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Handle Your Heart with Care: Curbing the Rise of Non-Communicable Diseases in Nigeria.

We got to Zenith Medical & Kidney Centre at 6:50am, and already, the place was beginning to fill up. Thankfully, we were early enough for my father to get connected to a dialysis machine before 7:30am. My mother and I found a parking space in the shade and tried to make ourselves comfortable. It was going to be a four hour wait, but before it was over, there would be a kilometre long line of cars; snaking from the gate of the Medical Centre, all the way to the junction. I’m used to the sight by now, but it still surprises and saddens me that so many people are grappling with kidney disease or failure.

“Daddy, I’m writing an article for World Heart Day, and I’d like to use your story. Can I?” I asked. Knowing how private my father is, I needed to gain his permission to use him as a reference in this story. I half expected him to decline, but he said, “Please go ahead and write the story, I’m okay with it. Hopefully, someone will learn from it.”

Getting a diagnosis
In 1999, a family friend who happened to be a nurse, noticed my father’s laboured breathing after he carried one bag of sachet water up a flight of stairs. She asked him a few questions, and immediately recommended he visit the doctor. He did and was diagnosed with high blood pressure (HBP) and placed on medication.

Nigeria Health Watch

Fast forward to early February 2021, my father started to feel unwell and assumed it was malaria so, he took some anti-malaria medication and his usual over-the-counter pain relievers; but after a week, he became worse. My mother had been trying to get him to go to the hospital from the moment he started feeling unwell. She had repeatedly suggested more frequent visits to his cardiologist.

Finally, when he could barely keep anything down, and had no strength left to resist, he was admitted into the University of Abuja Teaching Hospital. After a series of tests were done, it was discovered that his creatinine and urea levels were high, signs of kidney disease. He also tested positive for COVID-19, and was moved to the isolation Centre, where he had to undergo dialysis four times a week for the three weeks he was there.

When he tested negative for COVID-19, he was moved to another hospital, where an abdominal scan confirmed that his kidneys had failed, and that he needed to continue to undergo dialysis.

The cost of care for a person undergoing dialysis can best be described as catastrophic and not just in terms of the amount of money you spend. One session of dialysis costs between ₦28,000-₦50,000, depending on the part of the country or the facility; my father requires two sessions a week. There are patients that require 3 or 4 sessions and can barely afford one. There is also the long wait to use a dialysis machine as people often flock to the ‘cheaper’ alternative. Combined, the high medical expenses and resulting income loss can put a strain on any family’s wellbeing.

Nigeria Health Watch

Between the kidney disease and the heart
World Heart Day was observed on 29 September, and according to the World Heart Federation, cardiovascular disease causes over 18.6 million deaths per year; making it the world’s number one killer. More than 75 million of those deaths occur in low-and-middle-income countries, of which Nigeria is one. You may be wondering what kidney failure has to do with cardiovascular disease. Remember that my father was diagnosed with high blood pressure, and had been living with the condition for years?

The kidneys and circulatory system are dependent on each other to function properly. The kidneys use a lot of blood vessels to filter waste and extra fluid from the blood. When the blood vessels suffer damage, the nephrons that filter the blood can’t receive the oxygen and nutrients they need to function well, and over time, high blood pressure harms the renal blood vessels to the point of irreparable damage. It is for this reason that high blood pressure is the second leading cause of kidney failure. Diabetes is the leading cause.

Nigeria Health Watch

Lessons from my father’s experience

(1) Get yourself checked- Prior to our family friend noticing his HBP symptoms, my father had felt them for years without knowing what they were. He dealt with really bad migraines on a regular basis at a younger age and had been managing them with over-the-counter pain killers. Regular medical check-ups were not on his agenda, and he only visited the hospital when he became critically ill.

For many reasons, some of which are lack of access to affordable, equitable and quality healthcare — particularly in rural communities — this is not uncommon in Nigeria. However, regular medical check-ups can save or preserve the quality of your life in the long run, especially if you have a family history of chronic disease.
 
(2) Visit your doctor regularly– If you have been diagnosed with any chronic condition, it is critical that you keep your hospital appointments. My father loathed regularly consulting with his cardiologist because he felt it was time consuming.

When your doctor sees you regularly, they are able to monitor your progress, adjust medication where necessary, and advise on necessary lifestyle changes to help mitigate complications that may arise from your condition.
 
(3) Listen to your body- Don’t ignore the warning signs your body gives you. That persistent headache or pain in your chest, is your body alerting you to a problem. Please do not self-medicate; visit your healthcare provider and explain your symptoms clearly.

(4) Prioritise your overall health- This means being intentional about good diet, exercise, and rest. An unhealthy diet, physical inactivity, and obesity are some of the risk factors for developing cardiovascular disease. In addition to diabetes, HBD and others, long term use of skin whitening creams, as well as abuse of traditional herbal mixtures have also been identified as risk factors for kidney disease among Nigerians.

The rise in the prevalence of non-communicable diseases (NCDs) in Nigeria cannot be ignored. The country accounts for 25.50 of the NCD mortality rate in Africa. Access to quality care and affordable medication for chronic diseases in the country still leaves much to be desired and is worsened by attendant catastrophic costs. A report by Resolve to Save Lives in partnership with Médecins Sans Frontières Access Campaign looked into the pricing of antihypertensive medicines in low- and middle-income countries (LMICs). Findings included aligning national Essential Medicine Lists (EMLs) with the most current World Health Organization (WHO) Model List of Essential Medicines and ensuring greater transparency in pricing.

Nigeria has no laws guiding the treatment of kidney diseases as preventative care is very poor, especially at the primary health care level. Resolve to Save Lives also supported the Federal Ministry of Health in developing a hypertension treatment protocol for primary care settings, that includes the use of single-pill combinations (SPCs; two or more medicines included in one pill).

The creation of a National Renal Care Policy would also help regulate treatment and facilitate the inclusion of renal care and treatment for other non-communicable diseases in the National Health Insurance Scheme (NHIS). Subsidising cost of care would help increase the number of Nigerians who can access renal care and boost the quality of care they receive.

Even though it’s still a struggle sometimes, my father is eating a healthier diet and exercising more. He has realised that the cost of treatment is way much higher than the cost of prevention. I think that’s the biggest lesson he wants us to learn; that indeed, prevention is better than cure.

Use Heart for Heart
Having kidney disease increases the chances of having heart disease, heart attacks, and strokes. Keeping your kidneys healthy will help take care of your heart.

World Heart Day was observed with a call to use ‘Heart for Every Heart’. This involves making the right decisions about your health. It requires you taking that 15-minute walk 3–4 times a week, no matter how busy your life may be. It means putting down your phone, or shutting down your laptop, so you can get up to 7 hours of sleep. It also means you donating blood regularly; being more empathetic; or recognising when someone is under a lot of stress and encouraging them to rest or seek medical attention.

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