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14.05.2008 Health

``Health-Assets``

By Kofi Dankyi Beeko, MD- The Author - Ghanaian Chronicle

It is a dozen years ago, when I heard from the lion's own mouth, an American who had an operation carried out on his heart, with absolute success. He was glad the operation had been successful, and not only was he alive, but he was also free of pain, and could do once again, all sorts of exercises, at will.

His life had got normal again. He had gotten married a second time around, since the operation, and had fathered a child. As if he didn't think people would believe him, he had the child and mother with him in the studio that day, on his talk-show. The man is called

Larry King, and the whole world knows his program on CNN as, “Larry King Live.”

He was on the same program on the 22nd of February, 2008, talking about his ordeal, which turned into joy, after the operation. The previous day, I had listened into a BBC Radio-Program, which quoted the renowned Britain-based Medical magazine, the “Lancet.”

The issue was the déjà vu', “brain drain of medical personnel, from third world countries.” Two conditions led to the plight of Mr. Larry King, and he talks freely about them, and try, as a famous man, if he could advise the public. He had at one time grown very obese, “the American way.” He had developed what is known as Type II Diabetes Mellitus, (adult type), and arterial hypertension as well, which so often accompanies the former.

Both conditions lead generally, to very bad sequels for the heart, and the brain, (arteriosclerosis, non elastic-non-smooth vessels). Larry King, with sedentary work, as a broadcaster, was prone to obesity, and its sequels.

Myocardial Infarction, (heart attack), and Cerebro-vascular accident, (CVA), a condition in which a blood vessel supplying “some district” of the heart may get clogged, or burst).

Both conditions don't do the brain any good. Both can lead to severe temporary deficits, or worse still, permanent impairment or even death. Mr. Larry King was 'lucky” to have lived in the country that he lived, (and still lives in), when he fell ill 22 year ago. He had all the bad diseases, which tend to shorten life. His heart had reached a stage, where blood-supply to the heart muscles, was compromised, i.e. the muscles of the heart were hungry for nutrients, and oxygen.

This was at the eleventh hour. In America, or anywhere else in the West, something could be done about this condition instantly. The procedure in simple terms could be compared to a situation in which your water pipe gets blocked, just behind the house. If you could get a plumber who could detect the point of blockage, then he could introduce an extra-pipe, or a hose, and direct the water into your house, leaving behind, and the point of blockage. This is the by-pass. It is a procedure developed and almost perfected in the last four decades or so. Thousands of individuals carry “cardiac by-passes” in the West, but prominent among them are the former Singaporean Prime Minister, (Mr. Lee Kuan Yew), ex-US-President, Bill Clinton, and the incumbent US vice President, Mr. Dick Cheney. In the case of Dick Cheney, complications have set in several times, whereby a procedure called “stenting” has been necessary, -all since he assumed office in 2001. With this procedure, even the “new vessels” which have been implanted in the by-pass operation but have got clogged, could be made patent again, using a special probe, (stent), which re-opens the vessel, without the need of undertaking yet again, a major surgery.

Yet another prominent personality who survived the procedure of “by-pass surgery” for seven years was the late Russian President, Boris Yeltsin, who finally died only a couple of months ago. We have a National Heart Foundation in Ghana, and I understand meritorious work is being undertaken, and that, foreigners from other African countries, as well as our compatriots patronize and benefit from it. Services of this magnitude are so “few, and between”, that, such reports as the BBC/Lancet interlude recently don't bother to mention them. If Mr. Larry King had lived in Ghana though, as a Ghanaian, his story would have been told by a wife, or some family member, rather than himself. Other than South Africa, where the late Pioneer, Christian Barnard gloriously surprised the world with Heart Transplantation in 1968, not much is heard about Africa, and from Africans. In a related article, by the same author, a South African Brain Surgeon encountered in Europe some seven years ago was of the opinion that, “the state of economic affairs in South Africa, and that embracing the superb health care delivery that nation had enjoyed culminating in leading the whole world at one time, when talking of cardiac surgery, was a “triumph of the white man!” He seemed convinced, that, “the South African situation would not be duplicated by any other African country, in another 100 years.” South Africans of Indian origin, a lot of them Nelson Mandela's personal friends, and tallest among them, “Fatma Meir”, author of the best-selling biography on Madela, “Higher Than Hope”, are passionate about the “new South Africa”.

A lot of them are nevertheless apprehensive about their beloved motherland, “South Africa,” at the helms of one of us, and they don't make any attempt to hide this feeling. A number of them, prominent Brain Surgeons, that I knew, have recently left; some for Australia, and others for America. Nelson Mandela in his trial, (treason trial), of the early sixties, following which he was incarcerated on Robin Island for 27 years, said:

“The Sough Africa I have in mind should have room for the black color, for the Asian, for the Arab, and for the white man. This is an ideal I am convinced about, and believe in, and I' m even prepared to die for, if need be.” The applause, usually not a matter in the court, did not settle down for almost an hour. The judges sat behind the scene, for over two hours before resurfacing to pronounce, LIFE IMPRISONEDMENT. They were not raised by fools. Can that S. Africa be sustained? The BBC/Lancet discussion three days preceding this article was not the first, and I would doubt, if it would be the last. For people like me, who through no fault of ours had to study somewhere else, such discussions have been a frequent occurrence, even before we finished our first degrees, and throughout post-graduate education. I encountered nobody, (and I mean nobody), who was not motivated to return home, from Overseas, having qualified. The reality though was like this: On some occasions, you would come home from your job wherever it might have been, meet a colleague, or colleagues enter into discussions of partnership, and you reach a rapport of teaming up together, and be effective in the community.

Most of us were not interested that much in working in Public Institutions, but in the country though. You may “return to your base after such promising discussions”, and try to contact your would-be partner, or partners thereafter. There was no e-mail or Fax then. Telephone calls were hardly possible. If you happen to be lucky, to have relatives that were motorized to drive to find out; this is what you would get as feed-back. “Dr. X, or Y, left for Canada six weeks ago”. It was not only Canada, it could be England, or if you yourself were in Switzerland, you could be living in the same host-country, only you would not know. It must be emphasized, that this is not an attempt at finger-pointing. If you tried to get a job with an established institution back home, (many succeeded in so doing), but for most others who tried, it was a kind of “masser el Shareef”, or graveyard of the bold. Our beloved motherland is full of people who hate hearing what they did not do well, and at the same time, are quick in assorting blames. Let's say, it's a matter of opinion.

But, is what we are experiencing now, (paucity of health care delivery) so unique to Africa, or let's say Ghana? To seek an answer, we all have to turn back thousands of pages in history in general, but perhaps, medical history in particular. Three thousand years ago, star Physicians and Surgeons, who were trained either in Greece, (Herophilos von Chalchedon, Galen von Koos,), or from the land between Tigris, and the Euphrates, ( present day Iraq), (Ibn Sana, and Abu Kasim), all migrated and converged on Alexandria, Egypt, where learning in the then known world had concentrated, (compare that situation to the USA today). The biggest library ever built sat in Alexandra.

(To be continued).

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