The Public Health Crisis In Africa No One Is Talking About

During the final match of a soccer tournament in Aledjo-Koura, Benin, I received a medal for my role on the tournament planning committee, integrating health education for spectators.


“Come measure me.” I would hear men and women shouting in Tem, the local language spoken in the rural town of Aledjo-Koura, Benin, as I meandered around the soccer field. I approached the woman who called me and measured her blood pressure. As a community health agent with the Peace Corps from 2016-18, I led health outreach programs—sometimes this meant impromptu health education sessions at a soccer match.

I dreamed of serving in the Peace Corps for years. The role fused my taste for adventure and passion for service while providing continual opportunity to learn about global health systems. Working as a community health agent, my job was to gather feedback from the community about health priorities. Collaborating with local counterparts, I would pitch ideas to the community health center to address needs, then plan and implement projects.

I expected that during my time in the Peace Corps I would learn to navigate cultural differences, master new languages and hopefully make a positive difference; however, I did not expect to encounter the same chronic diseases I had seen working in a cardiac rehabilitation clinic during graduate school. Just before leaving for Benin, I received a master’s in exercise physiology from the University of Virginia, where I learned about physical activity and nutrition as means of preventing and treating chronic disease. Chronic non-communicable diseases (NCDs), like hypertension, diabetes, cancer and heart disease are the largest causes of death world-wide and are on the rise in Africa.

Six months into my service, my neighbor told me she was hypertensive. I asked what her blood pressure typically was. She didn’t know. She would periodically take blood pressure medication but did not know if it was effective as she could only check her blood pressure at the hospital. Seeing the need, I asked a friend in medical school to mail me a stethoscope and blood pressure cuff. I started measuring her blood pressure weekly, then began doing the same for friends and neighbors. There was immense interest in NCD education and monitoring.

A post-workout picture of some of the women in the women’s sport initiative in Aledjo-Koura, Benin.

Word spread quickly. Soon, I was requested throughout the village to conduct lessons on the prevention of hypertension and diabetes, a need previously not identified in the Peace Corps health framework. Hypertension monitoring sessions were integrated into women’s savings groups and community meetings. People were motivated to grow nutrient rich plants to enrich their sauces. The momentum even allowed me to create the first adult women’s sports team in the village, breaking gender boundaries in the name of health.

Through these activities, I discovered that hypertension was common, and most people in the village who had it did not know what it was. “Tension” was a menacing catch-all for headaches, fatigue or unexplained death. Equipping people with knowledge is empowering, but it is not enough to meaningfully prevent disease.

Prevention requires the strengthening of health systems through capacity building, technology and infrastructure, as well as addressing the social determinants of health. To motivate change in low and middle-income countries, government officials and stakeholders at international organizations must mobilize around the problem. This demands data, which is unfortunately limited.

In response to this dearth of data, the World Health Organization developed a standardized NCD risk factor surveillance survey which has been completed in dozens of low and middle-income countries. This survey looks at risk factors that contribute to NCDs such as diet, waist circumference and blood sugar. In Benin, this study was completed in 2015, and 26 percent of the population had hypertension. In neighboring Togo, the most recent study was completed in 2010, finding 19 percent of the population had hypertension.

A map of West Africa. Benin and Togo are two francophone countries found between anglophone Ghana and Nigeria.

In West Africa, rapid globalization and technology access has monumental effects on behaviors that effect NCDs like diet, physical activity and consumption of alcohol and tobacco. Given that these factors transcend borders, I decided to complete my research in Togo. It has been nearly 10 years since the last study in Togo, and much has changed. The problem is that funding for NCD research is difficult to obtain.

I realized I was in a unique position to help fill this need for data. I speak French, the Togolese national language, and Tem, the language of an ethnic group in Togo, Benin and Ghana. I have a background in research methods, chronic disease prevention and project management in West Africa. Most importantly, as an American, I have the privilege of applying for funding through a Fulbright grant.

Upon returning to West Africa to start my research, I was warmly welcomed at the airport by Razak Bah-Traore, the director of my affiliate organization, ONG Tibi, based in Bafilo, Togo.

This research would not be possible without my Togolese partners NGO Tibi and Doctor Mofou Belo, Head of the Department of non-Communicable Disease Surveillance at the Ministry of Health. Since arriving, I have had the opportunity to collaborate with brilliant Togolese statisticians, epidemiologists and health care professionals offering their expertise. Together, our hope is to use this data to demonstrate current prevalence of risk factors, advocate for future research and use our platform to educate people about NCDs.

I arrived in Togo in mid-September and will return to America in June 2020. I’ll be writing this column as a lens to share my experience and explore aspects of culture, food and identity in West Africa.

Until next time ~ A bientôt ~ Bilah bitassi.

Molloy Sheehan grew up in Manhasset and calls it her hometown. She is the principal investigator and project manager of a public health research project in Togo, West Africa. Harnessing her expertise in chronic diseases and her experience with West African culture and health systems, Sheehan is working to shed light on the prevalence of chronic non-communicable diseases such as hypertension, cancer and diabetes in Togo. Her work is funded by a Fulbright research grant.

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