Over the years since I graduated in 1975, I have seen a dramatic change in the disease profiles amongst my patients. This is particularly noticeable in the rural parts of Africa. In the early days, working at a Mission Hospital in Lesotho, it was rare to see patients with diabetes, atherosclerosis, autoimmune disease, and dementia. Much more prevalent were TB, gastroenteritis, typhoid, dysentery, and measles. However, the pandemic of non-communicable diseases has reached even rural Africa, placing enormous strain on the human and financial resources of this continent.
In recent years, for many young doctors and allied health professionals, NCD’s threatened to overwhelm them. Never-ending lines of patients coming for their repeat prescriptions felt like trying to heal sores with Band-Aids. In the early days of managing infectious diseases, our medicines could provide a cure. But with NCDs, at best, we are merely slowing disease progression.
In response to this failure to combat NCDs, some doctors gave up Medicine. Others dabbled in Integrative or Alternative Medicine, seeking ways to deal with the underlying causes. But the worldwide evidence-based movement called Lifestyle Medicine was germinating in various countries – the USA, Australia, and the UK. The American College of Lifestyle Medicine was established in 2004, shortly followed by the Australian Society (2008), the Philippine College of LM (2015), and the British Society of Lifestyle Medicine (2016).
In Africa, Dr Ifeoma Monye was the dynamic and visionary founder of Lifestyle Medicine in Nigeria. Thanks to her leadership and those who caught her vision, the Society of Lifestyle Medicine of Nigeria (SOLONg) has been a powerful force for the growth of LM in Africa. From the early days in 2017, the membership in that country has grown by leaps and bounds and is now a recognised medical speciality. Various universities are offering LM courses in Family and Internal Medicine training. Most of their LM practitioners are accredited by the International Board of Lifestyle Medicine.
South Africa was the next country to catch the vision. Dr Ernest Muragijeyesu completed the DipIBLM in 2019, becoming the first LM practitioner in this country. He was elected as the first President of the newly formed South African Lifestyle Medicine Association at the end of 2020. This organisation has grown steadily, led by passionate medical and allied health practitioners, whose only remuneration was the satisfaction of helping their patients achieve remission or marked improvement in their diseases.
A significant milestone in the provision of affordable certification came when the BSLM offered their 60-hour Lifestyle Medicine Core Accreditation course at a huge discount to candidates residing in Africa. Some of the leaders in SALMA and LiMAB (formerly Botswana Association of Lifestyle Medicine) were involved in adapting this course to the specific needs of Africa.
Medical Practitioners in other African countries have also caught the vision. In Botswana, Dr Samba Nyirenda has been the driving force. The goal of registering their Lifestyle Medicine Association of Botswana (LiMAB) is finally within reach. In Egypt, Dr Ahmed Mettawi, an Endocrinologist and Senior Lecturer in Internal Medicine, was the first LM diplomate. He designed and has led recurrent 6-week training courses in the foundations of LM. They are now in the 4th season of offering this course, with participants from various Middle Eastern countries and even one candidate from Zimbabwe. More than 55 health care workers in multiple medical specialities and allied health professions have completed the course. Dr Mettawi’s team is also close to completing the process of registering the Egyptian Society of Lifestyle Medicine.
African countries with qualified LM practitioners include Zimbabwe, Zambia, Kenya, and Ghana. Countries with individuals undergoing certification in LM include Eswatini, Cameroon, Malawi and Rwanda. Ethiopia has one resident Medical Practitioner with an interest in Lifestyle Medicine but is being encouraged by Ethiopian LM practitioner friends based in the USA.
What has inspired the growth in LM in Africa? I have been fascinated by the stories many of the new members have shared. A common theme is the frustration of not being able to offer patients a cure for their NCDs. Some have thought seriously of giving up Medicine altogether. Others have faced personal NCD journeys or those of close family members, where searching on the internet introduced them to the power of LM for either remission or significant improvement in the quality of life. Sharing information with colleagues about LM has been another source of recruitment. An abundance of information on LM is available through TED talks, webinars, blogs, documentary movies and virtual conferences. Social media sites can also be a source of LM information.
One of the most inspiring recent stories came from Zambia. Malambo Kunolu is a 4th-year medical student at the University of Zambia in Lusaka. He hails from the Western Province of Zambia, close to the Angolan border, growing up in a faith community that emphasised healthy living. His upbringing stimulated his interest in Medicine and his desire to impact the health outcomes of his patients. He later learned about the Physicians Committee for Responsible Medicine (PCRM) led by Dr Neal Barnard, and their published food-related research. He watched TED talks by Dr Dean Ornish and various icons in the Lifestyle Medicine world. Together with eleven of his classmates, he was motivated to start LM interventions at his medical school. They named their group the African Youth Rise Health and Wellness Cohort to recruit new members and promote lifestyle medicine training for the students and staff of their Medical School. An e-Cornell Plant-Based Nutrition certificate scholarship was obtained and completed for their entire cohort. They are members of the T-Colin Campbell Centre for Nutrition Studies – Whole Communities for Change Makers and the CNS Kitchen culinary medicine programme. Lecture slides and lessons for Zambian medical students and the public have been produced. PCRM has sponsored “Lunch and Learn” events on campus. One of their professors has agreed to supervise a research project, comparing whole indigenous plant-based foods versus standard interventions to reverse T2 diabetes. Their 5-year vision: Plant-nutrition research, teaching, advocacy, and establishing a Zambian Lifestyle Medicine Hospital and registering the Zambian College of Lifestyle Medicine.
Malambo also persuaded some of his friends studying at the Agriculture College to learn to grow sustainable indigenous food crops to promote health. So many Zambians have adopted the processed Western diet to their detriment. He now has 12 student colleagues in what is called the African Thriving Cohort at the Agricultural School. What a wonderfully inspiring story of youthful energy committed to making a difference in Zambia and throughout Africa. We connected him with the only LM-accredited practitioner in Zambia, and they are now working together to promote LM in their country.
Each of us has a story of our journey into Lifestyle Medicine. By sharing that story, we can encourage others to begin their own “March to Freedom” in health, changing the narrative from disease care to health care.
Imagine if every country in Africa had an active Lifestyle Medicine association or society to encourage incorporation of the principles and practice of LM into medical and allied health curricula. That is our vision through the African Lifestyle Medicine Council.
Dr Dave Glass
MBChB, FCOG(SA), DipIBLM
VP AfLMC.
ExCom member, WLMO