Heart to Heart

The ICHA Blog

It is always hard to put pen to paper, or finger to button, as it were, after a trip to a distant land.  The obscurity of capturing living and vivid memories in succinct phrases worthy of their descriptors is, in my mind, one of most difficult tasks in writing. So continues my struggle during my recent sojourn to Ghana.

As I sit here in a Charlottesville coffee shop, furiously pecking away at my streams of consciousness, proper words to describe my experience elude me.  I learned long ago that only through travel do we realize how truly provincial we all really are.  The beauty of travel, particularly to a destination that challenges your own paradigm of the world, is that the memory stays with you far longer than any trinket, souvenir or written description ever will.

The trip started quietly enough.  With the assistance of pharmacotherapy, my last memory was that of a bad airline movie and a stale meal.  I awoke with a thump in a new continent.  The first couple of days were spent getting to know my colleagues: a medicine resident from India who recently crossed the intern year finish line, a sharp-minded first-year medical student collecting data for a research project, and a seasoned and wise veteran from...well...Michigan, I suppose, though recent Locums stops include Alaska, Hawaii, and Vietnam.  The four of us would be spending the next two weeks teaching local health care providers - mostly nurses - some of the basic tenets of managing chronic diseases.  Main topics included hypertension, diabetes, obesity, smoking cessation, proper diet, and exercise.  Each of us was to lead sessions on these specific topics, but oftentimes conversations became appropriately tangential.

On my first day of leading the session, I was to talk on - among other things - choosing healthy food options.  Having recently returned from a month of medical work on Lake Atitlan, Guatemala, I fumbled for a proper comparison.  Here the obesity rates in the towns surrounding the lake seemed to directly correlate to the level of tourist infiltration; and, I had noticed, the tourist business appeared to correlate with the number of foil wrappers strewn about the streets of dust.  Foil wrappers that were very recently filled with foods high in saturated fats - Fritos, Doritos, potato chips, Cheesy Poofs.  In my awkward proclamation that "most foods which come in foil wrappers will contribute to clogged arteries and other poor outcomes," I was met with a roomful of blank stares.  The nutritionist raised her hand and - without hesitation - asked how the foil in the wrapper could possibly cause the food to be unhealthy.

I was once again humbly reminded that the student often is observing an object, or subject, from a completely different perspective than the teacher.  As an American who lives within a stone's throw of a gaudy supermarket, and as a recently graduated Family Medicine resident with little to less time to think about what's healthy, I had programmed myself to try - and oftentimes fail miserably - to avoid the foil wrapper food group and aim for something more conducive to healthy living.  Here in Ghana, however, that luxury of choice is not so evident.  Often, in a country like Ghana, the cheapest and most readily available foods can be found in the foil wrapper food group. Here, where fruits, vegetables and fish appear abundant, they are oftentimes too expensive for the family to eat on a regular basis. Yams and mangoes are common in the area, as are a whole host of exotic and edible fish.  And it turns out that fish, for instance, is found on a majority of the plates in Elmina on any given afternoon.  But foil wrapper foods are cheap, tasty and readily available.  And fish are fried in soy oil.

The same concept holds true, of course, in the States.  No difference, really.  The populations most likely to consistently go for the foil foods, or the fast foods, for sake of argument, are those who don't have the money or the knowledge to choose the healthier alternative. A Big Mac is a delicious alternative for most to a rice cake with a dollop of peanut butter.

The difference lies in the fact that there is a MAJOR push here and in other developed nations for healthy lifestyles; an emphasis on foods low in saturated fats and carbohydrates, and rich in protein and fiber,  among a spate of other relevant and long-overdue changes in the way we live our lives.  Our health care systems cannot possibly continue emphasizing the "treatment" aspect of medicine, and grossly underestimating the importance of the preventative side of medicine. A recent article in the New Yorker by Atul Gawande speaks to this point.  To wit: "Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit."

To avoid the proverbial worm can, I shall digress no further but to say that prevention is a critical aspect of medicine that has sorely been missing in the United States, though I am encouraged by a recent emphasis on Evidence-based Medicine (for example: Is surgery really no better than conservative measures for a herniated disk?  Does riboflavin really work to prevent migraines?) and the importance of patient responsibility.  A mentor of mine described it as this:  the doctor and the patient are in a rowboat, each with an oar.  If the patient stops rowing, the boat goes in circles.  The patient's "oar" in this case is healthy living, healthy diet, exercise, alcohol moderation, smoking avoidance and cessation.  And so it goes....

The same holds true in developing countries, including Ghana. Countries that were specializing in damage control with such devastating diseases as AIDS and polio, are now starting to actually tread water.  The infectious disease aspect of health care in developing countries is no doubt going to continue haunting us for time eternal.  But, in Ghana as in most other developing countries, overall survival rates are increasing.  Ghana's life expectancy in 1960 was 46 years old.  Today it is 60 years.  Still appalling statistics, given so many people still die a young death from wholly avoidable diseases.  Chronic disease is now becoming more of an issue in these countries.

This is where ICHA comes in.  In my estimation, ICHA has done a masterful job at looking into the future and seeing the need for teaching local health care workers - the real teachers - about the importance of healthy living now the.  The simple but powerful message that good food is good for you.  That exercise is good for you.  That preventative medicine should be practiced in every country regardless of the GDP, or the number of foil wrappers strewn on a dusty street.

I could write of so many other experiences during my short stay in Ghana.  Perhaps I'll save the story of getting my pants pulled down in the front of a thousand Ghanians celebrating the last day of Bakatue, a festival to usher in a new fishing and farming season in the Elmina traditional area.  Or the nurse who offered to give me a pineapple enema to cure my viral-induced myalgas.

Then again, perhaps some experiences are better left in memory and not on paper.