Sudanese president Omar al-Bashir, 73, was reportedly discharged from a Khartoum hospital in January 2017 after undergoing a cardiac catheterisation procedure.
Mujtaba, who is 35 years younger than Mr. al-Bashir, suffered a similar heart scare in January and underwent the same procedure in a neighbouring hospital. Mujtaba may not be an ICC-wanted head of state like Mr. al-Bashir but his lifestyle is just as complicated if not more stressful.
Like many Sudanese, Mujtaba is a very sedentary person who habitually spends most of the day either lying or sitting down. His desk job is demanding and like many of his middle class contemporaries, he provides for an entire household and spends most of his day worrying about making ends meet.
He suffers from high blood pressure and high cholesterol levels, two of the leading risk factors for heart disease in Sudan and worldwide. Genes have not been kind to him either as he has a strong family history of coronary heart disease which in a way reflects the sharp increase in cardiovascular disease in Sudan over the last century.
Cardiovascular disease was rare in Sudan in the early twentieth century and was mainly caused by syphilis and rheumatic fever. The main killers at that time were malaria and dysentery, both of which continue to kill tens of thousands of Sudanese every year, particularly in rural areas.
The incidence of coronary heart disease has seen a rapid increase in the last fifty years and now accounts for a high percentage of emergency admissions to Sudanese hospitals. This is mainly attributed to changes in Sudanese lifestyles particularly in urban areas.
Sudan is a poor African country but has seen improvements in living standards (GDP), telecommunications and transport over the last 25 years notably after the short-lived economic boom that followed the creation of Sudan’s oil export industry.
Sudanese eating habits have also changed over time. Sudanese diet traditionally consisted of vegetables, legumes, cereal grains (wheat, rice, millet and maize) and to a lesser extent red meat and fish. In cities like Khartoum this has largely been replaced by a ‘western’ diet containing foods high in calories, refined carbohydrates, salt and saturated fats.
This has resulted in a surge in ‘junk food’ consumption with an extraordinary number of fast food restaurants now lining the streets of Khartoum and other Sudanese cities.
Although this has become a normal trend in the era of cultural globalisation there are other reasons to why Sudanese people are turning away from indigenous foods.
The accelerating pace of life in Sudan and changes in working patterns means that there is less time for families to prepare and eat nutritious, home-cooked meals. The soaring prices of fruits and vegetables have also made it difficult for many Sudanese families to buy fresh produce on a regular basis.
The Sudanese agricultural and food industries have declined and there is increasing reliance on imported foods from Egypt, Turkey and South Asia. Even in rural areas, people are buying canned meats and processed food as they are often cheaper than local produce.
The so-called westernised diet is a major health issue worldwide and is a leading contributor to the global obesity epidemic. Fat is no longer a problem for the ‘developed world’ alone. A report published by the Overseas Development Institute in 2014 revealed that nearly two-thirds of the world’s overweight population live in low and middle-income countries.
In Sudan, classed by the World Bank as a lower middle income nation, an obesity rate of 53.9% was reported in 2011. Physical activity levels in Sudan are low, particularly amongst women who are often discouraged from exercising in public by cultural sensitivities or due to the lack of suitable or affordable health facilities. Many women choose to exercise at home or not to exercise at all.
To some Sudanese mothers the latter is not necessarily a bad thing as some still encourage their daughters to be plump. Sudan, like many African countries, has historically had an obsession with body fat which was believed to denote good health, wealth and fertility.
Curvy or overweight women were considered more desirable and it’s still common practice to fatten up Sudanese girls before their weddings. This has led to a recent trend of injecting insulin or consuming steroids such as Dexamethasone, known locally as Abu-Najma, by slim or average sized women who want to gain weight.
The silent killers in Sudan and the rest of Africa are processed sugar and artificial Trans fat. Sudan’s per capita consumption of processed sugar is very high for a country with a significantly high incidence of diabetes. Sudanese are well known for their sweet tooth and the vast majority add sugar to their food and drink.
The hot weather is often blamed for over-consumption of sugary carbonated drinks and to most Sudanese, no traditional cup of tea is complete without adding several heaped spoons of white sugar.
Many ready-made foods on sale in Sudanese markets contain artificially-created trans fats that are considered by health experts to be the worst type of edible fats. These hydrogenated fats are used by food manufacturers to help give products a longer shelf life and are found in a wide range of processed foods including biscuits, cakes and sweets.
Trans fats are detrimental to health and have been linked to heart disease as well as diabetes, obesity and certain types of cancer. Almost all artificial fats are imported and are not adequately regulated.
The increasing burden of cardiovascular disease is recognised by the Sudanese health authorities who are faced with increasing demands for services and severely constrained resources. Sudan’s total expenditure on health and is low and ultimately more funds are needed for adaptation of health strategies that focus on primary prevention and promotion of healthy lifestyles, particularly among young people.
Several governmental and nongovernmental campaigns have been launched to raise public awareness about risk factors of heart disease – most notably high blood pressure, obesity and cigarette smoking.
Yet, many challenges remain. Tobacco, for example, is big business in Sudan and the government relies heavily on revenues from cigarette taxes. In hospital Mujtaba was advised to cease smoking completely but his wife, Ameena, doesn’t think that he will.
“He keeps promising to quit smoking just like Omar Al-Bashir keeps pledging to step down,” she laments. “I’ll only believe it when I see.”
Dr. Mohamed Shawgi @shawgimd is a clinical radiologist based in the UK. He writes on health, education, culture and politics.
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