Traffic congestion in Nairobi: health implications

The city of Nairobi has been growing exponentially since independence. The population has grown from about 350,000 in 1963 to over 3 million today. Vehicular numbers have steadily increased too, with Nairobi estimated to host about 30% of all vehicles registered in Kenya. The transport infrastructure has not kept the same pace of growth, hence the choking traffic congestion in the city.

IBM’s international traffic study ranked Nairobi as the 4th most gruelling commute out of 20 global cities in 2010, topping the list with Moscow with longest traffic jams averaging 2.1 hours.

Congested traffic has many drawbacks from an economic viewpoint. Time wasted in traffic jams translates into reduced productivity, higher fuel consumption, increased vehicular wear and tear, and many spillover effects. What about harmful health effects? Traffic Psychology studies show detrimental health effects of being stuck in traffic. The extreme is road rage, whose regular experience is extremely dangerous to human health.

Road rage is the irrational surge of anger towards another motorist. It varies in the response, which can range from a rude gesture or shouting to a full confrontation outside of the vehicle. The initial aggressive stimulation is very harmful to the body, especially if experienced on a recurrent basis. Anger is accompanied by release of stress hormones into the blood system, which is harmful to the heart and other functions of the body. One gets into a fight or flight situation, which in extremes is like driving under the influence.

Once high levels of the flight hormone adrenaline are pumped into the blood stream, all sorts of things can happen. Angry drivers become stressed, anxious, agitated and their hearts beat faster. They overestimate their own driving skills, believing other road users to be less adequate. This further escalates into loss of concentration and to accidents, which at worst can be fatal. In extremes, drivers will get out of their cars for a physical confrontation, as happens in the US about 1200 times a year. Children are not spared either, they have to contend with awakening early and arriving home late, with untoward psychological health effects and poor performance at school.

Even though most untoward health effects resulting from traffic congestion are transient, recurrent experiences can lead to longer term consequences. Psychological and emotional disturbances may ensue, and physical effects of daily stress may manifest in cardiovascular and other organ dysfunction. Whilst County authorities must invest in modern traffic management systems and public transport, individuals can take some steps to help themselves out. There are plenty of psychological coping strategies to mitigate against stressful situations. Flexible working hours, working from home, car-pooling or simply leaving the car at home on certain days may play some role. We can chose to take some actions, or the city will soon grind into a huge parking lot, with unhealthy individuals trapped in big four-wheelers.

A single pill to treat multiple ailments

You may have heard of the medical term ‘pill burden’. This refers to the realization that many people with chronic illnesses tend to take too many meds in any given day, sometimes for a lifetime. It’s no wonder then that some pills will be forgotten and missed out, interfering with optimal disease control. But what if all those different meds were combined into a single pill?

The combination of several types of meds aimed at simultaneously treating related diseases is already in existence. Such combinations are referred to as ‘polypills’ or ‘combopills’. Essentially, a number of drugs that treat different, and usually related conditions, are compounded into a single pill. The doses are worked out to be either curative of the specific conditions, or just preventive. Thus you end up swallowing only a single pill to treat a multiplicity of ailments.

The initial interest and application of polypills was in cardiovascular diseases. Those with heart disease can end up taking lots of medications to control hypertension, reduce cholesterol levels, and limit the risks of blood clots. A polypill combining all such medications makes sense, optimally improving compliance and limiting progression to heart attacks and strokes. There are other applications of polypills in infectious diseases like TB and HIV, where multiple intake of different kinds of pills is the norm.

The use of polypills in disease prevention programs, on a wider population basis, has even been suggested. Non-communicable diseases, especially cardiovascular and metabolic diseases, are on the spotlight. There appears to be a likelihood of reducing heart attacks and strokes if whole populations are given a fixed-dose polypill that lowers blood pressure and cholesterol, and reduces the risk of blood clots. Other polypills may reduce the rates of diabetes and some types of cancers.

The benefits of polypills are obvious. Pill burden immediately becomes a thing of the past, compliance with medications is improved, resulting to near optimal disease control. The overall cost of medications may be lower, improving access to needy populations in low income countries. If the envisaged disease prevention with polypills bears fruit, this would have a positive effect on economics.

But there are some concerns with polypills as well. Some combinations may provoke unintended and harmful side effects in the long ran. Fixed doses, especially for preventive applications, may not suit everyone. This however could be addressed by individualized compounding of polypills in specialized chemists, or hospital pharmacies. And drug manufacturers may not be too interested in merging their products into polypills. This will inadvertently eat into their bottom lines.

Either way, polypills are already in the market. If you already swallow a handful of pills a day, for whatever reason, it helps to check with your doctor if a polypill is available to ease your burden.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke

Just put down the phone already.

If you wake up every morning groggy, it might not be your pillow or the temperature in the room that’s keeping you from getting a good night’s sleep: It could be your smartphone addiction.

A new study from Deloitte found that one third of adults check their phones if they wake up in the middle of the night, as do nearly half of those under the age of 35.Researchers have known for years that the blue-ish light smartphone screens emit can make it harder to fall back asleep.

A small subset of this late-night phone-checking group makes it even harder on themselves, though, reading and even responding to work emails during the wee hours, a behavior that’s more common among users under the age of 35.

Roughly one in 10 smartphone users will check text messages in the middle of the night, a figure that climbs to more than one in five for the under-35 age group.Deloitte, which surveyed the habits of more than 4,000 mobile phone users in the U.K., also found that 10% of people look at their phone the instant they wake up, and a third do so within five minutes. More than a quarter of us look at our phones within five minutes of going to bed. That’s far too short a window, according to the report. “Exposure to light, including that from a screen just before going to sleep, can confuse the brain into thinking it is still daytime, and inhibit the process of falling asleep,” the study said. Experts have recommended an hour of screen-free time before bed, but Deloitte found that fewer than 25% of people actually do this.

One suggestion the study offers is to put the phone out of reach instead of right on the nightstand to resist the temptation, but for many people, that would also mean having to jump out of bed and go across the room to turn off their alarm in the morning. Another option would be to download an app that tracks your screen time—some, meant for parents who want to limit their kids’ time with electronic devices, even have a lockout function after a set time period—or rewards you for staying off your device.

Alternately, if you can’t resist late-night email-checking, you might want to consider swapping out the blue screen tint for a reddish or orange one, which scientists say is less disruptive to sleep. Apple’s iOS 9.3 has a feature called Night Shift that switches to a red-hued background; a similar app for Android users is Twilight. But really, you should just turn it off. That email from your boss will still be there in the morning.

Decrypting medical jargon

It is my bet that at some point in your medical encounters, you have come across situations when what your doctor said made no sense to you. You probably went along with an incomprehensible discussion, and adhered to the advice finally given. Such mumbo jumbos have no place in modern healthcare. Every discussion with you as a lay person must always be simplified to crystal clarity. There is always a simple way of explaining your diagnosis, and treatment options.

Yes doctors go through rigorous training, with lots of complex words and phrases to describe multitudes of disease conditions. But so does everyone else in their own specific professions. If we all gathered together and conversed in career-specific technical terms, none of us would really understand the other one. True, some medical terms have no direct equivalent translations to commonly used languages. But that’s never an excuse not to get stuff explained in an easy to understand manner.

You have many options to help decrypt medical jargon. The easiest one is to get your doctor to explain everything in simple language. If anything is mentioned in medical terminology, ask that it gets broken down into a comprehensible format. All it takes is an extra few minutes, which you are owed when seeking medical care. You want to take in as much as you can to facilitate decision making on your part. Ask for a leaflet that you could look up later, this backs up what might have escaped your ears.

You could of course access freely available online medical encyclopedias to look up what you haven’t really understood. Just simply searching for a medical word or phrase on your browser will bring up hundreds of hits. Be selective on the ones to read through. Wikipedia, Matapedia Wiki and information portals run by health organizations like the WHO should top your list. Explanations found on such sites tend to be directed to lay people, and are written in an easily understandable way.

Your healthcare providers have a duty to get you to understand everything they say. If you find one bloated with medical jargon, it may be a telltale sign of their confidence levels. Ask them politely to tone down and speak in common language. If they don’t budge, you could always play a trick card and ask if they mind you bringing in a medical translator. If that doesn’t go down very well, you are better off seeing somebody else who cares to explain everything in plain language.

Never allow yourself to contend with undecipherable medical information in this day and age. It should all be plain and simple, always. Anything colored with some unintelligible jargon may be a mask for something else. If you can’t understand it, then you can’t really make informed medical decisions.

Nairobi eateries, healthy enough to eat?

Eateries are establishments that serve foods. And they come in any number of form, size, location, menus and whatever other adjectives you can think of in Nairobi. Such varied choice is good, almost any budget can be catered for, meaning that most Nairobians will not go hungry regardless of their pockets.

But a cursory look at Nairobi eateries raises some health concerns for the suspicious patron. You will find lots of establishments on roadsides and on busy streets, most are temporary entrapments with no iota of health and safety, and cater mainly for the lower income groups. In the middle ground, you’ll find establishments catering mainly for the middle class. These so called nyama choma joints have all grades of quality, foods are prepared in makeshift kitchens and in all manner of standards, raising several eyebrows from a food inspector. Higher up the ladder are more formal establishments looking up to the upper middle class and above. You’ll find food standards here much closer to international guidelines, but we are talking of only a fraction of Nairobians who can afford to access such eateries.

So what’s the fuss about eateries? There is plenty to worry about, not least foodborne illnesses which are theoretically 100% preventable. A WHO report in 2005 was clear about foodborne diseases being a problem in Kenya, with health, social and economic impacts. The burden of the problem is not easily quantifiable due to the quality of available data, but easily amenable gaps in food safety seem almost obvious.

Nairobi and all other Counties must ensure there is a Food Safety Management System in place in all establishments. This is easily entrenched with Permits and Licenses, ensuring and constantly inspecting food handling, preparation and storage in ways that prevent foodborne illnesses. This is the only way to ensure safety between the eateries and the consumers, lessening disease transmission and the associated ill effects.

But Nairobians as consumers must play their part as well. There is a catchy saying that goes: ‘you are what you eat’. You can choose to eat anything and anywhere, and thereafter deal with the consequences. But it doesn’t have to be that way. Firstly, chose carefully where to buy your food, some apparent godforsaken eateries have fresher and healthier foods than their five star counterparts. Be very selective on the menus, the fresher the better. Anything frozen has potential of having incubated lethal organisms, depending on the freezing temperatures during storage. And get your orders well done (overdone may be healthier in certain cases), and simmering hot. Heat destroys most disease causing organisms, and may be your best defence where standards are low.

Finally listen to anecdotes, consumer ratings and give feedback yourself. Well-rated establishments have better quality and safety overall, this is where to go. Don’t accept second rate food standards whatsoever. Your health is paramount, and there’s always another eatery round the corner.