Common Things Common

Unexpectedly, black South Africans have most of the same chronic and acute disease processes as many Americans. Why??? Obesity - particularly in the female population. Naturally other co-morbidities like hypertension, diabetes, and maybe recently coronary artery disease affect the rural population. Of course, HIV/AIDS and TB outweigh obesity as the killer of black South Africans.

First of all, the women tend to be small in their teen years, but once they have children, they seem to blossom with BMI’s (Body Mass Index = kg/h^2 = measurement to measure obesity) into the 30-40s ranging into morbid obesity. Nearly all middle-aged women bear a noticeably substantial amount of weight and it’s not borderline overweight. Females are maybe 5’5”in height and 200 some pounds whereas the men and most elderly tend to be of near normal weights.

McDonald’s, potato chips, television, and Twinkies represent American obesity. But do these factors cause the obesity in females in rural South Africa? Here are some theories:

1) Westernization – Obesity was not as rampant as of 15 years ago as observed by Dr. Hla Tun when he first came to Nongoma. So maybe the love for KFC and improved access to fatty foods has contributed to this phenomenon
2) HIV Wasting – HIV has its stigma and a sign of HIV/AIDS is massive weight loss. To counteract the weight loss, individuals overcompensate by overeating.
3) Cultural – Perhaps South African men find larger women to be beautiful and correlate big hips with fertility.
4) Unemployment – The biggest occupation in Nongoma seems to be unemployment. Many survive on pension and consequently live a sedentary life.
5) Genetics- The cultural attitudes of female body shape may have caused a genetic shift or maybe the genetic shift created the cultural attitudes of female body shape.
6) All mixture of all of the above – Probably the most reasonable and safe answer.

In the Outpatient Department, anti-hypertensive meds (HCTZ-diuretic, enalapril- ACE inhibitor, adalat- Ca Channel Blockers) help control high blood pressure in many of the obese patients. On top of the hypertension, patients come in with neuropathy (loss of sensation) and decrease visual acuity which all show signs of progressive diabetes. Yet, in the US and here, we treat the symptoms rather than the root cause, obesity. As result another common killer is stroke. Often, hypertension and diabetes precipitate the stroke, but oddly not atherosclerosis.

Surprisingly, coronary artery disease (CAD) is not prevalent in the population. Doctors seldom check cholesterol levels and patients never come in with angina (chest pain) radiating into the left shoulder. EKGs are uncommon and in fact they seldom check the heart sounds in the outpatient department. Also, I have yet to see a patient with America’s favorite drug statin (Lipitor), a cholesterol lowering medication. However this may be changing if the cause of obesity is a newer trend of westernization and not genetics. That is, CAD will catch up with obesity in the following decades.

Epilepsy is a common diagnosis stemming from stroke, cysticercosis (tapeworm) infestation into the brain, or cerebral toxoplasmosis (protozoan).