More And Better
"Book of the Heart"
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Fifteen minutes later I was saying yes and arranging the details. With a tender smile, Dr. Liliana told me: “If you can convince people by the way you speak to them and by the things you say to them, why not write for them? The wind won’t take the words, your advice will be written and available to everyone, and the book might even be used in schools or even be sent to other countries with Portuguese as the official language!”
Result: for three months I wrote and wrote and wrote without a break, things I said to my students in classes or to my patients in my surgery, or to my readers in the newspapers or my listeners on the radio or TV. The other six months were spent setting out the sentences better, cutting out the redundant, consulting some books or articles, or … amputating that which Dr. Liliana censured: “I read some pages to my colleagues at the print office and they all liked the introduction, but … no one understood anything about the arrhythmias! If people stop reading because they don’t understand what they are reading, they put the book aside and then the aim has been lost – to conquer the reader so they will follow your advice”.
From then on my aim became much more ambitious: a book that would be useful for everyone, from the youngest to the oldest, from the most learned elite to the most illiterate man in the street - the “we, the little people”, who one day said to me in the street “We need you and your advice a lot”. That was in the days when it still wasn’t seemly for a doctor to talk on the media about disease or diagnostics, and I often spoke on television. I suffered, really suffered, when I felt that I had been misunderstood by laymen, and I suffered when I realised that my colleagues did not understand, and would not accept, that I would dare to simplify things and speak to the public for the public to understand.
In the same manner, throughout all the preparation and revision of the book what was at the forefront was that which in my understanding and in that of my closest collaborators – among which I included Dr. Liliana and Cristina, from the publishers – seemed to me to be most acceptable in terms of comprehension and concrete help for those who might read me (“You who are reading me” I used to write in the newspapers forty years ago).
I also wanted to make available to my readers that which I had always shown my students – the wonderful drawings by Dr. J. Netter, which accompanied me over forty-five years of teaching. Without these pictures (who said they were worth a thousand words?) the pedagogical value of the book would be drastically reduced. This demand turned out to be extremely expensive and almost prevented publication. It was Merck, Sharp and Dohme who immediately offered to pay for these drawings – see, for example, at the end of the book, fig.8, the most well-known to all generations of doctors all over the world: chest angina pain! An overweight man going up stairs coming out of a restaurant, carrying a bag and coming out into the cold and wind (it was snowing), clutches at his painful chest with his clenched hand, and even drops his cigarette! On one side a drawing explains the spreading of the pain to the left arm.
In another figure, now ours (at the beginning of the book, page 18), we show what prevention has achieved in terms of reduction in standardised mortality, with a quicker improvement at the beginning, in the years when I gave veritable lessons on TV to the whole country (there was still only one country) and since then mortality has always decreased until today. I still recall the envy shown by my American friends, who stated what they paid for a one minute message, and I had the “right” to a free half hour on our state TV.
Finally, the drawing of the CINDI Programme (Fig. 7, on the last pages), to which I attached great importance in the Fundação Professor Fernando de Pádua, with which we are attempting to maintain health promotion in the populations (adapted from Pekka Puska, in Finland). On the right column there are the non-contagious, or non-transmittable diseases, those that kill us most, fill up hospitals and block up the emergency wards; and on the left is the list of the risks and wrong attitudes or behaviour patterns, which are their main “support base” – that is, the true primordial causes of these diseases – and it is there that it is necessary to act before the appearance of clinical diseases: eliminating tobacco, correcting diet (salt, fat, fibres, sugar), reducing consumption of alcohol and daily stress, and decisively increasing physical activity every day, all beginning at school level (Cid dos Santos used to say that in Portugal “Everything starts at primary education”!).
The adopting of more healthy lifestyles may very substantially reduce obesity, hypertension, diabetes, cardio-vascular accidents, myocardial strokes, metabolic syndrome and the other non-transmittable diseases with identical risk factors, which fill the whole of the right column (and exhaust the capacity of our hospitals).
My great hope is that besides the adults who are already acknowledged as ill or on their way to it, the under twenty population (that is from birth until nineteen years old), highlight the young people among them (and above all young medicine students), may and will wish to take these notions to heart, and also transmit them to the much younger children in their families (and why not also to the adult relatives?) thus contributing to less suffering, lower morbility and fewer early deaths among their peers and their relatives.
They will even be helping to correct, if they all survive, the current ethnical pyramid in Portugal, which we show at the beginning of this book (page 27), and which looks more like a tree than a pyramid (the trunk is the few young people at the moment).
Besides transmitting medical knowledge with immediate application to the general population, it is my hope that medicine, pharmacy, nursing and other students preparing for other professions connected to health (psychosocial or pedagogical professions, even for primary and secondary education), might see this book as an aid (which I immodestly think may be precious) towards the broadening of their field of vision as students at a still early stage of their lives or of their professions.
So be it!
Prof. Fernando de Pádua
January 2009
fernando.padua@incp.pt
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