June 2014 Edition with Dr. Tawa Ayuba took us through Medical School and back.  It was a unique session within our Health and Lifestyle Series, and need I add that we woke up and paid attention! Who doesn’t love life?

A brief profile of Dr. Tawa Ayuba

Dr Tawa Ayuba was born 50 years ago in Niger State and is presently working in one of the private practice clinics in Abuja – ZANKLI Medical Centre. An experienced healthcare professional of over 25 years extensive experience spanning primary, secondary and tertiary health care sectors in Africa (Nigeria, Swaziland and South Africa) and United Kingdom.  She has worked within a governmental environment, private sector and in a voluntary capacity and has the proven ability to deliver results within regimented, target driven environments. In addition to demonstrating the full range of clinical, research and laboratory based skills within the field of Microbiology, she has particular interest in, and has managed the diagnosis and treatment of tropical and infectious diseases such as (HIV/AIDS), TB, Hypertension and Diabetes Mellitus for patients within inpatient, outpatient and specialist clinics in Nigeria, Swaziland and South Africa

Dr. Ayuba has extensive experience of both African and British healthcare systems. She understands the political environment surrounding the healthcare sector in Africa and has spent time in medical satellite clinics across Swaziland demonstrating the ability to deliver healthcare within remote areas with limited facilities and secondary care support.

Her experience also covers partnerships within the industry. She has been involved in an international aid alliance between African, Caribbean and Pacific countries. She has sound interpersonal skills which see her effortlessly engaging with diverse people, building trust and rapport across cultural, religious and linguistic boundaries. She is blessed with the ability to communicate technical information in a clear and concise manner, leading tutorials, lectures and seminars to doctors, nursing and medical trainees. You will also find her occasionally driving medical outreach programs to diverse communities within the Federal Capital Territory as well as giving health talks to staff of various schools in Abuja on invitation.

Dr. Tawa Ayuba is a Member of The Nigerian Medical Association; The Nigerian Women Medical Association; South African HIV Clinicians; as well as a Fellow of the Royal Society of Tropical Medicine and Hygiene. She is a happy grandmother who is passionate and dedicated to what she does. She is compassionate, reliable and timely too!

Below is the excerpt from our Community Session with Dr. Tawa Ayuba.

Dr. Ayuba welcome to Friendraiser Community. What we aim to do is essentially provide a platform that inspires, motivates, and encourages every woman out there to pursue her dream with passion and focus. Recently so many things have happened, the kinds of information that’s out there tells us that we really cannot take things for granted and that’s why we introduced the Health and Lifestyle Series. So tell us, when you say “Know Your Numbers”, what do you mean by it?

Okay, thank you Friendraisers for inviting me. “Know Your Numbers is a well-known subject all over the world, and until maybe about two years ago, I wasn’t aware that this programme was on. Actually they started it 2nd January, 2013 but this has always been around since I came in 2011. It has always been around in Pathcare Lab. So this is just about 1 year and 5 months plus. Know Your Numbers basically is about a way of getting healthy, knowing what your blood pressure measurement is, knowing what your cholesterol level is because you know in cholesterol you have, basically what you need to know is your good  cholesterol and bad cholesterol. The good cholesterol is the one called the high density lipo protein, the bad cholesterol is the low density lipoproteins. Don’t bother yourself with the figures when you go to your doctors they’ll definitely discuss that with you. Your blood pressure, you know, for each gender, for the male and female and for the age differs, but you know, we’ll say ok for a 25-year-old male weighing 70kilograms, normal will be 120/80 because there’s what you call pre-hypertension. So pre-hypertension is if it’s greater than 120-129, that’s pre-hypertension. And then hypertension is diagnosed as anything above 140mms of mercury for the systolic readings. You know we have two readings in blood pressure – the systolic and the diastolic. The systolic is when the heart is pumping and then the diastolic is when the heart is at rest  and you know we have two heart sounds; heart sound 1 and 2. So the first one is when the heart is pumping and then when the heart is at rest, that’s the diastolic. The down one should not be more than 90. So once it’s more than 90, we say its hypertension. You can have diastolic hypertension, you can have systolic hypertension. But we are more particular about the top one, that’s the systolic hypertension. Then the second one, your blood pressure, your cholesterol, then your waist circumference, not where your trouser line is. It’s a little bit above your hip, your hip bone, just  maybe one inch above your hip bone, that’s where we take, below your navel.

For the female, African female, it should not be more than  35 inches. Between 32.5″ and 35″ is safe but watch it. You need to do something about it because the fat here is more dangerous than the fat in your hips or any other part of your body i.e. the fat in the tummy. The more your waist circumference, the more likely you are to be prone to diabetes with other factors coming into play, it’s not just the one factor only. For a male, African male, not more than 37″, Asian male not more than 35″. Watch it. So that is the 3rd parameter, your waist circumference.

Also, knowing your weight. You use your weight together with your height to calculate what we call the Body Mass Index. I’m sure we all know what is body mass index here, your BMI. We say you are underweight if it’s less than 18.5, then between 18.5 and 24.9 we say you are healthy. Then between 25 and 30 we say you are overweight. Now between 30 and 40, obese. Greater than 40 markedly obese. Those are the people they do banding for, you know, they go and do banding, gastric bandings, surgeries and things like that for. Then the other about knowing your numbers is for you to screen to see if you are diabetic. You know, obesity too makes you prone to hypertension. Obesity makes you prone to diabetes, obesity makes you prone to cancer. You understand. Also hypertension leads to a lot of complications, you know. They say hypertension is a silent killer. 1 in 4 people are hypertensive, unknown. 1, that’s how bad the statistics is and four diabetes in, by the time its 2030 in Africa, quite a lot, millions will be diabetic if we continue with our present lifestyle. So it is very, very important to know your numbers. For those that smoke, we encourage them to reduce their smoke or even totally stop smoking and those that take alcohol. Okay we say for female, 2-3 pints of alcohol is allowed per annum, per day. You calculate for a female, for a male, 3-4 units per day. They say, information, knowledge is power. So it’s very very good to know.

Dr., there are some people who say that alcohol is actually healthy, is that true and to what extent?)

In life, everything is moderation. Red wine to a certain limit. You understand. What i tell people is that if we take every day, we take 3 units of alcohol, in a week that will be 3 times 7, 21 units. It has a compounding effect, yes, on your liver. The liver is important for metabolism and excretion of a lot of products and things like that. It will lead to damage in the long run. So it’s just moderation, once in a while. But for some people, it is every day, and alcohol is something that makes you very dependent. You become dependent, you increase the shots, you increase the number of units, shot of whiskey you take or the unit of wine, red wine or white wine, you increase the unit of beer you take per day, you know. You become dependent. It’s just like smoking, alcohol is just like smoking. So, in life it is moderation. You know a cigarette has over 4000 chemicals. The nicotine aspect in cigarette is what makes it addictive but those over 4000 chemicals they have effect on virtually all organs in the body from your skull, you start to have frequent headaches, your eyes are always brownish. You know a smoker from their eyes, it is ever itchy. Their lips will be black because there is no proper oxygenation of the blood vessels. They have frequent abscess in their gums, frequent sore throat, you understand, that’s why when you have frequent inflammation it leads to changes in the mucosa. So it makes you more prone to cancer- they are prone to cancer, lung cancer, for the males their sperm count is low. You know it leads to infertility. Even breast cancer, Every cancer in the body is related to smoking. So it is advisable that you don’t, it’s very addictive and also it leads to you spending quite a lot of money. If for example you smoke a packet of cigarette which is 26 and its about N500.00 for example, I don’t know the actual amount, so in a week, N3, 500. That is quite a lot. You know if you stop smoking you can spend that money on yourself. Spoil yourself with something you understand, or even save that money towards a car, holiday or something. That’s what I always tell people. It’s being practical. You have to give a good reason why the person should stop that bad habit.

Knowing your number is also about knowing your blood glucose to know if you are diabetic or not. We have normal levels and when you go to your doctors they will tell you what is normal and what is abnormal when you do the test and also the glycoses haemoglobin, the one they call HB A1C. That one shows your glucose consumed in the last 2-3 months. Now it is used to diagnose diabetes. Together with the fasting glucose. You can use it and also your oral glucose tolerance test in which they will give you 75gs of glucose and then they will check your blood after 1hr or 2hrs and see how your body reacts to glucose load and things like that. From the result, the doctor will interprete it for you and tell you if you are diabetic or not especially if you have a strong family history and things like that. So, basically  that’s just know your numbers- your blood glucose level, your blood pressure, your waist circumference, your body mass index and also I will want to add something for the females. We need to screen, once you are 40 years your mammogram and if you have a strong family history of cancer, breast cancer, go for a mammogram in a centre you know that they are good at it not just any anywhere they advertise. Also pap smear, once you are sexually active. In the United Kingdom I know once you are 25 years they will send you a letter, your GP will send you a letter, you will get a letter and then you know you go and do it. So it’s advisable as females that we go for cervical smear you understand, what you call pap smear. And also our kids or even our sisters, our nieces, from school age from 12 years, sorry from 9 years you can give them, you have the human papilloma virus vaccine, you can give them 3  shots start one month, and then they can take the third one 6 months after or so for the females.

The vaccine or what?

Yes,  the vaccine, human papilloma virus vaccine, prevention against human papillomavirus which is a cause of cervical cancer.

And you recommend that children should take that?

From school age, from 9 years- yeah.

From 9 years, really?

Yes, from 9 years. School entry, primary school going to secondary school, yeah. From 9 years check.

As a preventive measure?

Preventive measure, yes, before they become sexually active. It’s just that when you are giving talks on HIV and AIDS, somebody is already sexually active and it’s not as if it would not have effect but catch them young. When they are in secondary school, yeah give them before they think about it, before they dwell into it, before they start thinking about sex. It’s always advisable. It’s from 9 years you give the human papilloma virus vaccine. Yes.

So how frequently are these tests that we ought to take?

Okay, if you have a strong family history and you start having symptoms of maybe frequent headaches, like hypertension, there is a leaflet I have I’m going to pass it round, on hypertension. It tells you what hypertension is, what causes hypertension. So if you have a strong family history, you are overweight, like of any physical activity, your diet is not healthy, you start having frequent headaches, palpitation i.e. fast heart beat, you walk up the steps and every second step, you have to pant the rest of the way, you know you are not healthy. Your feet gets swollen, especially ankle swelling or you can’t sleep properly at night, frequent headaches or you are having blurry vision and you have a strong family history, it’s advisable you see your doctor. But once you are 40 you know the aging process is there, you know, they said men as they are aging, they are more likely to be hypertensive. Then females once they are menopausal, they stop menstruating, they are more likely to be hypertensive. It’s the men first, and then it changes. Women as they become menopausal, they are more likely to be hypertensive. So you go for the screening. For diabetes, okay. If you have a strong family history, maybe first degree relatives, what I mean by first degree relatives are your mum, your dad, your siblings, if one of them has, there is a strong family history and you are symptomatic.  What are the symptoms of diabetes Miletus, you feel thirsty excessively, you pass urine excessively and also you eat a lot. Maybe your family, friends, will make fun. “oh Tawa you are eating a lot you know”. Then you know for the children usually they are lean and slim.

When you say eat a lot, err…just so that we understand what is different between breakfast, lunch and dinner

Maybe instead of eating 3 regular meals you eat up to 5 or 6 times a day. You are always hungry, you are not satisfied. Remember there is also a first condition, which is your family, your parents or siblings or a combination of both.

And also for some diabetes, they may not be symptomatic, but they have frequent boils. This month they have this boil somewhere and next month they have this boil. Or they have frequent skin infections. You understand? So if the, parents or the person has a high index of suspicion, go see your doctor, they will screen. You understand?

They will screen for diabetes immediately?

Yeah, with your blood. They will check your fasting glucose. You fast for 8-14 hours. If for example you are going for the test tomorrow and you take your last meal between 9 & 10pm, you won’t take anything again after then. But you can take sips of water and then you go by 8am the next morning. You know that’s about 10hrs fast. You take the fasting glucose, yeah, then you check the glycated haemoglobin that is indicated in know your numbers. That one shows your glucose control in the last 2/3 months.

(Audience contribution: I’ve done this test before because my dad was diabetic and he passed. So I was having my daughter, they made me do that) When you were pregnant? Did you have gestational diabetes mellitus (No no, I don’t know what happened, they just made me do that)

Dr. Ayuba: No, usually where I work we are trying to introduce that. At 24 weeks, that’s when you know, it becomes more pronounced if you have what is called gestational diabetes mellitus i.e. GDM. You know, you go for screening. You do the fasting glucose, you eat. You do what we call the oral glucose tests. Just as we said earlier on and then they check your blood 1hr/2hrs and see if you have diabetes in pregnancy. That one resolves after pregnancy

oh okay that’s pregnancy induced diabetes?

Pregnancy related diabetes not pregnancy induced. Yeah but you know you need to follow up the person, the lady, the woman, 3-5 months’ time to see, to make sure that she doesn’t have frank diabetes mellitus not gestational diabetes mellitus i.e. GDM.

Then for the hypertension too, with a strong family history, the person is observed. As I earlier said, knowledge is power, read, it’s not to frighten any person. Read about the common things. Hypertension is very common, 1 in 4 people.

Wow, 1 in 4?

Yes, for hypertension. Diabetes is becoming more common because of lifestyle change. In Abuja, it is diabetes and hypertension, due to predisposition factors- urbanization and westernization. What do I mean by urbanization? In urbanization, you are always in a car, sedentary life, your food..oh you think you have arrived, taking polished rice instead of taking ofada rice or taking your brown rice which is more healthy and has more fiber. You know fried chips, you understand, fried chicken (chicken and chips…general laughter), yes, fried fried fried, fast food, you understand and things like that, carbonated drinks, ice cream instead of taking your tuwo shinkafa, tuwo masara, tuwo dawa and em your ugwu leaf, your edikang ikong. Anything you can boil, steam, grill or roast, go for it or anything raw even. You can take a big bowl of salad but not a big bowl of rice. And that’s why portion control is very important. You know there is what you call the wheel of portions

I saw that somewhere..

Yeah (passes round) for something like rice, I even wanted to bring a serving spoon, but I think we all know the 15ml serving spoon, 15ml, if we put water that it will be 15ml. For rice, 2-3 heaps of cooked serving spoon. When you go to a Chinese, you know the standard, that’s just what it is. Yeah for spaghetti, scoop, you know the spaghetti scoop 2-3, you understand. If it’s somebody that’s small why will they eat 3? That will be too much. One will even be enough, depending on the size of the person and depending on how the person burns, what we call the basal metabolic rate – BMR, you understand. For somebody that does a work that is labor intensive, maybe, labourer, bricklayer, you know its labor intensive, obviously they will need more energy, so the largest, the highest limit of normal 3 scoops. Then, like potatoes, you know, we don’t have jacket potatoes here but we have medium sized potatoes and will I say large. For the medium potatoes, somebody of my size, 4 is okay, maximum 6, boil steam or grill, not fry. Okay for things like em, weetabix or wheat. Ok ’m supposed to take wheat bread not white bread, you understand, maximum two slices. But you see people, ten slices of bread. That’s not healthy because we don’t expect you to just take the bread, we expect you to take it with maybe some grains, maybe some lettuce, slice of tomatoes, or some egg, one sliced egg. Maximum of one egg, you understand. Slice it, make it like a sandwich, then take your freshly squeezed orange or blend your watermelon or blend your pineapple or even make a smoothie from cucumber with carrot and orange. One orange you know and take it. Because you know the most important meal of the day is the breakfast. We always say your breakfast you should eat like a king or a queen, your lunch like a prince or princess and super like a pauper – light. You should eat at least two hours before you sleep because you need to burn it. If you don’t burn, it leads to fat deposition in the waist which is the most dangerous sort of fat, just as I mentioned earlier on, mostly prone to diabetes. So your breakfast, it should have what we call the different groups of food. You know you have the carbohydrates, all your meal should have the different groups of food, carbohydrate, your protein, your oils and fat and the more colorful your food is the more nutrients you get. Normally in terms of the eat well plate, I’ll pass it round, the eat well plate, 33% of your food intake should be carbohydrate and 33% should be fruits and vegetables, 12% should be your proteins; your fish, your meat, your chicken, your lentils, your fish and them 15% should be your oils and fat and 8% should be your foods that are high in sugar. Things like your coke, your fanta, cake, sausage rolls, your em cheese cake and the others. So you can do without that. I always tell people that purple, the purple portion, that’s the 8%, you can do without it. Maybe during Sallah, Christmas, christening, weddings and things like that, you go for it. You understand. That’s the purple portion which is 8%. The yellow portion, that’s your carbohydrate, the green portion that’s your fruits and vegetables, you see they are equal, one third, then the pink is your protein which is 12%. Your meat, fish, chicken, your beans, you know and things like that.

And then, as a rule avoid canned things. Left to me, canned things will not sell. If it is left to Tawa. Anything Mexican beans when you can cook it yourself or cooked chips, you understand, or, peas. Your sardine, please, once in a while. It’s not as if I don’t take, I’m not pretending. I don’t believe in pretense, no. I take sardine,

Because of the convenience…

Yes, but there’s frozen sardine, there’s frozen mackerel, there’s frozen tuna. You can boil it too, you know mix it with your margarine and then make it in sandwich. Put your lettuce there or your cabbage. It’s very healthy

But sardine is just nice for sandwich…(general laughter)

The things that are good for you, or good for us that’s the one that cause us more harm, that’s what we’ve just realized. Then the blue portion is the oils and fat. It’s not as if you are obese or if you are diabetic you won’t take it. You just go for the low fat portion. Your milk, you have the full cream milk, skimmed milk and semi-skimmed. Skimmed milk I tend to go for. It’s very good for us as women, as mothers and sisters – the low fat milk; Now you know it’s been found out that in Nigeria we don’t have fresh milk. So they are setting up factories to that effect in Nigeria now.

Fresh milk?

Yes, which is more healthy. It is more healthy. When you go to some countries you’ll see green label, you know green is certainly skimmed. So they are trying to set up that now and we now have packed milk that’s 2% skimmed milk and then full, there’s packed watery. You’ll get it in most of the shops, so it’s for us to read it. As mothers, as grandmothers, as sisters, as friends, friend to somebody or someone and everybody we need to cultivate that habit.

Ok. Questions

Ah, not yet. I think we all know our blood group and genotype?


Ok. You know we have four type of blood groups A, B, AB and O. AB is the rarest blood group. O is the universal, one of the commonest, universal donor. Then you have em, RH+ & , I’m sure, genotype maybe you are AA, AS, S+C, SS Thalassemia, Alpha and Meta Thalassemia. You understand. So when you go to your doctor, tell them you want to do haemoglobin electrophoresis. They’ll just tell if you are AA, SS. etc Hemoglobin electrophoresis tells you everything. How many percentage you have in each bar. Like filter it. It’s not all the labs that can do it, Pathcare lab is very good. I’m not advertising for them. Sorry. It’s just, they are the best and have branches in most big cities in Nigeria.

Now, you see the thing is that when you are trying to, maybe stop smoking, you want to commence, for those that don’t, that are not involved in any physical activity at all, maybe you want to start your brisk walk which is moderate exercise, you know. You walk as if you are going to catch a bus. It’s not just walking like this. When you are doing brisk walk, you feel a little bit warm and a little bit breathless. When you are speaking to the next person, they don’t hear you clearly. You feel some warmth in you, you know you are doing it because you are using all the muscles in the body. But brisk walk, you are not exercising. So you do that 30minutes everyday, 5 days in a week. You need 150minutes of brisk walk, moderate brisk walking in a week. 150, 30minutes everyday

Can I pass this round? (exercise pamphlet).

Yes please. Yes that’s good.

This is very fun. I’m going to be trying it every day.

Ok, like your BMI, you set goals if you see you are overweight, it’s always good. Maybe your partner, you know your husband, ok we say your husband here in Nigeria or your friend, your good friend or your sister or even your kids or siblings and you tell them ok, I think I want to lose my weight or I want to stop smoking. This is my targeted weight, I want to lose it over 6 or 1 year. It’s always good to tell somebody so that you can support each other and it’s always good you do it with somebody, you know. It’s not just the brisk walk. You can swim. Swimming is the best way to exercise. You use all the muscles in the body, but it’s not everybody who has access to a swimming pool or else ordinary skipping rope

…or even knows how to swim…

You can always learn, even at 70. You know. What I tell you, you learn from a new born. You can learn everyday in our life. Open our eyes and your ears. You’ll learn. So don’t say it’s ever too late to learn. I’m always ready to learn from anybody and everybody. That’s my policy in life. You understand. And if today God lays it on my heart that i should change my career and go for this, I’ll go for it. That’s just my own policy in life but we are quite different so things like that. So you can decide to start swimming. Even ordinary skipping rope. Start with 20, increase it to 50. If you can do 100 in a day, super duper. Because…

(Audience contribution) How good is the skipping rope? Because I have one but I used to use it sometimes..

Another: …it’s on top of your wardrobe eh? (general laughter).

Dr. Ayuba: It’s advisable that you get one.

Another: But is that really effective?

Dr. Ayuba: It is.

Another: Because I know I loved skipping as a child.

Another: No skipping is hard because the handles are like, weight passed

Dr. Ayuba: or else tell two kids or two adults to hold it and then take it in turns.

Another: They’ll whip your ear nice and tight (general laughter)

Dr. Ayuba: alright, but it helps to sweat. Or you can dance. I tell you it’s not dancing just once a day, every day. Your favorite music. You understand. You dance. Or else go to owambe parties, weekend, but that’s just once. It’s not good you know to watch TV for 2 – 3 hours. In between advertisement stand up

and dance? (general laughter)

Dr. Ayuba: Yes, and dance or go to your kitchen, go to your room and things like that. At my work they always say “Dr. Ayuba, it seems as you are always restless” Oh no I’m exercising, especially when there are no patients, I stand up, I go down the stairs, come back and, now they understand.

Yeah…because you can be sitting up in that chair all day, right?.

Dr. Ayuba: Yeah all day and it’s not healthy. Sedentary life and the people most affected are executives, you know, accountants or people in the offices. So even if you are in the office as far as its not busy, 1, 2 hours, please walk around. Please walk around. It’s healthy. You understand. Even if you are healthy, you need to exercise your heart and lungs. And the advantage of exercise, it makes you more youthful. In the long run you lose weight and it makes you more energetic. You are more alert. You understand. And you know, it makes you sleep like a baby. And you know when you exercise you release endorphin. Endorphin is a feel good hormone. You feel so good and relaxed. You sleep like a baby. Try it and then let me have a feedback. It’s not something you do once, it’s a daily thing. For those that have not started exercise or what you call physical exercise, please start. For those that are doing it, you can still do more. So we need 150 mins a week, 30 minutes every day. Or cycling on a bicycle. Or treadmill for those that have treadmill. The thing about treadmill is you know it’s flat. You incline it, increase the speed, incline it, increase the speed until you know, don’t do it to the extent you start having palpitations. If, you’ve undergone and do 10-15mins. What I tell people, whether it’s a Muslim or Christian. If you are a Muslim, after your Sunnah prayers in the morning or for a Christian after your early morning devotions, the next thing you should do is your exercise. Most of us have walls round our homes. You can, if it’s not secured outside, run round with your partner or even if it is, if you live with a maid or any, or if you are alone or get somebody within. You know. Your next door neighbor and things like that. That’s why it’s always good to know your neighbors. You know. You build bridges with them, you understand, and also friendship. You know, one thing to another and then if you have kids, it’s even better. It’s not good to have your high fence round the house. And you don’t know who your next door neighbor is and anything can happen. So, that’s just the physical activity.

Then even for those that have arthritis, they say “when I exercise the pain is worse”. That exercise is part of the therapy, especially water aerobics. Water aerobics is one of the best ways to exercise. But in Nigeria…

Where can we do that?

In swimming pools. It’s difficult; or else squash, table tennis, badminton, you understand, football.

Anything that allows movement.

Yes. Move, move.

But Dr., what would you say is the most effective form of exercise? Ok sometimes if you have like an office job that you know, you are seated all through, it’s just, I know like you are saying, you have to squeeze in the time. Sometimes you are always on the rush, there are children, so you have to really make time for it. Which one would you really say is the best, maybe not, that you can just put into your schedule?)

Dr. Ayuba: The thing is you are aiming for moderate physical activity not anything vigorous that would have negative impact on your health. So like brisk walk, you can do that, or skipping or dancing in the evening when you are all around. You make it fun. So the whole family is even involved, which is better.

I actually like this, because this is almost like a do-it-yourself thing. So you don’t even need to rely on someone. What is this one? (another pamphlet)

Ok. It’s called the wheel of fun. You can try this or try this, you know like, you can run on the spot for 2minutes. I’m a very practical person although I’ve added weight since i came because

You eat more?

Dr. Ayuba: No, no, no. My portion control is very effective (laughter), because of lack of physical activity. That’s my problem. Before, from my work place, i have my gym bag. I use either the ship or the bus and go to wherever the gym is and then i walk to my house. Here, car has spoilt me. Nonetheless, you can run on the spot for 2minutes. But before you start any exercise, please do your stretch exercise. Stretch, stretch, stretch or like this, you understand, you know. You can just stretch to any shape, any position. Just move your body. Don’t just go into an exercise like start brisk walk. No, no, no. Please stretch muscles before any exercise. And if you think you are not doing well, if you paid some money you’ll be more disciplined, then go to a gym. Register in a gym where an instructor will be there to help you achieve your target.

The Wheel of Fun has many suggestions. Strut like a chicken, the bunny hops, dance to a tune on the radio, skip on the spot for minutes, Wiggle like a worm. Wiggle, wiggle, wiggle or you go flat on the mat and wiggle, wiggle, wiggle.

That’s actually tedious you know.

Hmmm depending on how vigorous you do it. And you are losing some weight. Do 5 star jumps. You should know that. You know those 1,2,3,4? Go from 1 step to the other and then you turn back again. Do 5 – 10 hops on one leg. I’m sure you remember that one. (1,2,3,4,5 and then 1,2,3,4,5). Yeah.

This is interesting and easy to follow. Ok what have we left out? I see foot care…

Dr. Ayuba: Is anybody hypertensive here? (No show of hands). Ok. We were talking about the “Eat Well Plate”. For those that are diabetic, the Eat Well Plate will change. Instead of your carbohydrate being one third, your diet, half will be fruits and vegetables and your nuts. It’s very important.  Nuts are very important in the body please.

For diabetic patients?

For every person. Almond nuts, cashew nuts, groundnuts, walnuts. It is healthy fat. So now you are taking half to be your fruits and vegetables and nuts, one quarter will be your carbohydrate and one quarter will be your protein. That’s for those that are diabetic. That’s how healthy eating diet changes. So the dynamics change. For other people the values may be different.  Ah this is foot care for diabetic patients but every other person can do it.

Why do they need foot care…?

If it’s not properly controlled they are prone to droll-patching. So they start having pricks and needles. They don’t feel sensations, so they can match on a stone or a nail or fire and not feel it and then it leads to more damage. And because the blood vessel, especially in the lower limbs, are not working properly, they are prone to what you call gangrene. It’s blackish or greenish and then it may lead to amputation. That’s why you see some people with amputation because of the diabetes that is not properly controlled and things like that. Apart from leprosy, that too can lead to nerve damage and some things. Would you like your BP to be checked?

(Audience chorus and response): Yes please…I’ve been thinking a lot..Of what?..Boko Haram. (general laughter)

(Audience contribution): Let me ask you Dr. My husband checks his BP. I think he is worried, maybe because his dad is hypertensive. So he got this thing. So he’s always like oh I checked it. I’m just, he needs to be relaxed. I don’t know why, why is he so worried about it?

Dr. Ayuba: You gave the answer. Because of his dad I think. The thing is that, you know, you learn from other people’s mistake. What was the reason for the dad being hypertensive? Like me, my mum, both my parents were hypertensive. Ok. Was it essential hypertension? That one, the cause is unknown or was it secondary or maybe a kidney disease or a heart problem or a problem in the brain, a tumor. So, you know there are some tumors near the kidneys or even some problems with the adrenals. It can make you hypertensive. Usually such people, they present very early, at a much younger age. You see a 22year old hypertensive or even a 15year old hypertensive. Obviously you should know that  that one is not secondary, is not primary  hypertension but hypertension that starts maybe 40 or 50 years, you know. Like the men as I said, the men, when they are in their 40s, they are more likely to be hypertensive in terms of statistics. You’ll see more men will be hypertensive at that age but a woman once she’s menopausal, you know from 50s, you’ll see the ratio changes. More women are likely to be, yeah. So, their own was it essential hypertension that the cause is unknown, you won’t find any factor, maybe in the brain, in the heart, in the lungs, or liver or kidney. Or was it, were they obese. That may come in, you know sedentary or urbanization and westernization. That’s why you are going to have more diabetes. So let’s continue with our high fiber diet which prevents you against colonic cancer; diets and exercise. Those are the two principal things. For those that have not started, I encourage you to start. For those that have started, you can still do more. And you are the one that can support your husband and motivate him and encourage him to do that.

And this similar diet plan will be the best, will be right for him?

Yes and what I normally advise is the smaller the plate, the better. Ok you have the dinner plate that is quite large, use the side plate to eat please. Yeah. Don’t heap it please. So your 2 – 3 spoons of cooked rice depending on the frame of the person, add your carrot.  Your salt, with somebody with a strong family history of hypertension, salt please, it’s a no, no. Not more than 1500g that’s the teaspoon level, total across all the meals, breakfast, lunch and dinner, 1500grs. Please. That’s a teaspoon, level teaspoon, salt intake is very very important please even if you are not hypertensive, except if you are hypotensive then  we encourage you to take more salt, .

Hypo…? what does that mean?

How your blood pressure is low. There are some people their blood pressure is low, so take more salt. You know salt retains water, sodium chloride, sodium, it retains water. Jacket potatoes are great, you know jacket potatoe is about this (makes a fist). In Nigeria, we have two  sizes, small and medium, medium for my own frame, 6 maximum, 4 is okay. In your eat well plate, you take from each of the green, the yellow, the purple, yes the one I always tell people not to indulge is the 8%, the purple. 8% or mineral & malt drinks, your cake, sausage roll, biscuit, cheese and things like that, you can do without it, weddings, Christmas, new year, sallah, but if you can, burn it. Like the kids you know what makes them very hyperactive? The sugar and they start hoping about. You can catch them either as a parent or as a grandparent. You know some people like the “halleluyah diet”, they don’t take anything boiled that has been put in hot water or oil. Everything is plant fresh, straight from the farm, washed; your carrot, cucumber, lettuce, cabbage. Okay broccoli they may allow steaming, and your cauliflower, obviously you need to steam those ones. Everything’s fresh, fresh, fresh.

Okay who is going first? (for complimentary self-exam)

Normally you know, when you come to the consultation, the person should have rested for up to 5 minutes. (individual self-exam in progress). And please let’s avoid the use of sleeping tablets, they are very addictive, like lexotan, doxepine, like trazodone. They are very, very addictive please. Because you educate a woman, you educate a nation but if you educate a man you are just educating one individual. So if you can’t remember anything, just remember your weight, your height, your blood pressure, your cholesterol, your glycoted haemoglobin, increasing your physical activity, smoking, alcohol control. You know Africans fight with this, clinicians in Africa. They say BMI is not an African thing, it’s an oyibo thing. But let’s be frank. It’s always good to be healthy. I know there are a lot of people, ministries, may be once in  6 months they do this runs and everything, we can start. Like you know, I told you that my portion is ok, the problem is my physical activity. When i was in the UK and South Africa, I used to prepare marathons. I used to prepare yes, twice a year for marathons. The 5k and 10k  marathons. So it’s not something you can jump into. You have to prepare. Here since i came I’ve, you know, no physical activity at all. If you read this very well, certain hypertensives can make your BP, your pulse to be low.

What is not normal with the pulse, if it’s less than 60?

If it’s less than 60 or more than 100 but for children, they can have pulse rate of up to 160 especially new borns. In new born, up to 160 is normal. And then please when you go for blood pressure checks, don’t wear tight fitting, wear something loose, you may get a false reading except if it’s very very light cotton. Just relax and then what i tell people is “think of your loved ones”. I think that should relax you. Any more questions? Questions, answers, contributions?

How often is the pap smear again?

Ok. Once you are sexually active, from 25 we encourage you to go for pap smear. Even if its once in 3years and then once you are 50/55 once in 5 years. Then when you are 65 no need for that again. Yeah. No need. If there’s anything, it would have been found out earlier on so why traumatize yourself with things like that. So once you are 65 you don’t bother…

So all the tests that we have in this ‘Know Your Numbers’ chart, you do them at the centre? Yeah we do

So can I ask for the average cost for running all those tests, if you know that?

Truthfully I don’t know because we the doctors are not involved in the costing, but the lady at the reception in the lab will help calculate. Your blood pressure will be done with your consultation and your height and weight. Then eye check. For those that are diabetic, it is very important, once a year. There’s what you call regional strain. You have to go for regional strain. That’s something I’m discussing with my diabetic patients. I’m trying to form a diabetic association in Zankli. So what we are trying to do, we are trying to get a register of all diabetic patients and their contacts and some other very important information and then we’ll send a message to them. That way they can get to liaise with themselves, discuss within themselves, talk about their management as a way of us improving the management where we think we are not doing it properly. Also liaise with the national, like you know all states in Nigeria, there’s this diabetic association. The government is not doing much about non-infectious diseases. You know. That way, they can talk about it.

The doctors…. So actually that’s for the diabetic patients. So once you are 40, you’ll notice, your Koran and your Bible. There, what we call Presbyopia, and you start reading using reading glasses. So once you are approaching 40 or you’ve a family history of glaucoma, it’s very important. Glaucoma, you see they have big eyeballs like myself, protruding eyeballs. But protruding eyeballs can be due to a lot of other things, you know. Can be due to thyroid problems, it can just be genetic. I think we all know what is glaucoma? In which you have rays, intraocular pressure. So it’s always good you go for eye check.

Now the fat around the waist? Yeah? How do we burn it?

Exercise Exercise Exercise.

Start with 5minutes, see how you’ll tolerate it and then increase. Or maybe even 20minutes then you increase it to what your body can tolerate. Don’t go beyond what your body can tolerate. Increase your physical ability, increase your fiber intake, reduce your fat intake. Fiber is good. A lot of us are having colonic cancer because we now westernize diet. So fiber, fiber, fiber, fiber. So oatmeal, anything oil – BAD, anything wheat, wheat flour, weetabix, barley – GOOD. Also, Couscous, yam, potatoes, then of course your vegetables, which is blessed with fiber already.

Thank you so much Dr. Tawa Ayuba, it’s been a wonderful, wonderful time.

You are welcome. Thanks for the invitation.