Malaria, HIV/AIDS, and cholera are the diseases most Americans associate with the developing world, and most would also guess that these and other infectious diseases have the greatest impact on people’s health in poorer countries. But the worst threats to the health of those living in the developing world have more familiar names: heart disease, diabetes, and high blood pressure.
At the College of Nursing and Health Sciences (CNHS) at UMass Boston, Assistant Professor Eileen Stuart-Shor is leading a team of students to find out why the same health issues – namely cardiovascular diseases – that plague Westerners are now affecting the non-Western world at such high rates. This summer marked the third time that she and a group of her nursing students traveled to central Kenya to survey and screen locals for heart disease and diabetes as part of a project called Kenya Heart and Sole, patterned off of Stuart-Shor’s disease-reduction program in Boston, called Roxbury Heart and Sole.
Stuart-Shor has been studying cardiovascular health in Massachusetts’ minority populations for most of her nursing career, most notably establishing the Roxbury Heart Center, and using grant funding to launch Roxbury Heart and Sole, to help patients at risk of heart disease learn preventative measures. Stuart-Shor’s students who are interested in health disparities in minority communities are involved with Roxbury Heart and Sole as well – which is how Mercy Kamau, a nursing student from Kenya, made the connection that her friends and family members back home were experiencing some of the same health problems as Stuart-Shor’s Roxbury patients.
Stuart-Shor saw an opportunity to tie the work she and her students do in Boston to a very different population, and in 2008, working with Kamau and with local hospitals, she was able to begin recruiting students to travel to Kenya to do hands-on field work at heart screening clinics. The inaugural trip happened that summer, and students have been visiting Kenya every year since.
“First of all, it’s a service trip, where we try to help, try to understand the local culture, and partner with local organizations. Second, it’s an experience for students to learn about cross-cultural care. And finally, it’s a research opportunity. \We can contribute to a sustainable solution for a real problem,” Stuart-Shor said, describing Kenya Heart and Sole’s objectives.
“When I came to the U.S. and I heard about people from my village dying in Kenya, I knew I had to do something, to give back to my community and keep them from dying from preventable diseases,” Kamau added.
On this year’s trip, 16 CNHS students, along with Stuart-Shor and a few advisors, spent their 10 days in Kenya touring hospitals, talking with Kenyan nursing students, helping to dispense medications for pain, diabetes, and hypertension to patients, and also screening large numbers of villagers for heart disease and diabetes. The students got to meet Kamau’s family, see wildlife up close on a safari, and attend a final debriefing session with their Kenyan partners to discuss their findings and next steps.
The students’ findings were surprising. Although it is commonly assumed that high rates of cardiovascular disease follow globalization and the ‘Westernization’ of non-Westerners’ lifestyles and diets, the Kenyan villagers whom Stuart-Shor and her students met with did not eat Western food, and were hardly sedentary. Racism, another risk factor for cardiovascular disease that Stuart-Shor has identified in her work among African-American communities, is barely relevant to the predominantly black Kenyans, who seldom face race-based discrimination within their communities.
The population studied rarely drinks soda, does not smoke, and does not eat a high-fat diet of processed foods. They are generally farmers, who engage in vigorous physical activities for over one hour each day. Yet 60 percent of all individuals screened had high blood pressure, 14 percent met the criteria for a diagnosis of diabetes, and 47 percent met the criteria for being overweight or obese, while 60 percent had two or more risk factors for developing cardiovascular disease.
“These health behaviors do not fit with our standard Western understanding of cardiovascular disease risk factors,” Stuart-Shor said. “Over the course of the year, we will have to work hard with our Kenyan colleagues to understand these findings and plan appropriate medical interventions for the June 2011 trip.”
Stuart-Shor said that in Kenya, “this isn’t talked about, reported on, assessed, or measured. We need to build our partnerships [with Kenyan health organizations] so that the Kenyans are the ones leading the way against heart disease.”
The students involved in Kenya Heart and Sole – who raise their own money for their expenses, and receive no credits for their participation – are universally touched and changed by their experiences in Africa. Of her experience with the Kenyan people she met, undergraduate CNHS student Alia MacPherson said, “I was teaching them about keeping their hearts healthy. They were teaching me how to use mine."