Making a heartfelt difference in patients with high blood pressure

 

Armed with a Discovery Foundation Rural Individual Fellowship Award, Dr Trenton Oliver is determined to raise awareness on hypertension, or high blood pressure, and to educate patients in KwaZulu-Natal on how and when to take their medicine.

First-year internal medicine registrar Dr Trenton Oliver has very personal reasons for having gone into medicine and research. When he was one year old, he lost his policeman father in an on-duty car crash. Then just four years ago, his grandmother, who he lived with during his high-school years in Durban, was diagnosed with metastatic breast cancer.

Dr Oliver is busy doing his specialist training rotation through several Durban academic hospitals. On 14 January 2019, he remembered his father while treating a man admitted to the RK Khan Hospital. The patient was suffering from a massive brain bleed sustained in a car crash, exactly 26 years to the day after his dad died − of the same cause, at the same hospital. “I thought, this is also someone’s father,” he says. While growing up, he often considered becoming a neurosurgeon as a direct consequence of his childhood loss, but soon realised that, “cutting and surgery are not for me.”

He wants to be a specialist physician within three years and then super-specialise in medical oncology. “I grew up in Queensburgh in Durban and attended Pinetown Boys High. I lived with my gran for my high school years. We grew very close,” he says. “If I can better care for cancer patients and maybe prolong life that would be great. I don’t expect to find the cure for cancer, but I’ve developed a huge love for research that can improve people’s quality of life.”

Dr Oliver developed his social and empathic skills by doing a large variety of vacation jobs while studying for his MBChB and living in residence on the University of KwaZulu-Natal medical campus. He had secured a medical school bursary with his matric marks and continued his academic achievements on campus.

Simmering love for research

Dr Oliver’s love for research began simmering strongly after he successfully applied for a Discovery Foundation Award to conduct a retrospective study of 170 stable hypertensive patients at the Prince Mshiyeni Memorial Hospital hypertension clinic in Umlazi. With his data collected, he wants to uncover the rate of non-adherence to anti-hypertensive medicine in his cohort of patients, correlating this with age, gender and the number of medicines prescribed. His research has the potential to introduce widespread, targeted preventive interventions that could save many lives.

He outlines some of the consequences of poorly controlled hypertension as strokes, vascular disease, gangrene of the feet and hands leading to potential amputation and permanent disability, and irreversible renal failure requiring ongoing dialysis or a kidney transplant. “High blood pressure affects even your basic senses, your ability to walk or even see. And that’s just the morbidity,” he adds.

The difference between medicine compliance and adherence

Dr Oliver says many people do not understand the difference between compliance and adherence to medicine. Compliance involves the timing, dosage and frequency of taking prescribed medicines, and adherence is the act of refilling a prescription on time. “I want to further this study. If you really want to address compliance, you have to do a qualitative study. Take a smaller group of a dozen or so chronic hypertensive patients and interview them, do home visits and do recorded interviews,” he adds passionately.

He says factors affecting medicine adherence and compliance include patients’ age (the elderly and the very young being most vulnerable for obvious reasons), co-morbidities and even simple things like the doctor-patient relationship and poor counselling. “Language is a huge daily barrier that too many healthcare providers face,” he says, explaining that 99% of his patients in Umlazi speak isiZulu.

South Africa has a high rate of hypertension

Dr Oliver says data shows that South Africa has the highest reported rate of hypertension among the 50-plus age group globally. “We need better counselling and communication to improve adherence, more social workers and more translators. Just the record taking itself is fraught and involves taking a travel history, for example for malaria testing, and what immunisations or vaccines or any other prophylaxis they have had. Many of our patients would rather see a traditional healer before taking prophylactics for travel,” he explains.

He says that for children and the elderly, support services are crucial, especially for those with diabetes. “The simplest thing like having a social or healthcare worker explain the importance of their daily insulin shots can save a life,” he adds. “Purely as a doctor, how can I make a difference seeing 500 patients a week? I mean, if we just had a better transportation system, you’d see an immediate drop in mortality and morbidity,” he observes.

Plans to boost awareness

Dr Oliver is hoping to improve awareness of the dangers of uncontrolled chronic hypertension by persuading the Prince Mshiyeni Memorial Hospital to print and distribute catchy illustrated pamphlets, tailored to his specific local findings. He also hopes to place posters around the community and to start a multi-media messaging system, reminding patients of appointments and carrying preventive behaviour messaging.

When his mind is not on his patients, Dr Oliver is a surfer who enjoys cooking, high-detail sketching (his art teacher was bitterly disappointed he did not study art) and spending time with his girlfriend who is also a medical doctor. “I would love for my study paper to be actioned while I take my research further,” he concludes.

About the Discovery Foundation

Each year, the Discovery Foundation gives five different awards to outstanding individual and institutional awardees in the public healthcare sector.

The Discovery Foundation is an independent trust with a clear focus to strengthen the healthcare system by making sure that more people have access to specialised healthcare services.

Since 2006, the Discovery Foundation has invested more than R230 million in training and support for more than 400 medical specialists and institutions. The grants support academic research and clinical science, sub-specialist training, rural medicine as well as programmes to develop public healthcare resources. For 2019, Discovery Foundation awarded 42 grants to medical specialists working in South Africa’s healthcare sector to the value of R27 million.

Learn more and apply for the 2020 Discovery Foundation Awards.

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