Diabetes & Hypertension cannot be controlled by holding conferences & meetings at Five Star Hotels

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 Diabetes & Hypertension epidemics
Diabetes & Hypertension cannot be controlled by
holding conferences & meetings at Five Star Hotels
Healthcare professionals must target rural areas and urban
slums to create awareness and educate the public
Setting up Hypertension and Diabetes Clinics at DHQ and
THQ hospitals with a proper referral system and ensuring
availability of cost effective medications could be useful
interventions to achieve the desired results

ISLAMABAD: Prevalence of diabetes and hypertension is increasing fast and most of the patients come to know about it when they are confronted with some complications. Despite the fact that we have too many professional specialty organizations, Non-Governmental Organizations (NGOs) and other interested groups working in these fields and they keep on organizing seminars and conferences mostly at Five Star Hotels all sponsored by the pharmaceutical trade and industry but it has so far failed to make any impact. The most recent surveys have proved it beyond any doubt that the prevalence of both these diseases is spreading fast and a very minor percentage of those who suffer from these diseases are taking appropriate medications and even a minor fraction of them have been able to achieve desired control.

Apart from ignorance and lack of health education, non-affordability of medications is an important factor in failure of compliance with therapy. The situation is worse in the rural areas and urban slums and if we wish to control these diseases we will have to think and plan of some effective interventions. Some time back Prof. Khawar Kazmi former General Secretary of Pakistan Cardiac Society and a noted cardiologist had suggested the setting up of Hypertension Clinics in all the major hospitals in the country where simple essential cost effective drugs like diuretics and calcium channel blockers can be provided to control blood pressure. Similarly diabetic clinics can be established in all the major hospitals where patients suffering from diabetes can be provided cost effective anti-diabetic drugs. If all the diabetes and hypertension patients attending these clinics are provided drugs either free or at a subsidized cost which is not difficult, it will go a long way in reducing the burden of these diseases. Prevention has to take preference and major emphasis needs to be put on use of healthy diet, regular exercise and taking care of the known risk factors.

The healthcare professionals particularly its leadership will have to target rural areas, small cities and town as well as urban slums. They should organize camps and motivate the community leaders as well whose help can be sought for creating awareness and promoting preventive strategies. The pharmaceutical trade and industry which is asked by the medical profession to sponsor meetings and conferences spending billions of rupees can be approached and they will be most willing to sponsor these camps, clinics in small cities and town and they can even be persuaded to provide needed drugs at a concessional price, provided they are spared of coercive methods used by conference organizers who demand millions of rupees not only for setting up stalls at the conferences but also sponsor travel and accommodation of speakers as well as delegates. Conference expenditures also needs to be controlled by ensuring that only those registered delegates are allowed to participate, luxuries like Gala Dinners, Banquets, music and cultural programmes can be eliminated. Similarly presenting shields, other mementoes and conference bags for the conference participants needs to be done away with. These conference mementoes should be presented only to a selected few like Chief Guest or the Guest of Honour.

Pakistan Hypertension League as well as Pakistan Cardiac Society both have come up with their comprehensive Guidelines on Prevention, Detection and Control of High Blood Pressure but unfortunately not many family physicians or other healthcare professionals are either aware of it or have read it, what to talk of using these guidelines. Hence all this hard work put in by the authors of these guidelines goes waste.

As regards diabetes, there is too much reluctance on the part of not only the physicians but also the patients to start Insulin therapy early which could prevent many complications. Even if the patients use insulin, they tend to use sub-optimal dose so that they can use the insulin vial for more days and thus save money. The diabetics need to be convinced that they need to take appropriate dose of insulin and also ensure proper follow up and continuous monitoring by the physicians who might like to change the medication, its dosage or add another drug if the blood glucose is not controlled. Same is the case with patients suffering from hypertension and the patients need to be educated not to stop or change medications without the advice of their treating physician. It is also essential that the doctors spend some time with the patient to educate them instead of rushing to write the prescriptions which is usually the case. Now diabetes educators, diabetes nurses are playing an important role in prevention and control of diabetes all over the developed world. However, in countries like Pakistan, diabetes educators, diabetes nurses as well as other specialized nurses and technical staff still lacks proper recognition. Health care is a team work wherein these allied health professionals are an integral part of the healthcare teams.

Another important measure which would pay rich dividends is the setting up of some referral system so that patients referred from Basic Health Units, Rural Health Centers or by family physicians are entertained at THQ and DHQ Hospitals. Since not many of these patients are satisfied with the healthcare they receive at these primary healthcare centers and secondary healthcare facilities, they tend to rush to tertiary healthcare facilities and teaching hospitals in the big cities which always remain over crowded. The authorities need to strengthen the secondary healthcare facilities like THQ and DHQ Hospitals with proper trained qualified staff and equipment to cater the needs of the patients. Each medical college can also be asked to look after a particular area where their students and medical staff can provide basic healthcare facilities and refer to their tertiary care facilities those who need specialized care.

Diabetes and high blood pressure are both chronic diseases which need lifelong treatment. Pharmaceutical trade and industry also spends lot of money in these areas which has given rise to too many professional groups, societies and unfortunately there is no co-ordination among them which in return leads to wastage of lot of resources which can be put to some better use. Conscious people within the medical profession need to look into these things and assume a leadership role to urge the doctor’s community to uphold professional ethics and practice ethical medicine. Every patient coming to see a doctor for any complaint must have his blood pressure checked but unfortunately not many doctors are interested in doing that. We also need to specially target the younger generation, organize some health talks in schools, colleges and universities, tell them the hazards and risks of using junk food and cold drinks as well as other sugary drinks. Such eatables should not be available in or around the educational institutions as well in healthcare facilities. Parks have disappeared from many cities thanks to the corrupt land mafia, builders and corrupt politicians with the result that people do not find any place to go for exercise. The present disease burden is already too much and it is likely to increase further. For countries like Pakistan prevention remains the only best option hence instead of giving too much importance to curative services, the healthcare professionals as well as the authorities need to give prevention of disease a serious thought.

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