The Sunday News
Dr Cherifa Sururu
At 45 Robert (not his real name), had established himself as successful indigenous businessman in the high density suburb of Pelandaba, in Bulawayo.
His six children were all in public schools in the suburb and he was the envy of his neighbourhood.
Despite being a very obese man, he had enjoyed very good health for most of his life. He had not visited any doctor.
Like many members of the community, he knew very little about the health delivery system in the city. He also did not think that he had a role to play in improving the health delivery system in his community.
Over the last three months, he started experiencing loss of weight and peeling itchy rash all over the body. This itchiness was made worse by heat and sweating. His hair was thinning and would fall easily. He also had a very itchy rash in his genitals associated with small wounds that developed due to scratching. He would not stop scratching because of the worsening itchiness. His wife suspected that he had a sexually transmitted infection.
Despite repeated visits to various clinics, faith and traditional healers, his condition continued to get worse. His brother in South Africa then decided that he needed to see a doctor.
He had several HIV tests that come out negative. Various courses of antibiotics, creams and ointments were tried to no avail. Robert had tested HIV-negative. His symptoms, however, were the same as those experienced by those developing Aids. He would get very uneasy when people stared at him because he would think that they perceived that he had HIV. He was amazed that, despite being a faithful man, his wife was afraid to come close to him.
He had to sleep in the spare bedroom with the children. He was not allowed to share towels and other household utensils with the rest of the family.
This, the family thought, was a way of stopping the disease from spreading to other family members. He however, felt lonely and segregated.
Despite, the very hot temperatures in summer, he would cover as much as possible of his body. This he did to conceal the very bad rash from the “prying” public. In an effort to limit exposure to the heat, he would spend as much as possible of his time at home. The limited time at work directly affected his earning power as a self employed person. This was exacerbated by long waiting times at the clinics and other places where he was seeking alternative care.
He was very anxious about his health because all his efforts to be cured had failed. He would imagine the rash and general condition getting worse. He also thought that the condition was going to take his life. This would make him very sad. He would spend most of the nights “tossing and turning” thinking of this disease which seemed to have no proper diagnosis and possibly no cure. He would feel helpless about the whole illness.
On consultation, he was noted to be a depressed, wasted middle-aged man with malnutrition. He was told that he had a skin disease called sebarrhoeic excema and this genital rash was linked to a yeast infection also called Genital Candidiasis. The presence of yeasts infection prompted the doctors to do a sugar test which was observed to be very high. His blood pressure was also noted to be very high.
He was diagnosed with Type 2 Diabetes Mellitus and hypertension. He was put on appropriate treatments and he made an uneventful recovery. He was also given lifestyle change advice. This entailed exercising for at least 30 minutes for a minimum of five days per week. He was also given a diet sheet to assist with his diet. His diet sheet emphasised cutting down on carbohydrates and stopping sugar intake. He was referred to the diabetic sister for further health education.
Optimum control of his type 2 diabetes and hypertension was encouraged to limit complications. Robert was an obese middle-aged man who had rapidly lost weight. Obesity is associated with increased risk of type 2 diabetes mellitus, cardiovascular diseases and various types of cancers for example breast, prostate and colon. Other diseases related to obesity are gallbladder diseases, non-alcoholic fatty liver disease, dyslipidemia, glucose intolerance and insulin resistance, hypertension, gout, menstrual abnormalities, orthopeadic problems, reduction of cerebral blood flow and sleep apnea.
Type 2 diabetes mellitus consists of an array of dysfunctions characterised by high blood glucose and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion.
Hypertension affects approximately more than twenty percent of adults in Zimbabwe; it is a major risk factor for stroke, myocardial infarction, vascular disease, and chronic kidney disease.
Type 2 Diabetes Mellitus and hypertension and their complications are rapidly overtaking HIV/Aids as main causes of morbidity and mortality.
In the last article we spoke about the epidemic of obesity. It is thought that more than twenty percent of the Zimbabwean population is obese. Type 2 Diabetes Mellitus symptoms may be non-specific from weight loss, weight gain, too much appetite, increased in rate of passing urine and increased chances of getting opportunistic infections as the case in HIV positive people.
Conclusion
This article has highlighted the silent nature or non-specificity of symptoms of Type 2 Diabetes and hypertension. This highlights the need to have at least one blood sugar test and one blood pressure test at least once a year from the age of twenty. This is so because the proportion of people with these diseases is rapidly increasing in the population. The only sure way to diagnose these conditions is through the appropriate measurements for early diagnosis in order to avoid complications.
The health delivery system should refer patients to higher levels of care if not improving or if the diagnosis cannot be established.
Members of the community are also advised to actively engage their health delivery systems with a view of understanding how they work and be involved in their improvements to make them appropriate for their needs.
