The 4 big killers

There are four big killers among us. They strike without warning, they are insidious and devious. They are silent and use terribly slow and painful methods. They torture their victims and their families, sometimes lobbing off parts of a limb at a time before going for the heart. Sometimes a victim can survive an attack for years, living in fear and limbo, with scars as vivid as those gained on a battlefield.

Who are these terrible killers and why have we put up with them for so long? They are the modern scourge and affect every modern society in the world, blind to economic status; they strike at rich and poor alike. They are Cancer, Diabetes, Obesity and Smoking.

And why they have stayed around for so long, seemingly able to kill with impunity may be mainly down to two simple root concepts: Bad risk assessment and Familiarity.

Bad Risk Assessment

In modern times, people have become very bad at assessing risks. It is far safer to use a zebra crossing or cross the street at a traffic light but many people would just cut across a street randomly instead of walking the extra two minutes it takes to cross a street safely.

Familiarity

Familiarity also removes that feeling of danger. When computers first came on the scene, people acted in a far more careful manner – monitors had a screen to filter out the radiation leaking from them. People were very careful to use their hands-free at all times, so that they would not have to be exposed to the small but debatable increased risk in brain tumours that was alleged to happen if you held the phone to your face too often.

It now seems that people are no longer as wary and most children nowadays carry their own phones and stare blankly at screens for hours on end. Familiarity doesn’t breed contempt in this instance.

Smoking

It may be these two factors, familiarity and bad risk assessment, that people still regard smoking in public as acceptable. That familiarity in seeing smoking in public places may be the reason why it would not click in most people’s minds that this is now wrong and those cancer sticks have to be put out.

But the change is happening, albeit slowly. More and more smokers are giving up everyday, and for the younger generation, where most of the new recruits of smoking would be taken from, the message has mostly gotten through and they are less likely than any other generation to pick up a cigarette.

Smoking kills in a myriad of ways, it attacks the cardiovascular system directly and indirectly. It encourages fat to deposit itself along the major arteries and increases blood pressure. Much of the haemoglobin in blood is irreversibly bonded to carbon monoxide and the body has to work that much harder to supply itself with oxygen. You are at higher risk at developing strokes and getting a heart attack.

Getting a stroke or heart attack is never pleasant. You can end up an invalid in bed, relying on people turning you regularly in case you develop bedsores.

Immobility is a slow undignified killer and it can be a demeaning existence. But smoking does not stop there. The changes it does to your blood circulation can also lead to the horror of men everywhere. Erectile dysfunction. This supposedly macho habit, associated so much with cowboys and bike riders, strikes at the very heart of masculinity.

The danger smoking poses to extremities does not end at human genitalia. Heavy smokers tend to have cold peripheries. In other words, they have cold hands and feet. It’s easy to deduce that their blood is not circulating well in their limbs. In extreme cases people can lose a foot to smoking.

But all that information above is merely a teaser. Finally it can be stated here strongly that smoking is the biggest cause of cancer in the country. All the cells in the body are bombarded by toxins in cigarette smoke such that all cancer risks are increased. The lungs being the first in a long line of organs poisoned by nicotine is merely the frontline in this battle.

But why do people still smoke? The same reason why people cross the street without waiting for the lights to change. Bad risk assessment: the person in the body bag run over by that car can never be me.

Cancer

Bad risk assessment is certainly the reason why people are in absolute denial about cancer. Cancer remains a death sentence for most people, even though caught early enough, all cancers are nowadays curable. So it makes sense for people to avoid high-risk behaviour such as smoking, and adopt measures that will lower their risk of developing cancer; eating a healthy well-balanced diet with plenty of fruits and vegetables, exercising daily and protecting yourself from getting sun-burned.

It also makes sense for people to check their breasts and testes for lumps, and go for those regular, government-sponsored tests, such as pap smears, to detect cancers early. But common sense is not common. Many people ignore cancer signs and refuse to do any tests that may detect a cancer early lest they find out that they have it. Strange, wasn’t it just stated that detecting cancer early increases the chances of survival and if you detect a cancer early enough, it is almost certainly curable?

So why do some people so afraid to test for cancers early? Very bad risk assessment. Cancers do not happen to me or the ones I love, it’s not possible, cancer happens to other people.

The familiarity of high-risk behaviour; going out in the sun without sun block for fair-skinned people, smoking tobacco, eating an unbalanced diet with little fruit and vegetables, lazing about with little or no exercise, also play a factor in making cancer the number one killer in Brunei for years. If you saw a child running with a sharp knife, you would stop that child at once. The danger is immediate and apparent. Someone smoking a cigarette or having instant noodles daily? The danger is in the future, and everyone does it. Why worry?

Diabetes

In this country it is especially true of diabetes. It is a disease that many people are familiar with, and familiar with the habits that cause it. The preventive advice seems to be in contrary to the very spirit of Brunei Malay culture; cut down on the sweet and numerous Hari Raya cakes, don’t fry bananas, eat them raw, don’t take sugar in your tea, don’t take sweetened condensed milk as well as sugar. But the message is basically eat in moderation. How can that be contrary to Bruneian Malay culture?

But there are people here who do seem to think that it is contrary. They are the one’s who help sneak sweets to diabetic patients as a favour. “Kapunan karang”, is the usual excuse.

It is no favour to give sweets to a diabetic sufferer. A raised sugar level damages a range of body tissues permanently. The biggest cause of blindness in the developed world is diabetes. It raises the risk of getting heart attacks. It affects the hands and feet such that sufferers tend to lose feeling in them. Damage to the feet especially may go unnoticed and get infected. Eventually people can lose toes.

Diabetes is a killer just like the other four killers. Like smoking, it can cause a man to get erectile dysfunction. It has a horrible synergy with high-blood pressure, increasing the risks of developing heart problems and blindness exponentially with blood pressure. Researchers are so worried that they recommend that diabetics absolutely must have normal blood pressure ranges and doctors should not wait but treat their blood pressure aggressively should it be raised.

Obesity

This is Brunei’s greatest problem, imbedded in a food culture that celebrates eating, the situation can be saved if Brunei foodies can be convinced to eat more fruits, vegetables, have more sensible portions and exercise more. Many of Brunei’s diabetics are obese and many are diabetic because they are obese.

Obesity is just not being very fat for one’s height. It increases the risk of developing some cancers. It increases the chances of stroke, heart problems and developing arthritis.

And like all the other three killers, it is a habit of thought, a lifestyle issue that causes obesity. The advice for obesity is the same for all the others: Eat a healthy, balanced diet with three portions of fruits and three portions of vegetables a day; Exercise everyday for 45 minutes a day; Do not smoke.

The Ministry of Health recently held a monthly walkathon trying to highlight the above four killers and trying to encourage exercise as part of a healthy lifestyle to government employees from a range of departments in the country. During the Youth Camp at the Health Promotion Centre, the four big killers were the main themes behind many of the team-building exercises and projects the young campers went through.

Two initiatives, both aiming at different segments of society – the future and present work force of the country. It is a sign that there is hope and maybe one day Bruneians can kick their bad habit and the four big killers will cease to be.

Only time can tell. – Ministry of Health Public Awareness Programme

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