Unhealthy countryside

It was once associated with the rich and urban. Today, hypertension is fast spreading in rural India. This is a cause for concern because hypertension, if not checked, can lead to heart and kidney diseases. Healthcare facilities are already poor in villages, where nearly three-fourths of Indians live. For the poor the cost of treatment itself can add to stress, a trigger for high blood pressure. Vibha Varshney, along with Aparna Pallavi in Maharashtra, investigates the reasons behind rising hypertension

By Aparna Pallavi, Vibha Varshney
Published: Saturday 30 April 2011

Unhealthy countryside


Skinny and visibly weak, 39- year-old Rajkumar Haribhajan Patil had been suffering from contractions in the chest, and feeling panicky and restless for the past five years. In January 2010, he suffered severe palpitations and was rushed to a private clinic in Warud, in Maharashtra’s Nagpur district. Doctors diagnosed him with hypertension.

A marginal farmer, Patil shares a hectare of non-irrigated land with two brothers in Lohara Sawanga village of Narkhed taluka. “The doctor told me not to get tense. How can I not?” he says. “I earn not more than Rs 15,000 in a year from my land. Much of it must be invested back. I have to work as a farm labourer to supplement my income.”

His wife Renuka earns Rs 1,200 a month as an anganwadi helper. She doubles as a farm labourer and is often not home before seven in the evening.

imagePatil has taken to brooding since the birth of his two sons, says his sister-in-law Mahada Bai. “He is unable to eat properly,” she says. The couple’s main concern is the education of their sons, aged eight and 10. They put their first son in a private school, but when the second was ready to go to school, they decided to admit both to a government school. For, the cost was too high to afford. Despite this, Patil has had to take a loan of Rs 20,000. His troubles increased when doctors said he was suffering from hypertension (see ‘What is hypertension?’). The treatment cost him Rs 12,000. Unable to bear the expenses, he discontinued treatment after two months. “The cost of treatment was prohibitive,” he says.

But in January this year, he suffered a paralytic attack. He had to make several visits to a private clinic for treatment. Doctors again asked him to control his blood pressure. “I was told to take six tablets every day. Each trip to the doctor cost me Rs 450 to Rs 500.” After three weeks, Patil switched to herbal kadha (concoction) prepared by a vaid. The herbal medicine costs him just Rs 200 per week. He returned to work two weeks back.

Patil typifies what rural India is suffering from. Overburdened with financial responsibilities, the countryside is witnessing an increase in the number of hypertension, or high blood pressure, cases. Little intake of nutritious food compounds the problem.

imageHypertension has fast spread beyond its traditional urban base to rural India. It was once considered a rich man’s—at the most urban middleclass’— disease. Not any more.

Its steady rise is worrisome because the disease triggers cardiovascular ailments such as stroke and kidney problems which entail lengthy treatments. Healthcare facilities in rural areas are highly inadequate to deal with such diseases. And it is expensive to frequently travel long distances for treatment, just like Pail who had to cover 40 km to reach the clinic from his village.

According to data collected by the National Sample Survey Organisation in 2004, each visit to a doctor costs a high blood pressure patient Rs 198 in a public clinic and Rs 336 in a private clinic. A heart patient has to shell out Rs 341 in a public health clinic and Rs 485 in a private clinic. A single hospital stay for a cardiac patient would cost him around 80 per cent of his income given that India’s per capita income was Rs 25,320 in 2004. This is too high for a villager whose earning is miniscule.

According to the World Health Organization, around 60 per cent of deaths in India occur due to non-communicable diseases. It predicts that by 2030 most of these deaths would be caused by heart diseases.

Checking hypertension before it leads to fatal cardiovascular and kidney diseases is, therefore, critical.

What is hypertension?
Blood pressure is a measure of force that the circulating blood puts on walls of the arteries. The condition when the force exceeds normal limit (see below), is called hypertension. It can lead to stroke, heart failure and kidney diseases. Two values of blood pressureare measured— the highest when the heart contracts (systolic) and the lowest when the heart is at rest (diastolic).

It is measured in millimetres of mercury (mmHg). A diet rich in fat and salt; use of tobacco and alcohol; and stress are the major triggers for hypertension. Even a slight elevation in pressure can reduce life expectancy. To reduce harm, doctors prescribe a variety of drugs that can be taken either singly or in combination.

These include alpha blockers, which dilate the blood vessels; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, which protect blood vessels and heart muscles; beta blockers, which decrease the rate of heart beat and blood pressure; and calcium channel blockers, which dilate the blood vessels.


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