NATIONAL 5 (Spotlight Weekly)]

Alarming Increase

Despite growing health awareness, heart diseases are growing in urban and rural areas

By A CORRESPONDENT

The number of patients with rheumatic heart disease continues to increase among the rural poor, imposing an additional economic burden on an already vulnerable segment of the population. Although health awareness in urban areas has increased over the years, the rural people continue to lack basic information on the methods of preventing heart diseases.

Patients in hospital : Hoping for the best

According to an unofficial estimate, there are more than 100,000 patients with rheumatic heart disease who are in dire need of surgery. A patient needs to spend at least Rs.20, 000 to Rs 30,000 on surgery. Similar operations in hospitals in India may cost four times as much. The cost in private nursing homes can exceed Rs.100, 000.

The Tribhuvan University Teaching Hospital started offering surgery for rheumatic heart patients nearly four years ago. Now Ganga Lal National Heart Center has come out with facilities to a limited number of patients. "We can provide all kinds of facilities to heart patients. With a capacity of 60 beds, our hospital also has well-equipped facilities to perform surgery,"says Dr. Bhagwan Koirala, director of the center. "We are offering our service targeting the poorest citizens."

Heart diseases are no longer confined to prosperous urban communities. They are gradually turning into a major burden for poor rural families. Since curative methods are so expensive, experts have long stressed the need to go for prevention. Rheumatic heart disease is preventable in the early period with relatively inexpensive medicine. Because of lack of knowledge, however, a large number of rural children have the disease.

Although some facilities for patients with rheumatic heart disease have been added in the country, treatment is still not affordable for the poor community. Most would have to spend their lifelong savings on treatment.

The high prevalence of cardiovascular diseases (CVD) risk factors in older people, particularly raised blood pressure and raised serum cholesterol, suggests the need for widespread treatment. It can be achieved through slight changes in lifestyle, especially through physical exercise and adjustments in dietary patterns.

There are many risk factors for coronary heart disease, stemming from the changing lifestyles in the urban areas. Increasing number of smokers, the popularity of junk food, lack of sufficient exercise, among other factors, have led to a rise in the number patients with heart diseases.

Experiments have shown that reduction of blood pressure by 6 mm Hg reduces the risk of stroke by 40 percent and that of heart attack by 15 percent. A 10 percent reduction in blood cholesterol concentration would reduce the risk of coronary heart disease by 30 percent.

Dietary changes seem to affect risk factor levels throughout life and may have an even greater impact in older people. Relatively modest reductions in saturated fat and salt intake, which would reduce blood pressure and cholesterol concentrations, could have a substantial effect on reducing the risk of cardiovascular disease. Increasing consumption of fruit and vegetables daily could cut cardiovascular risk by 30 percent, according to the World Health Report of 1998, put out by the World Health Organization.

Smoking is the most important modifiable risk factor for CVD in the young and old alike. The decline in smoking may reduce the number of disease. Reductions in stroke and CVD rates from smoking cessation increase with the time since quitting the habit.

Although the number of heart-related ailments could be reduced simply taking some precautionary measures, the number of patients with these problems continues to rise at alarming levels. "As a country like Nepal, where a large number of the people cannot afford the treatment related to heart diseases, it is better to start prevention and awareness programs," says Dr. R.P. Shrestha, former director of Bir Hospital.

Even if the country were to develop more treatment facilities, a large segment of the population would not be able to afford the cost of consultation and medication. Greater awareness of ways of preventing the disease may be a more potent antidote.