Fighting NCDs in Barbados
Chronic diseases should be inserted into the national economic debate, says Sir Trevor
Fifty-four thousand Barbadians suffer from hypertension, 16,000 suffer from diabetes; three fifths of Barbadian women are overweight while one third of all men are overweight and seventy per cent of all deaths here are attributed to chronic disease like cardiovascular disease, diabetes, cancer and chronic respiratory disease. These figures are not new and the experts say they may even be higher.
These alarming statistics reflect the threat non-communicable diseases pose to the economic well-being of the country. According to Professor Sir Trevor Hassell who chairs the National Non-Communicable Diseases (NCD) Commission and the Advisory Committee of the Chronic Disease Research Centre, 60 per cent of the annual budget is spent on the drug service and the Queen Elizabeth Hospital (QEH) to tackle these illnesses.
Sir Trevor says the issue is so critical that the Chronic Disease Research Centre is looking for a health economist to identify the true impact NCDs are having on the country’s bottom line.
“It is my view that chronic diseases should be inserted into the national economic debate that is taking place, so that we view this issue through the lens of the economic issue,” he noted at the recent launch of the Barbados Association of Retired Persons – Barp On The Move: Just A Pinch Campaign earlier this month.
The former Consultant Physician and Cardiologist at the QEH says for too long the focus has been on the cost of care but attention needs to be turned to the loss of productivity in the workplace and the impact on family.
This situation is not unique to Barbados – in fact Sir Trevor’s concerns are echoed by Tenet Florida physician Dr Paul Acevedo, a Neurologist out of West Palm Beach. “As a neurologist I have seen quite a few patients with stroke and every single one of these patients is not in isolation, they all have family members, they have co-workers; they have brothers and sisters and children that are affected by stroke,” he said.
Dr Acevedo was speaking ahead of an upcoming visit to the island where he will be making a presentation on stroke awareness at a Healthy Lifestyle Expo hosted by the NUPW Insurance Agent Inc. (NUPW IAI), ICBL and Tenet (which is a health care network in South Florida made up of nine acute care hospitals with ten sites of service) on Saturday, March 22, at the NUPW’s Dalkeith headquarters.
He explained that, “the impact of stroke is not only on that of the patient but also on the family members and loved ones that are taking care of this patient after there is now a new deficit from stroke, weakness, speech impediment etc, so this really has a tremendous impact on communities,”.
Meanwhile, his colleague cardiovascular and endovascular surgeon Dr Ali Shahriari, a specialist caring for patients with aortic diseases and aneurysms, who will also be here for the Expo maintains that prevention is better than treatment. He says all countries facing increased cases of NCDs among its population should mount a large campaign to bring awareness to the risk factors.
These risk factors include exposure to tobacco, low levels of physical activity, alcohol abuse, genetics, eating habits and diet which could lead to hypertension, increased lipids or fats in the blood, increased cholesterol, obesity, strokes, kidney disease and kidney failure. Dr Shahriari cautions that these risk factors manifest in several ways including cardiovascular disease which is very common in the western hemisphere.
Dr Acevedo says the risk factors in Barbados are not much different from other areas in the Caribbean and even Florida. “These are risk factors that are silent and continue to be prevalent in the patient population, this makes it very important and imperative for us to be aware and know how to treat stroke.”
Sir Trevor says it is not all doom and gloom, he says that 80 per cent of heart disease and diabetes and 40 per cent of cancer can be avoided through relatively simple measures which include a healthy lifestyle and medication. However, he laments that in Barbados and globally only 70 per cent of hypertensives are well controlled at any given time.
“That is despite that fact that in Barbados we’ve got an excellent Barbados Drug Service in which I’ve documented some 40 different types of drugs are available for treating hypertension. I think that is something we really need to pause and reflect on,” he pointed out.
Dr Shahriari says there are several new medications which treat better to hypertension and hyperlipidemia or high fat levels in the blood. “There are newer devices for treatment of rhythm problems, electrical problems in the heart and also I specialise in aorta aneurysms and a lot of new devices that we’re using for minimum invasive treatment of patients with aorta aneurysms which really reduce the risks that have been associated with traditional operations.”
Dr Acevedo reiterated that prevention is the main component of stroke care and he introduced the risk of dehydration which he says increases the risk of large and small strokes.
“If we think about cerebro-vascular disease or the disease that is associated with changes and damages to the blood vessels over time in brains, we have to think about the common risk factors to the blood vessels in the entire body. However, in the brain it is a much more eloquent area of the body, a much more sensitive area to these changes.”
He further highlighted sleeping problems in the obese as a cause for concern. “Obstructive sleep apnea has now clearly been identified as an independent risk factor for patients that are at risk for stroke.” He said that patients with sleep apnea who go undiagnosed have a higher risk of presenting with strokes in the brain.
He says when there is a stroke and there is still time to save the patient’s brain he and his team go in with a catheter and remove some of the arteries of the brain to help the patient recover.
While here the two Tenet doctors hope to collaborate with local doctors to exchange information and learn from each other. Dr. Shahriari noted, “Hopefully we will also be able to get to Barbados some of the newer modalities and newer treatment options we are using here and not only learn from the doctors in Barbados but also be able to get something to the population of Barbados to improve the health there.”
Dr Acevedo added that neurologists aid with diagnosis and are a necessary back up for the General Practitioner, the Consultant and the Internist. “Stroke patients and neurological patients should be understood as patients with potential needs for immediate care as well as long-term care and for that you need to have some infrastructure, some kind of network to make sure that when patients can be treated locally, if necessary that you will have the infrastructure in place, the knowledge and the understanding to be able to provide these services.”
Sir Trevor Hassell says with political backing from Government via a mandate set by the CARICOM Heads of Government the NCD Commission will be advocating for national policies and legislation including taxation to increase healthy eating by making it more affordable and to make salt the difficult choice, “and that is an important issue also to ban the promotion and marketing of unhealthy food to our children. This is an issue we need to advocate for,” he stressed.
Professor Hassell is the featured speaker at the opening of the NUPW Insurance Agent Inc., ICBL, TENET, Healthy Lifestyle and Expo on Saturday, March 22.
Other local doctors expected to be making presentations include Professor David Corbin, Dr Jerry Emtage, Dr Raymond Massay, Dr Elizabeth Rochester and Tenet Florida Physician Dr Sandra Sanchez.