My recent encounters with patients have prompted me to write a short warning to everyone concerning the disease hypertension. I have already written in detail about hypertension (Link) and I don’t intend to repeat it again but simply to share a few concerns. One of my patients whom we recently diagnosed of hypertension and put on medication came back recently complaining of a severe headache and swollen feet. On further enquiry I realized that she had not been taking her medication for two weeks. This is despite the long conversation we had had on what could happen if her blood pressure is not controlled, she even gave me the full list of complications exactly as I had explained them to her.
This is a trend I have seen in many patients, especially men. Firstly there is a resistance to be tested for chronic diseases like hypertension and diabetes (even HIV but that may be a different topic). People generally don’t want to know and will give excuses to stay ignorant of their own health. The most common excuse I get is, “what if I have the disease?”. Well, that’s kind of the whole point isn’t it. I usually ask questions like, “isn’t it better to know now than when it’s too late?” and “what if you don’t?”
In this country, blood pressure is checked routinely whenever you visit a health facility. Public health specialists including myself have been advocating for routine blood sugar testing as well. This brings us to the second point of resistance which is the reluctance to start treatment. People generally tend to stay in the denial period for long, sometimes too long. I have seen patients who refuse medication only to come back years after being diagnosed. They usually come with complications such as kidney failure or after suffering a stroke. Even then they will still not believe that it’s hypertension, more often than not it is believed be an uncle or an aunt who is “jealous of my success”, even where there is no evidence of said success. In Africa, chronic diseases have probably destroyed more families than anything else.
The third point of resistance occurs after starting treatment. It is called defaulting. A lot of people default BP medication because by it’s very nature the disease is asymptomatic. This means you don’t feel any symptoms until it has done significant damage. In medical circles it has earned the name “the silent killer” Read more on this link. When I asked my patient why she had stopped taking her tablets, her answer was very short. “Tablets are boring.” I can’t argue with that, tablets are indeed boring but that’s an excuse you will never get from someone who is really sick and battling for their life. A few years ago another patient of mine stopped taking his HIV drugs because a prophet had told him some “holy water” was going to treat him. He fell for this nonsense and immediately went back to the first point of resistance only to come back in a serious state, I still joke about this moment of madness with him.
I believe that as a community, where our health is concerned, we live by the motto “what I don’t know won’t kill me.” Except in this case it definitely will kill you. We need to be proactive and be in control of our health. It is not easy, one needs all the support they can get, which is where everyone else comes in.
The message to take home is that while hypertension pretends to be innocuous, it is in fact a very dangerous disease. Shona folklore has many legends of healthy people being struck down by mysterious agents of witchcraft, behind each of those stories is a disease as old as time itself. It only takes a change in attitude as well as dialogue. Ignorance is not always bliss. Spread the message.