{UAH} M7's statement at Aronda's requiem service is a gold mine of advocacy against non-communicable diseases (NCDs).
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9:51 AM |
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President M7's statement at Aronda's requiem service is a gold mine of advocacy against non-communicable diseases (NCDs). Nobody could have stated the humongous challenge we are facing better and at a most appropriate time than HE. He said 'I am annoyed....he (the deceased) had a condition which was either not detected early or if detected was not managed properly'. The widow's statement then creates a very powerful contrast that clearly brings out how society perceives well-being:
"This heart problem you are talking about, OK it may have been there but we [the family] have never seen it', she says. 'My [two] children are my witnesses. He was full of strength...For 19 years he has never failed to get out of bed or fall sick", she adds.
How best to animate the insidious nature of cardio-vascular disease than in this statement. Ofcourse family cannot 'see a heart problem' because seeing it requires an 'echo-cardiogram' which if you found in someone's home would be enough to scare the day lights out of you! People in love do not see heart diseases, they see glowing faces! The combination of the two statements (M7's and the widow) show the expected vs. the norm regarding NCDs.
The current orientation of our health system is towards acute infectious diseases. Because of this, the anthropology of well-being is that: When you feel the symptoms (the fever, joint pains, etc) then you know you are sick. Unfortunately, cardiovascular diseases and indeed other NCDs present in the reverse. For a very long time (an average of 15 years) you feel very well yet some of the most vital organs of your body are ill! Unlike the developed world where cardio-vascular diseases are among the poor, in the developing world it is a mixed picture. Therefore, pple develop CVD during the years that they feel they are enjoying life the most: Dollars are coming in, pork, unbelievably comfortable gas guzzling SUVs, and p.o.w.e.r! Society loves them big (the adage 'big is beautiful'). For the women, the bigger the bum+'ka-bustingo', the bigger the presumption that there is a huge fertile 'kitone'. For the men the more 'pregnant' the bigger the extrapolation to a huge fecund 'waleti' - society's correlation coefficient between chronic over-nutrition and success is very high. Combined with the 'stress to keep up there', this makes an optimum recipe for hypertension and heart disease.
M7 expounds further in his informative speech: That the deceased was found to have had evidence of 'multiple heart attacks' that occurred in the past (as seen from the post-mortem); that he was known to have 'mild hypertension' for many years; that he complained of 'dizziness and abdominal pain in Korea'. Very correct on this too. Many pple with heart disease actually get multiple 'silent' heart attacks, some of them going off unnoticed as vague pains in the left upper abdomen (around where the stomach is located) - sometimes the pain 'radiates' to the jaw - because the diaphragm (the tough membrane that separates the chest from the abdomen and is key for breathing), the heart muscle and the top of the lungs are served by the same nerve - so the pain is vaguely 'referred' to other places which further confuses the picture. I do not have an immediate off-hand publication but one physician at Mulago, in a conversation we had, chatted about seeing a series of middle-aged men who come to his clinic complaining of 'ulcers' and when he examines their hearts, he finds they are having real-time 'silent' heart attacks. Some of them report to have been on 'ulcer' medication for months or years.
M7 expounds further: 'I know he is up there and we are all moving there, but he still had a lot to do here'. Exactly! In this statement, HE alludes to the concept of 'early death' and 'life years lost due to early death'. A heart attack in the 50s can cut off an average of 20 life years because as we know, life expectancy at 50 years is much higher than life expectancy at birth in Uganda. A person who hits 50 in Uganda expects to live up to 70 at the minimum, on the average. In one of my small studies, I saw diabetes peaking at 45-50 in Eastern Uganda yet it peaks at 65-70 in other studies done in developed countries.
M7 then gives a prescription in form of an order (unfortunately he gave it only to his generals): 'You all should have periodic medical check-ups!!!!' And he was f***ing right. The key point here is that unlike acute conditions like malaria, by the time you develop a 'seemingly simple symptom like 'abdominal pain' as a result of CVD, you are already terribly terribly ill! With much of the damage irreversible!
Unlike acute diseases, for chronic conditions, the signs (the things that health workers can detect) often precede the symptoms (what the patient complains of). So in order to detect the CVD early, you need a med - at least every 5 years from when you are 40. And of course he talked about 'officers and their body-weight' and the diminishing levels of physical activity with rank. Save for Afande Teargas, Uganda's generals look like in-fecund castrated toads! It appears like ever since they left the bush in '86, all they've been doing is masticating and sitting. Some of them carry a sleeping gait even when standing. Even when land-grabbing they do so while seated. A quick way to cause a coup is to invite all the generals to spur with me on one of my regular 1 hour trots around Kololo-Kintante hills - all of them would fibrillate except ATG (This last statement is intended to be a joke). These issues require another full exhortation at another date and time. Then M7 castigated the Medical Officers for writing 'jargon' that cannot be understood by the non-medical person. Correct!
UAH members especially Gook,do not be scared - the big butt has no problem as such. The problem is a big abdomen. The fats on the bum are relatively healthy - they are meant as a reserve to handle shocks like illness - it is those on the abdomen - unfortunately the two tend to go hand in hand but not always. If you can maintain a healthy 'waist-hip ratio' i.e. a smaller waist than your hip, it is fine! (But the waist in this case should be measured through the umbilicus, not the groin)
This speech (and indeed the alter-ego speech by the widow) are a gold mine for lifestyle education against the budding problem of chronic diseases in Uganda. They should be scrutinized for decades as our dual burden of disease unfolds. Because recent surveys show that as many as 20% of Ugandans have high blood pressure - and this is for all ages - when we zoom in on older age-groups, by age 40, at least one third of Ugandans have high blood pressure. Unfortunately the journalists picked the statement 'am annoyed' and will keep spinning this over and over without bringing out the real message. RIP to the 'gentle giant'!
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-- "This heart problem you are talking about, OK it may have been there but we [the family] have never seen it', she says. 'My [two] children are my witnesses. He was full of strength...For 19 years he has never failed to get out of bed or fall sick", she adds.
How best to animate the insidious nature of cardio-vascular disease than in this statement. Ofcourse family cannot 'see a heart problem' because seeing it requires an 'echo-cardiogram' which if you found in someone's home would be enough to scare the day lights out of you! People in love do not see heart diseases, they see glowing faces! The combination of the two statements (M7's and the widow) show the expected vs. the norm regarding NCDs.
The current orientation of our health system is towards acute infectious diseases. Because of this, the anthropology of well-being is that: When you feel the symptoms (the fever, joint pains, etc) then you know you are sick. Unfortunately, cardiovascular diseases and indeed other NCDs present in the reverse. For a very long time (an average of 15 years) you feel very well yet some of the most vital organs of your body are ill! Unlike the developed world where cardio-vascular diseases are among the poor, in the developing world it is a mixed picture. Therefore, pple develop CVD during the years that they feel they are enjoying life the most: Dollars are coming in, pork, unbelievably comfortable gas guzzling SUVs, and p.o.w.e.r! Society loves them big (the adage 'big is beautiful'). For the women, the bigger the bum+'ka-bustingo', the bigger the presumption that there is a huge fertile 'kitone'. For the men the more 'pregnant' the bigger the extrapolation to a huge fecund 'waleti' - society's correlation coefficient between chronic over-nutrition and success is very high. Combined with the 'stress to keep up there', this makes an optimum recipe for hypertension and heart disease.
M7 expounds further in his informative speech: That the deceased was found to have had evidence of 'multiple heart attacks' that occurred in the past (as seen from the post-mortem); that he was known to have 'mild hypertension' for many years; that he complained of 'dizziness and abdominal pain in Korea'. Very correct on this too. Many pple with heart disease actually get multiple 'silent' heart attacks, some of them going off unnoticed as vague pains in the left upper abdomen (around where the stomach is located) - sometimes the pain 'radiates' to the jaw - because the diaphragm (the tough membrane that separates the chest from the abdomen and is key for breathing), the heart muscle and the top of the lungs are served by the same nerve - so the pain is vaguely 'referred' to other places which further confuses the picture. I do not have an immediate off-hand publication but one physician at Mulago, in a conversation we had, chatted about seeing a series of middle-aged men who come to his clinic complaining of 'ulcers' and when he examines their hearts, he finds they are having real-time 'silent' heart attacks. Some of them report to have been on 'ulcer' medication for months or years.
M7 expounds further: 'I know he is up there and we are all moving there, but he still had a lot to do here'. Exactly! In this statement, HE alludes to the concept of 'early death' and 'life years lost due to early death'. A heart attack in the 50s can cut off an average of 20 life years because as we know, life expectancy at 50 years is much higher than life expectancy at birth in Uganda. A person who hits 50 in Uganda expects to live up to 70 at the minimum, on the average. In one of my small studies, I saw diabetes peaking at 45-50 in Eastern Uganda yet it peaks at 65-70 in other studies done in developed countries.
M7 then gives a prescription in form of an order (unfortunately he gave it only to his generals): 'You all should have periodic medical check-ups!!!!' And he was f***ing right. The key point here is that unlike acute conditions like malaria, by the time you develop a 'seemingly simple symptom like 'abdominal pain' as a result of CVD, you are already terribly terribly ill! With much of the damage irreversible!
Unlike acute diseases, for chronic conditions, the signs (the things that health workers can detect) often precede the symptoms (what the patient complains of). So in order to detect the CVD early, you need a med - at least every 5 years from when you are 40. And of course he talked about 'officers and their body-weight' and the diminishing levels of physical activity with rank. Save for Afande Teargas, Uganda's generals look like in-fecund castrated toads! It appears like ever since they left the bush in '86, all they've been doing is masticating and sitting. Some of them carry a sleeping gait even when standing. Even when land-grabbing they do so while seated. A quick way to cause a coup is to invite all the generals to spur with me on one of my regular 1 hour trots around Kololo-Kintante hills - all of them would fibrillate except ATG (This last statement is intended to be a joke). These issues require another full exhortation at another date and time. Then M7 castigated the Medical Officers for writing 'jargon' that cannot be understood by the non-medical person. Correct!
UAH members especially Gook,do not be scared - the big butt has no problem as such. The problem is a big abdomen. The fats on the bum are relatively healthy - they are meant as a reserve to handle shocks like illness - it is those on the abdomen - unfortunately the two tend to go hand in hand but not always. If you can maintain a healthy 'waist-hip ratio' i.e. a smaller waist than your hip, it is fine! (But the waist in this case should be measured through the umbilicus, not the groin)
This speech (and indeed the alter-ego speech by the widow) are a gold mine for lifestyle education against the budding problem of chronic diseases in Uganda. They should be scrutinized for decades as our dual burden of disease unfolds. Because recent surveys show that as many as 20% of Ugandans have high blood pressure - and this is for all ages - when we zoom in on older age-groups, by age 40, at least one third of Ugandans have high blood pressure. Unfortunately the journalists picked the statement 'am annoyed' and will keep spinning this over and over without bringing out the real message. RIP to the 'gentle giant'!
--
"War is nothing but a continuation of political intercourse, with a mixture of other means. Man will never be free until the last king is strangled with the entrails of the last priest."
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