Beginning part two of the alcohol and hypertension study

The hypertension survey is complete. From mid-December to early-March, three hundred and four men have been visited in their homes, had their blood pressure (BP) checked, and were asked questions relating to exercise, diet, tobacco use, and alcohol use. Initially, the goal was to simply collect data on alcohol use, but the strong alcohol-associated stigma prevented the sharing of honest and reliable answers. Rather, the survey was paired with a hypertension study. Using the local village health worker to gain trust and acceptance, the study focused on blood pressure to reduce the fear of stigma and create an environment where men could be honest. While many men continued to understate the amount they drink or chew, a safer environment was created and reliable data collected. Besides that, the study allowed me to explore the fascinating village and create relationships that otherwise would not have been made.

Of the 304 men, 46% had normal blood pressure, 37% were pre-hypertensive, 12% were stage 1 hypertensive, and 5% were stage 2 hypertensive (BP greater than 160/100 mm Hg). 31% of the men were found to drink at least once per week – 42% of whom drank up to seven glasses per week, 13% up to fourteen glasses per week, and 45% fifteen glasses or more. And this isn’t beer and whiskey but rather country liquor, as 82% drank an odd mix of distilled brown sugar with battery acid, trash, and other things I don’t know about. The more alcohol a man drank, the higher his blood pressure was found to be – of non-drinkers, 52% had normal BP and 10% were hypertensive, whereas of those who drank heavily, 28% had a normal BP and 37% were hypertensive.

77% of the men use a tobacco product, with 85% of these men chewing tobacco (grinded up in their hand) and others using bidi (cheap cigarettes), goa gutka, cigarettes, paan, or marijuana. Of those who drink or use tobacco, 12,045 rupees ($251) were spent on alcohol and 9991 rupees ($208) on tobacco per week. Thereby, 22,036 rupees ($459) are spent in total on both alcohol and tobacco, averaging to 92 rupees per week per drinking and/or chewing man, an astonishing amount considering the average female laborer makes 40-50 rupees per day and male laborer 60-90 rupees per day, five to six days per week. We also found that 90.5% eat mutton at least once per week (counter-intuitive to the western idea that India is a vegetarian country) and 93.5% eat green vegetables at least once per week (mostly palak – a form of spinach).

With the understanding that the data would be used to uplift the health of the village and direct community-inspired interventions, a meeting was held on Thursday for all the men and their families to learn about blood pressure, hear the results from the study and discuss solutions. The week previous was spent up and down the village informing people about the meeting and getting them prepared for it. By 6:45pm on Thursday, two men had shown for the 6pm meeting. Back into the village we went, a pack of six guys encouraging every man we saw to make their way to the hall. That helped to get fifteen men to the meeting. Then the rickshaw (three-wheeled taxi) with a giant speaker strapped to the top rumbled through the village, announcing the meeting that was now taking place at 7pm. The rickshaw, combined with the Hindi music blaring from the meeting site, attracted the other forty people by the 7pm start, many of them drinkers.

The meeting was intended to be led by Dr. Shobha (director of CRHP) and Asha (local VHW) but the meeting soon became dry and information-filled without proper context. So Dr. Arole (co-founder of CRHP) took over and began to place the data in the context of the larger problem, explaining the risk factors and ill effects of hypertension. Unfortunately, once the data regarding alcohol was shared, five men immediately felt targeted and left. The skit by four village health workers on the effects of hypertension and stroke made the situation even worse, as it merged into a skit on alcohol abuse by men, causing ten more men to leave, some taking friends with them. By the end of the skit and song, the safe feeling of the meeting had largely dissipated. The twenty or so men who remained were very interested and some discussion was held but with little lasting effect.

The most discouraging thing from the meeting is not the failure to create a safe environment for those using alcohol but rather the failure to even create a comfortable environment for them. While there were no direct attacks to the men who drank and they have certainly heard that drinking is a problem before, the values that supported and drove the survey to completion were lacking at the meeting. It was a meeting led by data rather than by honesty, trust, support, love and unity, all values that make the information understandable and introspective. Since this was the first meeting with the community, chances of getting full participation is low, so another meeting will be held in the following week to shoot for a different result. This time we hope to build on what was successful, including the informative survey results, and correct the downsides of the last meeting to create an engaging and comfortable meeting.