MAINTAINING GOOD HEALTH IN A NOXIOUS POLITICAL CLIMATE & AILING ECONOMY

presented at

EDO NATION ASSOCIATION OF THE AMERICAS ANNUAL CONVENTION 3-6 SEPTEMBER 2004

Held at

CROWNE PLAZA HOTEL, DETROIT METRO AIRPORT, DETROIT MICHIGAN USA.

My dear brothers and sisters, I thank you whole heartedly for the opportunity to deliver this speech at the 13th Annual Convention of ENA in the motor city of Detroit, Michigan USA. The topic 'Health Promotion and Disease Prevention' adopted for this convention is very timely considering the number of our brothers and sisters that have died recently due to preventable causes and the dismal state of health in our nation Nigeria and our Edo State in particular as I discussed in Boston Massachusetts in July 2004. http://edoglobalorganization.org/poverty.htm

My topic for discussion 'maintaining good health in a noxious political climate and depressed economy will try to advice on health promotion and disease prevention and enhance our economic status simultaneously both at home and in Diaspora. As there are a number of speakers for this topic digging in from all directions, the likelihood for repetition cannot be completely eliminated.

We must first define a depressed economy and a noxious political climate. In most countries, the economy is either depressed or the political situation is noxious. Unfortunately it is only in Nigeria where the economy is not only depressed but the political climate is noxious as well. This compounds the health status of the populace because it is only in a thriving economy with adequate funds set aside for the health sector and a peaceful political climate will the population thrive socially and enjoy good health. Only in Nigeria is it government policy not to talk of the ills of the society. It is only in Nigeria that individuals boast that they will produce state governors based on the facts that they have political fixers in government rather than the results of the ballot boxes. (Obehi David) (http://www.vanguardngr.com/articles/2002/viewpoints/vp118082004.html<http://www.vanguardngr.com/articles/2002/viewpoints/vp118082004.html> ) Only in Nigeria are appointments made on quota system rather than being the best candidate for the post. Only in Nigeria are Nigerians settlers rather being indigenous. Only in Nigeria are medical staff imported from overseas when there are unemployed medical staffs in the country not indigenous to that state.

A depressed economy is one sluggish in growth or activity with features of high interest rates; increased foreign competition; a pressured, sometimes sliding, exchange rate; high unemployment rate and  lay offs, a widening merchandise trade deficit; and a growing internal debt, the result of government bailouts to various ailing sectors of the economy, particularly the financial sector. Depressed economy can lead to civil unrest, this is unlikely in Nigeria as Nigerians are the happiest people in the world and secondly the most religious people in the world looking up to heaven for the answers. Does manna still fall from heaven? Depressed economy can also lead to serious violent crimes which is common place in Nigeria. Mortality and morbidity from violent crimes add to the high figure of fatality due to accidents and violent crimes in Nigeria.

I will define a noxious political climate as one that is detrimental to the physical, mental, psychological and social well being of the population of the nation. It is a situation where there is no rule of law or the law is made for the weak who cannot bribe their way out, where those in government are the masters rather the servants of the people, where the press is not free as should be, where there is irregular or non payment of wages for work done; where the people are totally docile about happenings around them as they have become inured, where those in authority adopt the divide and rule tactics and fan intra and inter tribal or ethnic clashes to have their way; where a discredited corrupt and vile leader will stand on the rostrum and proclaim that only God can prevent him from becoming head of state when the country is not his birthright nor is the country for sale. Only in Nigeria! Only in Nigeria and nowhere else.

Nigeria's former military rulers failed to diversify the economy away from overdependence on the capital-intensive oil sector, which provides 20% of GDP, 95% of foreign exchange earnings, and about 65% of budgetary revenues; leaders who are totally bereft of ideas of good leadership, leaders who failed to improve on the largely subsistence agricultural sector of the economy; whose functions were to preside over how to share the national cake derived solely from the oil sector of the economy should never, ever be allowed to rule the country again.

I will now discuss maintaining good health for Nigerians particularly Edos both at home who are bearing the brunt of the depressed national economy and noxious political climate and those in Diaspora and finally lay emphasis on maintaining good health in Diaspora under the following headings, nutrition/diet, smoking, exercise, sexual orientation, prophylaxis and the role of Edo State and Nigerian governments.

Good Nutrition & Average Healthy Body Weight.

Good nutrition and balanced diet gives good healthy body weight. In a depressed economy, good nutrition is still very possible when the right balance of protein, carbohydrates and fat are consumed. When expensive sources of protein like animal products are outside the reach of the average Nigerian, they should compensate with grains like the many varieties of beans available in the country that grow easily in the back gardens without the requirements of manure. The quantity eaten should also be reduced not only to conserve funds but to improve good health. Every one should aim for a body mass index (BMI) of 19-25. A BMI of 25-30 is over weight and above 30 is obesity. A quick way to check your weight at home is to measure your weight in pounds and divide by your height measured in feet squared and multiply the result with a factor of 703. Easier still, measure your weight in kilograms and by divide your height squared in meters. If the above is too complicated, measure your weight in kilograms and your height in meters and go to Goggle search engine on the internet, type BMI calculator, click search and put your weight and height in the space provided in the appropriate units and click calculate. It will give your BMI instantly.

In Nigeria, BMI are extremes, those who are under weight with low BMI are in the majority while at the other extreme are those who are well to do with very high BMI. There is an erroneous belief amongst the well to do that to be seen as successful, you must have a pot belly and a large bottom. Pot belly referred to as central or truncal obesity is more associated with cardiovascular problems and stroke and early death. Excess weight is associated increased risks of heart disease, diabetes, high blood pressure, stroke, arthritis, gallbladder disease, and some types of cancer. Obesity is hard to treat once established, so prevention is the better alternative. To help reduce excess weight and to maintain a healthy weight, experts recommend that individuals eat a balanced diet, moderate total calorie, eat less fat and more fruits and vegetables which abound in Edo State. Exercise on a regular basis help to use up the excess energy which otherwise would have been stored as excess fat.

Regular Exercise.

Regular exercise will help you control your weight, improve your overall health, and reduce your risk of medical problems such as heart diseases and osteoporosis. To get the most benefit, you should exercise for at least 20 minutes three times weekly.

When you exercise, make sure to take all the safety precautions that are recommended for the activities that you choose. It is especially important to always wear a helmet while cycling. Wearing a bicycle helmet can reduce your risk of head injury by 85%. Other safety equipment such as knee and wrist guards can also reduce your risk of injury.

Although exercise is beneficial for almost everyone, some people need to consult a doctor to find out what level and types of physical activities are safe for them. This precaution is especially important for pregnant women, people who have medical condition that could be aggravated by exercise (such as angina or arthritis), and people who are taking any type of medication (especially medicines for elevated blood pressure or heart disease).

My personal recommendation is walking for at least 30 minutes daily. It may be cheaper to walk the children to school and save on taxi fares and walk to the supermarket as well as work occasionally. You will not only reduce your transport expenses, you will be prolonging your life. Research has shown that if you take a thousand steps a day, you will increase your life expectancy by at least three years and at most seven years. No wonder our farming parents who trekked to the farm were stronger, lived longer and suffered less from osteoporosis than the new generation of Edos.

The best way is to buy a pedometer (size of a mobile phone) which will cost less than 20 dollars from a DIY shop and strap this to your waist to count the number of steps you take daily. The axiom is 'Walk and prolong your life and save on your transport expenses as well' It will be good fun walking the children to school if you can afford it at least thrice weekly.

Smoking:

Edo Nation of the Americas dedicated this convention to improving people's health both at home and in Diaspora hence my discussions is directed to helping our people set priorities for a healthy living and long life but when it comes to achieving long life and good health, we as individuals largely determine our own fate.

Smoking is massive public health problem anywhere in the world as it causes massive morbidity and mortality especially from lung cancers and cardiovascular problems. Here in the USA for example, cigarette smoking is the number one cause of preventable deaths. Tobacco use is responsible for almost half a million deaths each year and more than $50 billion in medical expenditures. One in every five deaths in the United States is smoking -related, and half of all life long smokers die of a smoking- related disease.

In a depressed economy like in Nigeria, smoking is uneconomical. Money spent on smoking could be used to provide balanced diet and nutritious food for the family. How would you rate the mental state of a man whose wages has been delayed and he gets a loan to buy cigarettes instead of food. Those who smoke in temperate climates claim it is to warm the internal organs; do we need such warming up when the average daily temperature averages 30 degrees centigrade in Nigeria? Is it not one of our impressionist attitudes that when it is done in Europe or America it must be the right thing to do without comparing the circumstance and different climatic conditions?

My brothers and sisters, stop smoking if you do and do not start if you don't. Make your life smoke free.

Do not Drink and Drive.

Never drink and drive. Equally important, never ride as a passenger in a car driven by someone who has been drinking alcohol. In Edo State and Nigeria, we do not regularly check the blood of driver involved in road traffic accidents. There is no doubt that a large proportion of RTA is due to drink driving. The facility for checking blood alcohol levels is the breathalyser and it is highly recommended to the Nigerians Police for use especially at weekends in Nigerian major cities. In the USA where there are good statistics, 41% of all RTA is alcohol related. More than 17000 Americans are killed each year in alcohol-related crashes, and more than 600,000 are injured (one person injured every two minutes.

Alcohol taken in moderate amounts is food but excess is a problem, so if you plan to drink, make safe transportation arrangements. If no designated driver is available, use mass transit or call a taxi. Money spent on excess alcohol is waste of scarce financial resources in Nigeria or in Diaspora.

Remember there are many loved ones waiting in Nigeria who depend on your monthly stipend for their livelihood so do not throw your life away. Moderate drinking is OK for most adults. If you are middle-aged or older, it may even benefit your health by reducing your risk of heart disease. For men aged 65 and under, the limit is two drinks per day, for men over 65 and women of all ages it is one drink a day.

Heavy drinking (that is, drinking that goes beyond the limits of moderation) is not helpful. Apart from the increased likelihood of RTA, the heavy drinking of alcohol is associated with increased risks of injury, liver disease, heart disease, high blood pressure, several types of cancer and worse still abuse of loved ones when under the influence of alcohol. It is responsible for more than 100,000 deaths in the USA each year.

Regular Medical Maintenance and Screening:

As we maintain our vehicles to make them road worthy so also our body needs regular maintenance or check up. From birth, children are screened for good eye sights, hearing, speech and coordination. Their growth are monitored on a growth charts and any deviation from normal is an indication for referral to an appropriate specialist. Screening is done at intervals. At birth, pre-school, school age, as young adults and in pregnancy. From the age of 20 years when women become sexually active, they screened for cervical cancer, at the age of 50 they are screened for breast cancers with mammography while the males are screened for prostate cancers and both sexes are screened for colon cancer. For cervical screening there is a call and recall system so that no woman is left out from screening and this screening has reduced the number of deaths from cervical cancers in Europe and America where they are an effective programme. There is need for such screening in Nigeria and in particular Edo State in particular

After the age of 50 years, there is a strong need to check for hypertension, heart diseases, diabetes mellitus, overweight, obesity and cholesterol levels. If any abnormality is detected, they are corrected before any serious damage is done. Medication to lower blood cholesterol can be purchased across the counter in most countries. Check your cholesterol levels at your care provider's clinic.

In Nigeria, some of these screening facilities are available but our people do not patronize these clinics as they wait for irreparable damages to be done before seeking help. It is wise to register with a doctor to provide health checks on ourselves, and our parents in Edo land while we are away from home. On the long run it is cheaper, provides continuous and consistent care.

Immunization:

During our childhood we were protected from deadly diseases like tuberculosis, cholera, small pox, yellow fever, whooping cough, polio, diphtheria etc by appropriate immunization. As adults in Diaspora, there is a strong need for us to be protected by similar immunization when we travel to Nigeria. Although small pox has been eradicated totally in the world since 1980, diseases like polio, typhoid, yellow fever, cholera, hepatitis A, B, C, and E in the northern part of Nigeria are still prevalent in Nigeria. It is essential for all Diaspora Edos to be appropriately protected against these preventable diseases when travelling home. Top hygiene should be maintained when travelling to the North of Nigeria due to likely exposure to Lassa fever, meningococcal meningitis and Hepatitis E virus infection. There are effective immunization for meningococcal meningitis using meningococcal A+C vaccine.

Edos in Diaspora travelling to other parts of the world should discuss with their care providers about SARS virus and avian flu and get appropriate advice.

Anti-malaria prophylaxis.

Malaria risk is predominantly due to P. falciparum as it exists throughout the year in the whole of Nigeria. P. falciparum is resistant to chloroquine sulphadiazine-pyrimethamine in Nigeria and therefore should not be relied upon. The recommended prophylaxis includes mefloquine (larium), malarone (atovaquone + proguanil) and doxycycline which are effective where chloroquine resistance is prevalent like Nigeria. See your care provider for these and he/she will be able to answer all question or we can continue the discussion outside after the presentation.

During the transmission season in malaria-endemic areas like Nigeria, all non-immune travellers exposed to mosquito bites, especially between dusk and dawn are at  risk of malaria. This includes previously semi-immune travellers like you and I who have lost our immunity during stays of 2 years or more in non-endemic area like Europe and America. Most cases of malaria in travellers occur because of poor compliance with prophylactic drug regimes or use of inappropriate prophylaxis,

For those of us travelling home for good, we should avoid anti-malaria prophylaxis and get treatment after malaria attack to enable us build up new immunity against malaria infestation.

Be aware of the risk, the incubation period, and the main symptoms.

Avoid being bitten by mosquito, especially between dusk and dawn by using mosquito nets.

Take anti-malarial prophylaxis to suppress infection when appropriate i.e. for short stays holidays only.

Immediately seek diagnosis and treatment if fever develops one week or more after entering the area where there is malaria risk, and up to 3 months after departure or sometimes up to a year after leaving the malarias region.

Note that no anti-malaria prophylactic regime gives complete protection.

* Dosing schedules for children should be based on body weight.

* Anti-malaria that need to be taken daily should be started the day before arrival in the risk area.

* Weekly mefloquine should be started at least 1 week, but preferably 2-3 weeks before departure to provide optimal protective blood levels and to allow any side effects to be detected before travel so that possible alternatives can be considered.

*Anti-malarial drugs should be taken with unfailing regularity for the duration of the stay in the malaria risk area, and should be continued for 4 weeks after the last possible exposure to infection, since parasites may still emerge from the liver during this period. The single exception is atovaquone/proguanil (malarone) which can be stopped one week after return.

Normally I use malarone because one can start prophylaxis the evening before travelling but it can cause diarrhoea which can be troublesome during long haul flights. Alternatively one can start it on the day of arrival in Nigeria and stop a week after getting back to base in Europe or America.

Those deaths occurring a week or so after coming back from home is most likely due to malaria infestation but a majority of us believe otherwise as to the causes, blaming grannies and grandpa and innocent step parents for using evil magic which they do not have.

AIDS and other Sexually Transmissible Diseases.

The best ways to protect ourselves against AIDS are to:

a.. Never use a non-sterile needle to inject anything into your body.
  b.. Abstain from sex.
  c.. Have sex only with an uninfected partner in a mutually monogamous relationship.
If you choose to have multiple sex partners (or your partner does), you can reduce your risk of AIDS and other sexually transmitted diseases in the following ways:

    . Ask all prospective sexual partners to be tested for sexually transmitted infections.

Use condoms properly and consistently.

Avoid sexual intercourse with people who engage in high-risk behaviours such as unprotected sex or intravenous drug use.

Preventing Deep Vein Thrombosis.

There have been recent increases in publicity surrounding deep vein thrombosis (DVT) and pulmonary embolism (PE) in association with air travel. DVT and PE following long haul flight became known as economy syndrome which is a misnomer as it is not confined to economy class travellers alone. Any prolonged immobility lasting more than four hours can predispose to DVT or air journey covering more than 10,000 kilometres at a time. There are associated factors like cigarettes smoking, pregnancy, delivery within last two months, cancers, age over 60 years, those on the combined oral contraceptive pills, presence of heart disease, those on hormone replacement therapy, varicose veins and those whose blood clot easily.

If you have any of the above conditions, see your doctors before travelling for advice.

The best prevention includes the following:-

Mobilize or exercise the lower limbs during the trip by walking about at intervals in the cabin, or along the carriage of a train or stop your car at intervals and stretch your legs by walking about for 5-10 minutes at interval. Maintain adequate hydration by drinking water and orange juice throughout the trip.

Avoid alcohol during flights and long journeys.

If you have any of the predisposing factors, consider using compression stockings or better still take 75 milligrams of aspirin daily or see your doctor for low molecular weight heparin if you have very high risk of developing DVT.

Stress

Stress is the "wear and tear" our bodies experience as we adjust to our continually changing environment; it has physical and emotional effects on us and can create positive or negative feelings. As a positive influence, stress can help compel us to action; it can result in a new awareness and an exciting new perspective. As a negative influence, it can result in feelings of distrust, rejection, anger, and depression, which in turn can lead to health problems such as headaches, upset stomach, rashes, insomnia, ulcers, high blood pressure, heart disease, and stroke. With the death of a loved one, the birth of a child, a job promotion, or a new relationship, we experience stress as we readjust our lives. In so adjusting to different circumstances, stress will help or hinder us depending on how we react to it.

Can We Eliminate Stress from Our Lives?
As we have seen, positive stress adds anticipation and excitement to life, and we all thrive under a certain amount of stress. Deadlines, competitions, confrontations, and even our frustrations and sorrows add depth and enrichment to our lives. Our goal is not to eliminate stress but to learn how to manage it and how to use it to help us. Insufficient stress acts as a depressant and may leave us feeling bored or dejected; on the other hand, excessive stress may leave us feeling "tied up in knots." What we need to do is find the optimal level of stress which will individually motivate but not overwhelm each of us.

There is no single level of stress that is optimal for all people. We are all individual creatures with unique requirements. As such, what is distressing to one may be a joy to another. And even when we agree that a particular event is distressing, we are likely to differ in our physiological and psychological responses to it.

We can manage stress better if we try the following tips:-

1. Become aware of your stressors and your emotional and physical reactions.

2. Recognize what you can change.

Can you change your stressors by avoiding or eliminating them completely?

Can you reduce their intensity (manage them over a period of time instead of on a daily or weekly basis)?

Can you shorten your exposure to stress (take a break, leave the physical premises)?
Can you devote the time and energy necessary to making a change (goal setting, time management techniques, and delayed gratification strategies may be helpful here)?

3. Reduce the intensity of your emotional reactions to stress.

The stress reaction is triggered by your perception of danger...physical danger and/or emotional danger. Are you viewing your stressors in exaggerated terms and/or taking a difficult situation and making it a disaster?
Are you expecting to please everyone?

Are you overreacting and viewing things as absolutely critical and urgent? Do you feel you must always prevail in every situation?

Work at adopting more moderate views; try to see the stress as something you can cope with rather than something that overpowers you.

Try to temper your excess emotions. Put the situation in perspective. Do not labour on the negative aspects and the "what if's"

4. Learn to moderate your physical reactions to stress.

Slow, deep breathing will bring your heart rate and respiration back to normal.

Relaxation techniques can reduce muscle tension. Electronic biofeedback can help you gain voluntary control over such things as muscle tension, heart rate, and blood pressure.
Medications, when prescribed by a physician, can help in the short term in moderating your physical reactions. However, they alone are not the answer. Learning to moderate these reactions on your own is a preferable long-term solution.

5. Build your physical reserves.

Exercise for cardiovascular fitness three to four times a week (moderate, prolonged rhythmic exercise is best, such as walking, swimming, cycling, or jogging).
Eat well-balanced, nutritious meals.

Maintain your ideal weight.

Avoid nicotine, excessive caffeine, and other stimulants.

Mix leisure with work. Take breaks and get away when you can.

Get enough sleep. Be as consistent with your sleep schedule as possible.

6. Maintain your emotional reserves.

Develop some mutually supportive friendships/relationships.

Pursue realistic goals which are meaningful to you, rather than goals others have for you that you do not share.
Expect some frustrations, failures, and sorrows.
Always be kind and gentle with yourself -- be a friend to yourself

7.. See your counsellor, pastor or priest, occupational health department for help when all else fails.
 

The Role of Various Levels of Government:-

The Local, State and Federal government have crucial roles to play to enhance and maintain the good health of all our people in Edo Land. It is the duty of the Federal government to spend at least 6% of the GDP on health purposes annually. What is being spent presently is a far cry from that amount. It is also the duty of the Federal government to provide for the training of all medical and allied medical staffs in the country and above all maintain standards. It is also its responsibility of government to keep abreast of new developments in medicines and the implementation of these developments to benefit all Nigerians.

It is the duty of the State government to budget adequate funds for health, ensure standards are kept in the State in healthcare provision, maintain health infrastructures in the State and ensure constitutional regulation of health activities in the State. It is the duty of the State government to obtain appropriate vaccines, maintain the cold chain during the distribution and in conjunction with the local government mount adequate campaign to ensure good take up of the vaccine and its distribution in the population.

The local government maintain the local health care clinics, ensure adequate staffing, mount immunization campaigns and are the first to notice and report promptly out break of deadly diseases to the State, Federal and International Organizations as a duty by law.

Finally, the provision and maintenance of health services should be partnership between the people and the government at local, State and Federal level for efficient health care delivery in any area or region of the world.

The take home message is

If you have health, you have hope and if you have hope, you have everything.