High RATE OF CARDIOVASCULAR MORTALITY IN HAITI.
The instantaneous viral spread of the news of the sudden demise of Mikaben during a concert in Paris from a massive MI at the tender age of 41 drives home the stark reality of this national scourge. Lest we forget, we ought to be reminded that in the Americas, Haiti and Guyana keep trading places for first among nations with the highest rate of cardiovascular mortality.
In two previously published articles in the columns of this newsletter, we have combed the literature to tackle the issue of salt, hypertension and cardiovascular complications as well sensible dietary interventions. They can be accessed respectively by clicking here and clicking here.
Just for historical curiosity, the Who is Who list of renowned Haitians that became victims is quite long. A sample of this tidbit includes the following: former president Éstimé died of uremia at Columbia P&S in NY in the fifties, Dòdòf Legros a decade later met the same fate at Cumberland Hospital in Brooklyn, Baby doc died of MI not too long ago. Another recent case deserves mention. A colleague, Dr. Reuben Pamies, vice chancellor and dean of Univ of Nebraska Med School died of MI in 2011 while vacationing in Haiti at age 52. Unfortunately, the list goes on and on.
The phenomenon of high cardiovascular disease among Blacks in the New World is well known. The exact etiology of this disproportion is conjectural. Nonetheless, dietary habits do seem to play an important role. In fact, Haitian cuisine follows our national narrative of a conflictual tale of a bane riding astride a blessing. In a pursuit of the perfect mix of spices to enliven our taste buds, a pleasure cherished by our ancestral cooks, the goal achieved exacted an exorbitant price. Going over the top with condiments laden with salt became an ironclad rule, protected by wrought iron in a sense. This act of faith passed from one generation to the next. This devolved in a mishmash of healthy with unhealthy offerings. Load of saturated fats, and high-glycemic index carbs, conflated with a plethora of healthy nutrients readily available that have been proven to be a godsend. Curing both with same condiments, laden with salt, especially maggy, tritri and other similar seasonings add heft to both taste and blood pressure. Armed with the best intentions, we end up harming ourselves unwittingly.
Reversing that trend ought to be the capstone of our generation. Studies referenced in the two articles have proven that a diet that includes tubers (roots) populates the gut with anti-inflammatory microbiome, a very salutary benefit. Yam, tapioca, manioc, sweet potato, and the likes grow easily in the countryside. The addition of green leafy vegetables cured without the addition of detrimental condiments to this regimen should make quite a bit of difference. We do indeed have a large assortment to choose from. Some comestible leafy greens are there for the taking but are not used due to our lack of familiarity. For example, in the Congo, leafy greens have attained cult status. Liboké, made with a mixture of steamed greens gets top billing while Saka Saka, made with only steamed manioc leaves is almost just as popular. In a role reversal, we are more adventurous with our use of beans. Congo beans are widely used back home but considered non-comestible in the Congo, according to our compatriots who had resided there. Our extensive use of beans is a very good healthy habit. Again, the same caution applies, they need be cooked without the unnecessary load of salty ingredients.
Unfortunately, our gastronomy suffers too much from our usual disdain of healthy, sensible local recipes in a nod for a misplaced search or affirmation of sophistication. We blithely will forgo bobori, a delicious preparation to drool for pizza. In this eternal battle of Jekyll and Hide, our outcome has been welded with a signpost that reads, “raw deal.” This terrible turn that veers to a cul-de-sac is a sometime fitful or fretful but always baleful bend that needs to be redressed.
This necessary change of behavior won’t be easy, despite the scientific facts, because eating habits are a cultural norm refractory to reform, if you will. I can already sense the knives sharpening to cut through the arguments advanced. Some folks consider it a crime to even think of drinking coffee that’s less than siroline! Or even to consume eggs without adding salt in any shape or form. Suffice it to say that our palate can ultimately conform to different gustatory propositions in a sustained and willful effort. In plain English it means that we can relearn to mold our taste buds to less sugary or salty meals. People’s usual instinct is to respond with a reflexive opposition as if this were a declaration of war to come up with the moxie to interfere with their beloved mixture or choice of condiments. Those of us in the trenches confront this war of attrition daily when we try to implement the concept of behavior modification. The fierce resistance when the rubber meets the road is unbelievable. The resistance includes many in the health care field who ought to know better but can’t help decades of dietary routine.
The key concept is behavior modification. It was a time when cigarette smoking was ubiquitous. Within a generation, its use has been severely restricted at public places. Smokers had no choice but to adjust. Their right to smoke can’t infringe on others’ refusal to become exposed to second-hand smoking that can be even more lethal. We need to continuously advocate for widespread reduced consumption of salty and sugary foods. We need to keep singing the praises of healthy living: a harmonious mix of sensible dietary choices and regular exercise.
Our lives and relatives’ lives are at stake. It is a public health crisis for all ethnic groups but in our own group it comes in an amplified version like a special delivery cargo fit for a jumbo size plane.
Reynald Altéma, MD.