You are What You Eat

Feb 24

Written By tbdejong2000 .

I have been asked to write a blog on what Bruce is up to. I am so proud of him but have been procrastinating due to the sheer volume of content. However, delving into what he's teaching is fascinating, especially for a lay person like myself. I hope you'll find it equally so.

A year ago, Bruce raised approximately $50,000 through the kindness of members of the Reformed Church of America. These funds were allocated for the purchase of handheld ultrasound scanners for use in Madagascar. The Butterfly company gave a discount and also a free subscription worth $400/year per unit. Global Health Ministries helped purchase and ship these scanners to the SALFA main headquarters in Antananarivo and from there they were distributed to the major SALFA hospitals.

By the way, a big shoutout to Global Health Ministries. (www.ghm.org/madagascar). Their website is absolutely beautiful with engaging visuals and the work they do is impressive. Detailed audits and line by line balance sheets are made public and they carry a 4-star rating from Charity Navigator, the highest possible,

Last year, Bruce conducted two ten-day ultrasound training seminars for physicians and midwives from the surrounding SALFA hospitals, one in Antsirabe and the other in Sambava. Some participants endured a grueling two days on crowded taxi brouses to attend, bracing themselves as they were tossed up and down on the pot-hole ridden roads. I remember as a child when traveling home from boarding school, I would cry in the back of our jeep as my head repeatedly bumped against the hard roof of the vehicle. The determination shown by the SALFA medical staff to participate n continuing education opportunities is impressive and their eagerness to learn makes teaching even more rewarding.

This year, he is continuing in this medical training, focusing on cardiology and dermatology. Although he teaches up-to-date research on pertinent topics using powerpoint presentations, Bruce prefers an experiential teaching style, where he mentors doctors and nurses while treating actual patients. The hospital administrator had announced on the radio that a "specialist doctor is coming to town”, and as a result, the waiting hall was full of hopeful patients.

At times, these experiences can be heart-wrenching. Last week, an old man presented with an excruciatingly painful total body eczema for the past 10 years. His head looked like he was suffering from mange. His suffering surpassed anything on a 1-10 scale, yet he couldn’t afford the treatment cost. Bruce offered to cover it and when handed the bill, he did a double take. It wasn’t that we couldn’t afford it, but rather that the medicines cost four times more than in India.

“No wonder the poor can’t afford medical care here.”

He is more determined than ever to try and find a way for SALFA to import medicines from India instead of buying them locally.

The population of Madagascar is around 28 million, approximately the same as Mumbai alone. When I was young, tropical diseases such as malaria, intestinal parasites, and schistosomiasis held the spotlight. Today strokes and cardiovascular disease are topping the chart. One major government hospital tracked the mortality trends in their institution over a span of 24 years revealing a significant increase in deaths from heart disease. Starting at 5.5% in 1992, the rate climbed steadily up to 26% by 2016. Today, the leading cause of death in Madagascar is stroke - women at 72 per 100,000 and men at 60 per 100,000. Malaria is down to 20. per 100,000 for both men and women but remains a public health problem according to the World Health Organization, as is HIV-AIDS.

The maternal mortality mate in Madagascar is categorized as very high by WHO standards. According to USAID, more than half of the population lives more than five kilometers from a health center and even so, the quality of many of services is questionable. Dr. Elson describes how women from the countryside suffering from a difficult labor are carried by oxcart or motor cycle to the nearest medical facility, sometimes traveling for two or three days, only to arrive dead at the hospital doorstep. Personally speaking, labor and childbirth is agonizing enough, even in the safest of situations. The thought of dying from the process of bringing a child into the world is unimaginable to me.

More than 20% of under-five mortality in Madagascar is due to pneumonia—the single leading cause of child death, followed by diarrhea, malaria and other nutrition-related factors. Other leading causes of death in Madagascar are tuberculosis, hypertension, malnutrition, measles, road accidents, and cervical cancer, The incidence of diabetes in Madagascar is 4% or 500,000 Malagasy people and rising. .

The life expectancy data reflects this country’s destitute poverty. Globally, even considering the poorest nations, the average life expectancy stands at 73 years. However, Madagascar lags behind with an average life expectancy of just 63 years. It is no surprise people here often find it hard to believe that I am 66 years old, . Many of their family and friends my age have already died from “old age”

Although Bruce mentors his colleagues on the accepted treatment protocols for cardiovascular disease, diabetes, and hypertension and in addition provides basic training in echocardiography, his main focus is on prevention. Based on latest research findings, inflammation is the main culprit at the heart of most modern diseases including diabetes, hypertension, atherosclerosis, asthma, and cancer. There is a massive amount of new research that we humans live in an ecological balance with our gut flora. An unhealthy gut flora is one of the causes of chronic inflammation which contributes to cardiovascular disease and diabetes. A healthy gut flora is maintained by a diet based on a large variety of fruits, vegetables and legumes, and damaged by sugar, excess intake of alcohol, processed food and high amounts of meat.

Bruce surprises his colleagues with the simplicity and clarity of his message. According to the American Heart Association, adhering to these seven healthy habits can reduce the risk of cardiovascular diseases by 75%, AND adhering to only three or four of these habits can reduce the risk of cardiovascular diseases by 40%.

maintain normal cholesterol
maintain normal blood sugar
maintain normal blood pressure
maintain normal weight
eat a healthy diet consisting of at least 1/2 of your intake by volume as fruits and vegetables
be physically active
By the way, the newest research shows that 7000 steps provides equivalent health benefits as 10,000 steps - good news for those who are holed-up during long cold winters.

The take home message is that even by changing three to four of these risk factors, 50% of the people who would have died from heart disease can now enjoy a longer and healthier life. He asks his colleagues,

“If you could take a pill that would reduce your risk of cardiovascular disease by 75%, wouldn’t you take it? Lifestyle changes are free of cost. The only price you have to pay is time and effort.”

My recollection as a child is that the main staple in Madagascar was whole grain red rice (vary mena) typically accompanied by greens (roamazava), a tomato chutney (rogay), a meat and bean stew (laoka) with ranon’ampango, a toasty rice tea, served at the end of the meal. Dessert would be a couple of bananas.

We purchased red rice from Tana to bring with us to Morondava and arranged for a small restaurant to prepare it for us daily, as red rice has become increasingly scarce in many parts of the country. Nowadays, people predominantly consume white rice, with much of it being imported from China. In Tana, we were curious about lines of people waiting to get into a certain restaurant, so decided to try it out. The only option available on the menu was Min Sao, a large serving of white, starchy noodles with a sparse scattering of vegetables and meat pieces mixed in.

Bruce shows slides in this lectures of the “Blue Zones”, the parts of the world with the largest number of healthy, active people over 100 years old. The Blue Zone studies suggests that maintaining one’s health potential boils down to three simple things.

Regular exercise
Eating plenty of fruits, vegetables and legumes, and meat in moderation
Being a part of a community of family and friends, feeling loved and acknowledging your own worth as a valuable member of society.

Street food we see in Madagascar:

Today he is starting presentations on hypertension, again emphasizing that according to current research, lifestyle factors play a huge role in reducing high blood pressure. Besides the usual risk factors of obesity, sedentary lifestyle, unhealthy diet etc, chronic stress is becoming known as a killer. And one of the biggest sources of stress is poverty: lack of food security, health care, a safe place to live, a feeling of hope for the future. Even though Madagascar is a country rich in natural resources such as gold and sapphires, it ranks as the fifth poorest country in the world. Seventy-six percent of Malagasy people lived in extreme poverty in 2017, subsisting on less than USD 1.90 per day, compared to 72.5% in 2012. In 2016, the average Malagasy was 42% poorer than 50 years ago.

His lectures resonated personally when two doctors volunteered to be practice patients and the beginnings of heart disease were discovered and seem motivated to make life style changes. Additionally, he notices more of his colleagues opting to walk to the hospital instead of breezing by on a pouse pouse. He hopes that they will succeed in communicating common sense healthy living to their patients.

“Why spend all your hard-earned money to doctors and pharmacists?” he asks the doctors to tell their patients. “Walk more and buy carrots and a handful of greens instead.”