Panorama: Physiotherapy: A Noble Profession Made in Paradise

By Sani Sa’idu Baba

My dear country men and women, I will begin with the popular saying, ‘health is wealth’. This is a fact that no one can contest. Not just because one enjoys pain and disability-free life, but also that health ensures complete harmony of the body, mind, spirit and mental wellbeing. The saying of Mahatma Gandhi that “it is health that is real wealth and not pieces of gold and silver” and the Arabian proverb that says “he who has health has hope; and he who has hope has everything” are true. However, despite its enticing meanings, it has become nearly impossible to achieve a perfect state of health owing to some factors. These factors include genetics, environment, access to health and behavior. Extending one’s own capacity to keep self physically fit has also become a challenge. While both medical and physiotherapy doctors share their responsibilities on patients particularly during diseased condition, the physiotherapy doctors are exclusively very close to the patients as well as the apparently healthy clients who seek to maintain their health to reflect a popular saying “prevention is better than cure”.

Against this background, I will relate to two key issues. One is the less talk about cases of sudden death shortly after engaging in physical activity like running or jogging or cycling in the gymnasium or other playground or at home, which is becoming rampant, especially among certain class of people I can attest to. And secondly, the incessant exodus of medical personnel from Nigeria. One might be curious to ask why I should say “physical activity” and not “exercise” in the other case. Certainly because they are two entirely different things in the context of health, and the key issues surrounding the observed problem lies in either being ignorant or misperception of the two misleading words. I will dwell on both cases subsequently.

I will not bother my readers with the definitions of exercise and physical activity because it may take round a clock to satisfactorily explain what both entails. But I believe that being able to remember a scenario that if one has a headache or fever or any other strange illness, one would first go and see a doctor, carryout some investigations, identify the problem and be placed in appropriate medications that suitably fits. Not a situation whereby one will identify the disease, choose any investigation he/she likes, buy any drug of choice and be taking it endlessly, certainly no. In fact, doing so is tantamount to committing suicide. The same thing when one decides to go to any gymnasium, or playground to start running, flexing or jogging because he/she has diabetes, hypertension or is obese. You can imagine if one is only asthmatic and then took anti-hypertensive drugs expecting to see results. Is it possible? No. It will never yield any results but rather threatens life in the end. It is the same scenario with exercise. Different exercise specifications are employed to target specific disease and not others. And just like we have drug abuse as more often been campaigned about, we should equally be aware of exercise abuse and its detrimental effect. So the exact difference without taking it too far, is the word “prescription” in the case of exercise, and that has been unanimously agreed worldwide to be one of the key jobs of the physiotherapy doctors by all standards.

Exercise is a very powerful tool for both the treatment and prevention of chronic diseases, for mitigating the harmful effects of obesity, and for lowering mortality rates. Years of research have provided irrefutable evidence for the benefit of exercise in the primary and secondary prevention of diseases like diabetes, cancer (especially of the breast and colon), hypertension, depression, osteoporosis, dementia, and heart diseases. In addition, regular exercises has also been shown to dramatically lower all-cause mortality rates, and especially cardiovascular-related mortality. Beyond all this, exercise has also been shown to significantly mitigate the harmful health effects of obesity. In fact, studies have shown that patients are better off being fit and fat than skinny and unfit. That means a low level of fitness is a bigger risk factor for mortality than mild to moderate levels of obesity. The important message for all patients and clients to understand is that the benefits of exercise are the same regardless of how much you weigh.

In fact, there is a linear relationship between level of exercise and health status. People who maintain an active and fit way of life live longer, healthier lives. In contrast, sedentary lifestyle has an astonishing array of harmful health effects. However, having known the detrimental effect of self-prescribed exercise, it is arguably quite better to be sedentary than to engage in it without consulting physiotherapy doctors. People who are sedentary and unfit predictably begin to suffer prematurely from chronic disease and probably die at a younger age or live with poor quality of life. This is because, their ability to live a normal life and do the things they want to do is often severely limited because the premature development of chronic diseases associated with an inactive lifestyle have impaired their functional capacity. This association between disease and an inactive and unfit way of life exists in every age group: children, adults, and the elderly. Results of several researches published in journals of physiotherapy consistently show that those who are active and fit are healthier and less likely to develop chronic diseases irrespective of gender or age. For this reason, many have suggested that sedentary lifestyle is the major public health problem of our time. It was therefore a consensus that “In view of the prevalence, global reach, and health effect of sedentary lifestyle, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences.” Can you imagine now the public outcry if such strong words had been used to describe a “pandemic” caused by an infectious disease or injury? You can bet there would have been numerous large scale campaigns mounted and associated publicity to deal with such a pandemic. Unfortunately, the clear identification of sedentary lifestyle as a pandemic barely generated any media response and awareness despite availability of physiotherapy doctors that can effectively play significant roles vis-à-vis preventing the occurrence of the diseases, diagnosing them in the presence of any health challenge and appropriately dealing with them. To make it clear here, sedentary lifestyle and self-prescribed exercise are almost the same because both are harmful to health. So the role of physiotherapist in global health cannot be overemphasized.

The fundamental issue on ground is that while people are battling with diseases like cancer, hypertension, diabetes and the rest, others are battling with the side effects of the drugs on top of the disease itself. A classic example of such situations is the paradoxical response to drugs in some cases, and drug induced severe pain in cancer patients. Physiotherapy doctors on the contrary, could target your heart, your lungs, your kidneys, your brain and manipulate your spines and joints with usually instant results and zero side effect. Besides, physiotherapy doctors around the world has achieved significant reduction in the occurrence of these diseases through their preventive efforts in various cases. Moreover, the recent Covid-19 pandemic has clearly exposed physiotherapy as a lifesaving profession by virtue of the observation that effective physiotherapy intervention is fundamental to achieving recovery in Sars-Covid patients with both mild and severe lung collapse. In fact in many countries, the intensive care units are being headed by physiotherapy doctors. They revived long Covid patients from post-exertional symptoms exacerbation, cardiac impairment, exertional oxygen desaturation, and autonomic nervous system dysfunction using several rehabilitation approaches. Many medical scholars like Meenakshi Wankhede recognized physiotherapy as a field concerned with all medical fields and based on the basic concept of human sciences, the importance of this field has been skyrocketing by the day as people are becoming more aware of their physical and mental health. So it is the need of the hour in the modern world especially because of the harmful undesirable effects of most drugs.

Coming back to the key issue I intend to address today, I believe my readers must have grabbed some ideas of the harmful effect of self-prescribed exercise. But to appreciate it more, let’s take for example, when one engages in self-prescribed exercise, he/she is not aware and has no control over many crucial vital profiles such as blood pressure, blood sugar, heart rate, oxygen consumption, respiratory rate, blood cholesterol level, general metabolism, and how these changes over time. These parameters if assessed and the outcome of pre-exercise testing are the key determinants that will inform whether one should do this for so so duration, or should do that for so so kilometers and for how many times or even to use certain machines or the other. Many people wrongly subject themselves to undesirable form of physical activities and beyond permissible limits for their age or conditions which the heart and lungs cannot withstand. In some cases, people are unaware they have a particular condition or the other, some have already developed obstructed blood flow and something like that. That is why, more often than not, people die of heart attack during or immediately after self-prescribed exercise and this is mostly the genesis of the key issue I am talking about today.

The second issue that stimulated me to pick a topic of this nature this time around is the issue of exodus of health personnel from Nigeria that has become the order of the day. Needless to say that, there is serious problem with leadership in Nigeria. Health is supposed to be a key priority of any administration. It was actually worrisome to learn about the brain drain going on in the health sector in Nigeria. Many health personnel are reportedly leaving Nigeria for Saudi Arabia in search of greener pasture. Although some are of the opinion that it is brain gain, and not brain drain for obvious reasons. And I don’t blame anybody honestly because the situation is already out of hand. It is very embarrassing to realize that despite the shortage of man power in the health sector, concerned authorities are keeping their hands akimbo, allowing the situation to collapse. Take for instance, despite millions of Nigerian patients that are in need of physiotherapy and rehabilitation services out of about 200 million population, the numerical strength of physiotherapy doctors available in the country today is abysmally low. The level of wastages and inadequacies in the field has been brought to the fore. In a 500 bed hospital for instance, where we are supposed to have at least 50 physiotherapists, we can have less than 10. This is terribly low. The rate at which physiotherapy doctors migrate to the U.K, U.S, Canada and other countries is also very disturbing. As of 2015, it was gathered that about 50% of the nation’s registered physiotherapists have migrated to seek greener pasture. Eventually, it is Nigerians who are suffering these deficits, because they are not having the best. The global ratio of physiotherapists stands at 1 : 4,000 people, Nigeria has one of the worst ratios in the world: 1 : 170,000 persons, after recording a shortfall of more than 41,000, because Nigeria needs about 43,000 physiotherapy doctors to be able to meet the growing demands of Nigerians. One of the reasons people go abroad to get care is not necessarily because the surgery is not going to be successful, if they were to do it here. But because of post-surgical care that is needed, which has been developed to a very high level in developed countries, but which has been neglected in Nigeria, up to the point that it now appears as if the surgery was not successful. And the reason why the surgery appears not to be successful is that the post-operative care, which the physiotherapists will have to embark upon, has not been supported by the system.

As has been exemplified earlier, self-prescribed exercise corresponds to self-medication. And also corresponds to over-the-counter drugs. While antihypertensive exercise prescribed by an expert physiotherapist tally with the antihypertensive drugs prescribed by an expert cardiologist. Most important to note here is, the detrimental effect of exercise abuse could be more dangerous than that of drug abuse because in the former it can lead to instant death while the later may presents with chances of reversal.

Based on the extensive highlights above, it is clear that exercise is the new medicine. It is the long-sought-after therapy needed to prevent chronic diseases, and extend life. Can you imagine a pill that had even a fraction of the positive health benefit like exercise? It would be the most widely prescribed medication in the world, and not prescribing it would likely be considered malpractice. So why has the medical community neglected exercise as a standard treatment? The answer to that question is quite complex, but I suspect it’s just easier for most physicians to prescribe a pill to reduce blood pressure, cholesterol, glucose, or even body mass index, rather than counsel patients on getting more active or referring them to physiotherapy doctors.

The other issue is the lack of reimbursement for exercise counseling and other preventive measures. However, it is clear that this focus on pills is flawed, because we know that medication adherence by patients is very low, let alone someone seeking weight loss. The affordability of these medications by the patients is also another issue.

In addition, a reliance on drugs seems to transfer responsibility for health from the patient to the physicians. In many cases, patients seem to be less active and eat more poorly when medications are prescribed. This is not to talk of the dangerous side effects that most of the medications come with. I therefore, appeal to authorities to do everything possible to enhance the number of physiotherapy doctors in every health institution.

Kano State, as a case study, with about 20 million people has only about 150 physiotherapists, where only 76 are under the state government, and more than 100 are currently not recruited by the state government despite the huge demand. My special appeal therefore, to our workaholic governor, Dr Abdullahi Umar Ganduje, is to be more pro-active to solve problems like these in the health sector.

Moreover, the dangers that are attached to allowing gymnasiums to operate without licensed physiotherapist is very alarming. Authorities should also mandate such facilities to employ physiotherapist. And the people, on their part, should never patronize any gymnasium that has no physiotherapist to properly evaluate them before any exercise activity.

A word is enough for the wise! May God Almighty continue to bless us with sound health.