves.
Celeste* was the typical last-born daughter who was now in the stage of life where children begin to parent their parents. She wheeled her mother into the consultation room, carefully situating her and ensuring that the wheelchair was immobilised. Thereafter, she took a seat and introduced them both.
Florence* was 86, having delivered Celeste 50 years before, as her third child. For the last decade, she had lived with dementia, hypertension and diabetes; and Celeste had moved her into their home, providing her with round-the-clock care in a family environment. Florence looked comfortable and happy despite loss of orientation and awareness.
All was well until Celeste started explaining the reason for the consultation. The previous week, during an MRI of the abdomen, the radiologist reported an incidental finding of an intrauterine contraceptive device. Celeste wanted it removed.
I couldn’t help but laugh at how panicked Celeste was! I took my time to explain why this was not necessary and would in fact likely cause unnecessary complications. Celeste was not convinced. I literally had to paint a mental picture of how the offending device would look like at the time, embedded into the wall of a shrunken uterus. I further elucidated how this would require removal under anaesthesia, under direct vision, and despite all precaution, there would still be a risk of pulling down the uterus, inadvertently causing a uterine prolapse.
Despite all of this information, Celeste did not quite look convinced. I figured there was more to this and asked her why she would want to disturb a device that had quietly resided inside her mother for her entire lifetime, without causing any trouble. Her response totally floored me. At 50, Celeste did not ever want to imagine her mother being sexually intimate; and the device made this a reality she couldn’t shut out.
I absolutely could not help myself. Here was a grown person, a mother herself, uncomfortable about her own mother’s perceived sexuality; yet she had fully invested herself in keeping her healthy, comfortable and free of complications. I couldn’t help but laugh at this reality. She was more comfortable regarding her mother as a sum total of her medical conditions, forgetting that long before the dementia, her mother was a human being first.
For many people in middle age, caring for elderly parents is now the norm rather than the exception. It is a clear demonstration of the increased life expectancy as our survival rate improves.
What is concerning though is the health messaging that is dominant with regard to age-related chronic medical conditions. The initial increase in life expectancy was strongly midwifed by the advent of antibiotics and vaccines; resulting in a sudden drop in deaths from infections. Successive contribution has included better maternal healthcare, improved nutrition, advances in surgical techniques and improved technologies in management of chronic diseases such as cardiovascular and cancer treatments.
With a focus on non-communicable diseases and a strong emphasis on prevention; the messaging has been heavily curated to encourage cancer screening; dietary transformation to address obesity; warning against alcohol and tobacco consumption; and encouragement of exercise to avoid a sedentary lifestyle. To add to that, we have also prioritised mental health messaging in a bid to destigmatise mental health conditions and improve access to care.
All these are amazing interventions that are chiefly driven at primary healthcare level. They heavily depend on information dissemination and patient education. And herein lies the crux of the matter. The packaging of our messages is wanting. A lot of our messages are packaged to scare us into action rather than motivate us towards wanting better for our health.
Affected self-esteem
Pam* weighs 84 kilos; always has since she was 15. As a teenager, she was always conscious of how much bigger she was than her peers at school. This affected her sense of self-esteem. She sought refuge in sports, excelling in basketball and swimming. Later on, after college, she took to working out at the gym when she could not access a pool or a basketball team to play with.
Imagine her shock when she sought care for persistent headaches in her forties, only to find out that her blood pressure was rising. The doctor prescribed drugs and told her to lose weight in order to prevent a future stroke. She was aghast. She ate decently, did not drink or smoke and had been active all her life. Yet the doctor never bothered to dig into her history before passing judgement about her weight.
It took Pam two years to finally get into care with an empathetic doctor who evaluated her as a whole human being and not just her blood pressure; focusing on other parameters other than just her weight, to evaluate her state of health, and set milestones that were individualised and targeted to keep her in a good place.
Our primary health systems need to re-evaluate our preventive health messaging, to acknowledge the part of science that we sometimes choose to aptly ignore because we have no control over it; genetics. For every one obese, diabetic and hypertensive 52-year-old lady seen by a cardiologist in Kisumu, there is an average 46-year-old counterpart in Nyeri, whose hypertension has already destroyed her heart.
How do we package the message for the children of the Nyeri lady, to appreciate their risk without being frightened out of their lives with the threat of getting a stroke at 30 if they become obese? How do we motivated the Kisumu lady to want to reduce her risk of kidney failure without threatening her with lifelong dialysis?
Kenyans and most adults at large are stubborn in nature, especially regarding preventive health interventions at an individual level. It doesn’t help when the not-so-subtle messaging from our health financiers seems to point at how the rising cost of non-communicable diseases is the new headache in managing financial resources for health. What the public hears is that their individual indiscipline is what is running our coffers dry.
A country that has managed the health of its people well is pretty much left with paying for non-communicable disease care. Why is this so? To quote one of my good professors when he is being controversial, “The human body was not intended to live beyond the fifth decade. If we all live long enough, we shall surely get chronic diseases. The real determinant of when this comes to pass is dependent on the genes bestowed on us; thereby allowing some of us to die before our body parts give up.”
When we stop dying of preventable diseases, we shall live long enough to get chronic diseases, and even longer, because we can afford to pay for decent care of the same chronic diseases. Our population pyramid is slowly expanding at the top. If the advanced countries are anything to learn from, their 110-year-olds are alive because they are on costly treatment.
Not every person walking around is carrying a chronic disease by choice. The majority are truly victims of their genetic inheritance. Let us focus on empowering them to see the cards they have been dealt; and wake up every morning making a conscious decision to stall their genes, rather than live in constant fear of death!
The writer is a gynaecologist/obstetrician
