DR MALA MODUN-BISSESSUR
(LRCP.LRCS,I. DU(PUBLIC HEALTH)

Most probably one of the thorniest issues in the treatment of a patient is compliance to medication. A good compliance is at the very root of an effective recovery; but non-abiding is highly responsible for the persistence of ill health, undesired complications, pure waste of medicines at several levels, and an unwarranted strain on the health sector.
The ease with which medicines are obtained – free or at a cost, with or without prescription from a formal drug dispensing station or a small retail outlet, both in the private and public sector, here – is amazing. Yet, professional instructions for their use in several cases are not so freely followed. Very few are the real caring type who adhere to guidance given. Among the reasons why diabetes and hypertension, the two most persistent common diseases since years maintaining their leadership position, is the patient’s own views on the management of these ailments. Agree that the person has the foremost role to care for himself by adopting an appropriate lifestyle, starting from early youth, the earlier the better, but when it comes to medication, many patients of all ages and socio economic status have their way and a “back-up”: another person in whom they place a considerable amount of trust. Someone who not so quietly, “sans-gêne” even, claims to be more conversant on health matters than the qualified officer. Advisors of all sorts with their own savoir-faire, to quote a few:

“Manz salad margoz kri, pli li amer pli li bon pou tension – diabet,” as if life is not already “amer” without margoze!!
“Boui fey zanblon tann, to bwar so delo.” I wonder the fate of the mature leaves which happen to find themselves in “dilo boui.”

“Pikir pa bon, latisann fonn to diabet….”!!

“Dokter-la ki kone, pran sa konprime-la…” Drug substitution with dosage modification is very common.
Without the intention to belittle the role of traditional or herbal medicine in the maintenance of good health, evidence-based medicine should be the benchmark for prevention, cure and treatment, to minimize and avoid the risk of complications. Poorly or uncontrolled diabetes, hypertension lead to a gradual deterioration of several organs mainly the heart, eyes, kidneys often with irreversible damages, increase the burden of distress and discomfort on the patient, family members, relatives. It also has a negative socio-economic impact on the home, but, with a good control, an appreciable productive lifestyle and a near to normal life expectancy is a favourable hope.

Mauritius has an established network of accessible free public health care points and paying private institutions where primary to tertiary level care are dispensed. A medical unit for domiciliary visits for seniors, disabled ones provides their coverage. Financial support is given for treatment abroad. A big chunk of the budget yearly goes to the health sector. Input from health care givers including non-governmental organizations is not lacking. In a small island where several share the same DNA, independent of religious and other beliefs and differences – “nou tou fami” – the hereditary factor for developing diabetes and hypertension is ever present. Maybe, in the future, genetic engineering could address this aspect. To dampen the effects of other factors, a few efforts are needed: a goodwill for appetite control, the willpower to resist to the variety of mouthwatering food and beverages at home, at street corners “gato delwil”, dishes from almost every quarter of the globe “all-inclusive happy go merry”, not to mention the ad lib amount of sugars, salts, carbohydrates in processed food in super stores; a muscular activity away from sedentary technologies, frequent strolls down the lane and the maintenance of a disciplined line of action for use of pharmacological products under professional guidance.
Assuming due responsibility while strengthening sound scientific knowledge on Diabetes and Hypertension should help to reduce the prevalence of these most unwelcomed conditions and improve our quality of life.