As far the cause of death, we will never know the exact sequence of events that led to the demise of President Mwanawasa. We can only work backwards and try to figure it out. The appropriateness of the interventions or what could have been done differently is impossible to tell at this stage. It would be unethical to disclose the late president’s medical records to the public.
Case scenarios of what could have happened to President Mwanawasa
Scenario 1. By doctor A .Mwanawasa is said to have complained of chest pains first and this was the reason he was taken to this Egyptian hospital. Later we were told he had a stroke. It is therefore possible that the president initially had a Myocardial infarction(heart attack) or pulmonary infarction. A coronary catherization could have then lead him to have an Ischemic stroke. Ischemic stroke occurs in 0.2-0.4% of patients undergoing left heart catheterization, and is responsible for 5-10% of the mortality associated with the procedure.
President Mwanawasa however had so many risk factors for a stroke:
- diabetes,
- hypertension,
- a black male,
- previous stroke and the
- Office of presidency.
The other factors which we may not know relate to his cholesterol and albuminuria which is closely linked to diabetes and hypertension. He was however a non smoker
Scenario 2. By Doctor B It appears that President Mwanawasas medical conditions were not well managed. This was either because the president didn’t adhere to his treatment or the information given to the president was not sufficient enough for him to make an informed decision. The risk of having another stroke with poorly controlled BP, Diabetes, high cholesterol and stressful job should have been well explained to him. The risk of death with a second stroke should also have been well explained. So a lack of Bp control lead to a stroke which was massive if it lead to unconsciousness. Usually an ischemic stroke won’t knock you out so it was probably hemorrhagic stroke.
Scenario 3 By Doctor C The president had a hemorrhagic stroke.The Craniotomy done on the President to monitor his intracranial pressures could have precipitated uncontrolled seizures from cerebral irritation. This could have lead to aspiration which in turn lead to pneumonia. All this is what could have caused him to be ventilator dependent. Probably that’s when GRZ said he was stable. Being in ICU as long as he was he probably got hospital acquired pneumonia with possibly MDR pseudomonas or MRSA and the French, like all European countries don’t like to give antibiotics in such situations till you’re on your death bed (which he was).
Why President Mwanawasa had a craniotomy and tracheostomy.
By doctor D. The government informed the general public that the president had a craniotomy and tracheostomy. Well assuming he did have a craniotomy, it is likely this was done to reduce elevated intracranial pressure. The elevated intracranial pressure is likely from a hemorrhagic stroke (either a primary hemorrhagic stroke or hemorrhagic conversion of an ischemic stroke). The tracheostomy was likely done due to prolonged intubation.( Insertion of a tube through the mouth or the nose and into a patient’s lungs to help them breathe. The reason for the prolonged intubation was likely due to poor neurological function. He was not reported to have had major pulmonary disease and so should have been able to wean from the ventilator (breath on his own). The fact that he did not suggests that his neurological function was so severely impaired that it affected his ability to protect his airway and/or his respiratory drive was severely depressed. In any case, if this was a stroke then the cause was lost well before he reached France. Prognosis of strokes with intracerebral and subarachnoid haemorrhage is terrible even in the best of centers and the 1month mortality approaches 50%.
Discussion\Recommendations
By Doctor E.I think as doctors we should have the courage to tell the patients all the facts about a particular disease and the associated risks with or without treatment.
I believe the Presidents medical conditions were not well controlled. Why do I say this? The President flew to Egypt and the same day or was it the following day, his blood pressure was sky rocketing. Please correct me but I think he flew from Lusaka with uncontrolled BP. This should never have been allowed.
Doctor F Hemorrhagic stroke in our man with his history meant we lost him in Egypt. I do not believe he could have been STABLE post-hemorrhagic stroke and ventilator dependent. He had a very bad prognosis.
Doctor G I think there should be a committee of doctors to look after our President but doctors who can be consulted from time to time to give an a opinion. I don’t mean doctors who will spend all their time at state house to earn a living but doctors who will give specialist advice from time to time. These should not be hand picked by the President because they are MMD, or PF doctors. Some form of a body can recommend these doctors. They should be full time practicing doctors and should continue doing so even after been selected. They should be on a government t salary and not an allowance from state house.
Doctor H Obviously we can see that with all this speculation about what happened to our late president, it’s clear that our Medical Association needs to change from that of being an association to that of a union or another body stronger than it is, so that we can add our voices to such matters. We have representation of ZMA during the NCC and we expected that ZMA would have met to discuss the things we want enshrined in the republican constitution as regards the health of our president. We also hope on an improvement on the kind of reporting that we heard over the past months.So I pose the question –when should the chief justice call for a medical board? In our current constitution it states that and I quote:
36. (1) If it is resolved by a majority of all the members of the Cabinet that the question of the physical or mental capacity of the President to discharge the functions of his office ought to be investigated, and they so inform the Chief Justice, then the Chief Justice shall appoint a board consisting of not less than three persons selected by him from among Persons who are qualified as medical practitioners under the law of Zambia or under the law of any other country in the Commonwealth, and the board shall inquire into the matter and report to the Chief Justice.
If that’s the case, did we have to wait until it was too late? Such a board should be convened when the experts feel that a president is not fit to continue. Currently the Chief justice is appointed by the president so it will be extremely difficult for him to call for a medical board. Therefore we should advocate for a professional body like ZMA to decide to convene such a board and not Cabinet or the Chief justice. The French doctors should be ashamed of themselves for saying Mwanawasa was in a stable state and making steady progress. President Sarkosy felt guilty on his countries behalf and paid all the medical bills and gave us his presidential plane to bring home our beloved president.
Doctor D As far as the lessons to be learned from this, whether medical conditions should disqualify people from running for president is a tricky question. There are many examples in the US where people with questionable health have held important positions in government. Bill Clinton underwent bypass surgery. McCain has a lot of medical conditions, but they are all controlled and so it seems okey for him to run for presidency. Senator Ted Kennedy is currently being treated for brain cancer, but continues to work in the senate. So it is difficult to rule out candidate just on medical conditions alone. Further, President Mwanawasa had a potentially preventable condition. One thing is clear. There is a need to educate the public about diabetes and cardiovascular disease in general and stroke in particular. The need for education is great in Africa. Let’s keep trying to get the word out on disease prevention as much as we can. We have the ability to prevent the epidemics of hypertension, stroke and cardiovascular disease in Zambia before things get as bad as they are in the West. We can apply the lessons learned from the west to prevent disease before it gets more people.
Proverbs 24 v 11-12 “Rescue those who are unjustly sentenced to die;save them as they stagger to their death.Don’t excuse yourself by saying, “Look, we didn’t know.”For God understands all hearts, and he sees you. He who guards your soul knows you knew.He will repay all people as their actions deserve.
The purpose of this article is to educate the reader and to urge policy makers and doctors to devise better ways of taking care of future Zambian Presidents .The information was obtained from UNZA trained doctors who had no dealings with the Late President and who would like to remain anonymous to avoid victimization.
