By Beti Baiye and Oluwatoyosi Aibinuomo (lead authors)

Anyone watching 23-year-old Okenyi Collins as he goes about his business at the Heart Disease Prevention and Training Center (HDPTC) Nsukka might have mistaken him for a caregiver to one of the elderly patients waiting to see the cardiologist . So it was interesting when he said he was at the Center to see the doctor and had been doing so for over four months.

Collins is a final year college student. Forced into a sedentary lifestyle by the recent strike by the Academic Staff Union of Universities (ASUU), he spent his days eating, sleeping and surfing the internet. Then he developed severe pain in his chest area. “I’ve been to about four different hospitals. They did lots of tests and kept telling me I was fine, but I kept having pain,” he said. He decided to see HDPTC when one of the doctors suggested he see a cardiologist. “The cardiologist told me that due to the months of inactivity coupled with the food I ate; I have excess fat in my blood and it’s blocking my arteries.”

Clogged arteries can have serious, sometimes fatal consequences. Collins was thankful he went to the doctor when he did,”I have been receiving treatment here for 3 months now. So far, even though I’m not 100%, I feel better. The doctor had already told me that heart disease does not go away. Because there was a buildup before I started to feel the symptoms, the healing will also be gradual”.

A disastrous situation
Cardiovascular disease (CVD) has become a global concern. Data from the World Health Organization (WHO) revealed that in 2019, more than 17 million people died from cardiovascular diseases; about three-quarters of these deaths occurred in low- and middle-income countries. According to Dr. Francis Asogwa, Interventional Cardiologist and Medical Director, HDPTC, “The prevalence of hypertension in Nigeria is about 5.6%. These numbers come from studies done in teaching hospitals and communities. I can’t begin to tell you about stroke, diabetes, chronic kidney disease, but we know from research and experience that there is an upsurge in cardiovascular disease in Nigeria and Africa.”. Hypertension is a major risk factor for heart disease and stroke and when a person has both high blood pressure and diabetes – which is a common combination – the risk of developing CVD increases.

Health Surveillance in Nigeria

Significant lifestyle changes – smoking, unhealthy diets, physical inactivity – and resulting chronic diseases such as hypertension, diabetes, obesity, have been linked to increases in cardiovascular disease. There is also poverty, stress, inequitable access to health care and a health system that lacks the human and financial resources needed to prevent and treat cardiovascular diseases and their risk factors, which makes the situation even worse. worse.

A welcome disruption
Dr. Asogwa has always been passionate about fighting cardiovascular disease in Nigeria and he thought he knew how to go about it, but a chance encounter in India disrupted his well-laid plans. “A renowned professor who came to Mumbai to lecture on cardiovascular disease said, “You all came here to learn how to fix heart defects…but if you want to do good for your people, go back and learn- them to prevent these diseases.’ So, I went to India to learn about healing, but I was inspired to go home and stop people from getting to the point where they needed my specialty.”. Around the same time, he met Dr. Ezeugwu, also an interventional cardiologist and visionary and founder of HDPTC. Together, they defined a three-part goal: to teach people how to prevent CVD; train community health workers on basic and advanced care and reduce the cost of treating cardiovascular diseases.

Health Surveillance in Nigeria

Teaching people how to prevent CVD starts with every patient enrolled in the facility. When a patient is diagnosed with hypertension, he makes sure to educate him about the possible causes and complications. more, the measures to be taken to avoid them. This is an important step in the process because “by experience, out of 10 of our patients who suffered from a stroke, eight of them did not know that they were hypertensive and the other two who knew that they were living with the disease never knew that it there was no cure. They start their meds and as soon as the pressure normalizes they stop taking their meds and the next thing is they have a stroke or heart failure.said Dr Asogwa.

The establishment maintains an emergency medical register (EMR) in which it enters all the data of each patient registered in the establishment. This facilitates communication with outpatients, which they do weekly, bimonthly, or monthly, depending on the patient’s condition. Recognizing that the EMR may contain sensitive information, access to certain sections of a patient’s data is on a need-to-know basis.

The Emergency Medical Register (EMR) which captures all data of every patient registered at the facility contains sensitive information and therefore certain sections of a patient’s data are accessible when needed. Photo credit: Nigeria Health Watch

Preaching the Gospel of Prevention
Driven by the lack of awareness shown by the patients they saw; the Center also carries out free community actions. MaryAnn Osuagwu, Community Liaison and National Health Insurance Program (NHIS) Officer at the Centre, said:One day we went to one of the nearby communities for an outreach mission and found several men and women who had blood pressure readings of over 250. But they came to church and were dancing.”. They take awareness activities to churches, markets, villages where they offer free blood pressure readings – and sometimes free medicine for people in critical conditions, debunking myths and educating them on ways to prevent These conditions.

HDPTC organizes free awareness campaigns in churches, markets and villages where they offer free blood pressure readings, debunk myths and educate people on ways to prevent chronic diseases like hypertension and diabetes. Photo credit: Nigeria Health Watch

Cope with the cost of care
The cost of care for cardiovascular disease is high and although their rates are already subsidized, if a patient requires specialist interventions and cannot afford them, “we take your social history and if you are an indigent patient, we register you and give you free access to our services. Since we started, we have had about 7 or 8 such patients,” Asogwa said.

Health Surveillance in Nigeria

To further reduce the financial burden of treatment, they have recently been accredited by the NHIS and in an effort to encourage enrolment, through a random selection process, 200 people have been enrolled and will have access to care under of the NHIS program for one year.

The cost of care for cardiovascular disease is high and HDPTC has been accredited by the National Health Insurance Scheme to further reduce the financial burden of treatment for the people of Nsukka and surrounding areas. Photo credit: Nigeria Health Watch

A remarkable complement
The facility also has a library, and it’s not just for medical books. Besides medical and academic tomes, it is fully stocked with thriller, crime, drama, fantasy and fairy tale books with the works of John Grisham, CS Lewis, Enid Blyton and others on display. For anyone who grew up enjoying the traditional structure of the now defunct library, this is a fun place. It’s run by a librarian who said people can pay a token to access any book they want. “If you want to go with them you sign up for a library card,” she added. There is also a traveling library team that visits secondary schools to teach students about the joys of reading and to tell them about the library.

The HDPTC Library is fully stocked with medical, academic, thriller, crime, drama, fantasy and fairy tale books with the works of John Grisham, CS Lewis, Enid Blyton and others on display. Photo credit: Nigeria Health Watch

The heart disease center has been operational since July 2021. Setting up an operation of this magnitude is capital intensive and there is a constant need to ensure that their rates are low enough to be “affordable” and high enough to keep the “lights on”. ‘. However, according to Asogwa, the center is not yet generating enough funds. Kind donations from people who have visited the facility and international donors have helped keep the place running. This highlights the need to re-evaluate its current operating system and establish strong funding mechanisms to ensure sustainability.

It is clear that HDPTC fills a vital gap in cardiovascular care in Enugu State. Prevention is a step in the right direction and health education is essential if the increase in cases of hypertension, kidney disease and diabetes is to be reduced. Collaboration with the state government and other relevant stakeholders in the state will help scale up their operations and give them a broader reach than their current capacity allows.

The team wants to leave people they meet with an increased awareness of the need to regularly check their blood pressure and blood sugar levels. Although their efforts can be compared to ‘a drop in the ocean’, they hope it will inspire lifestyle changes among the people of Enugu State and eventually lead to a gradual reduction in disease prevalence. cardiovascular.