Nepali Times
Life Times
Double whammy: heart attacks and infections


Patients who've had heart attacks are a common sight in Nepali hospitals these days. Because most people have no insurance or receive state support, the economic burden for the average Nepali suffering from a cardiovascular illness like a heart attack is crushing, running as it does into hundreds of thousands of rupees. South Asia may be an open textbook for infectious diseases (TB, typhoid, typhus, etc), but these can often be dealt with by a course of antibiotics. With cardiovascular illnesses, the treatment can be much more drawn out.

Forty-year-old Ram Maharjan, for example, was a taxi driver. One day he experienced sharp chest pain with nausea and vomiting, but he drove himself to Bir Hospital where after tests, he was diagnosed as having had a heart attack. He was referred to another hospital, and after further more expensive investigations, they told him he required a stent (a tube to prop open an artery) for one of his coronary (heart) arteries with severe narrowing. However, he had run out of money for the potentially life-saving procedure of stent placement, having spent it all on preliminary tests. Such a sequence of events is increasingly common in Nepal, where until three decades ago illnesses were generally limited to infectious diseases.

Cardiovascular problems have become so widespread in poor countries such as ours that mathematical modelling has been carried out to determine if taking a preventive pill (a polypill that reduces cholesterol, blood sugar, and high blood pressure, the three important 'controllable' risk factors for cardiac illnesses) after the age of 50 helps. The results were very promising; field trials using inexpensive, generic drugs from the Indian drug company Cipla are underway. Importantly, the benefits derived from taking a polypill need to outweigh the risks (side effects) of taking the drug. In countries like Nepal, where treatment of cardiovascular diseases and their complications can be financially devastating, a well thought out, evidence-based preventive measure is an attractive idea.

In the meantime, we need to drink clean water, avoid fatty food, stop smoking, avoid sugary drinks and instant noodles, eat dal bhatroti, and go for morning walks. These precautions should be our health mantras.

1. Manav Bhattarai
There are practically two issues here both of which lead to the same conclusion-how can a country like Nepal combat the emerging and financially crippling epidemic of non-infectious diseases when it is still battling against the existing infectious disease? The first issue is- how to convince people or rather change the behavior of people so that cardiovascular diseases are averted. The next issue is- how to make sure that people are not denied health access when they suffer from these diseases irrespective f their economic status. 

Regarding tackling the  first issue it is not that simple as we might think. Just remember, how many of us have continued jogging or doing exercise after having started to do so. Sustainability of behavioral modification is the most important factor that needs to be addressed.

Regarding tackling the second issue, unless there is a compulsory National Health Insurance scheme, equity and access to health care cannot be achieved. This is practically impossible until there is a major overhaul in the system.

2. Nalin Banskota

Agree. Unless we tackle the real social determinants of health and health inequity the problem will remain and this is a daunting task. Health Education will also play a vital role but is only a tiny part of the big picture.

(11 JAN 2013 - 17 JAN 2013)