I returned from North America only a couple of weeks today having been invited to attend a symposium on the issue of stress from a psychological perspective and prostate cancer as a physical disease at UmassMemorial Hospital (University of Massachusetts) in Worcester by some colleagues of mine within the health care profession. A very worthwhile symposium, it was well attended by psychiatrists, psychologists, urologists, radiologists, physicians, dentists, nurses, health care researchers, nurse educators, patients and ex-patients alike. As Meads and Ashcroft (2000) point out, care management, individual needs assessments, care pathways all require interprofessional collaboration if they are to be successful. Indeed, being a health care professional today means becoming interprofessional. This view is reflected in government policies worldwide that demand seamless, ‘joined-up’ health and social care services. As such, it can be argued that the government is the central driver for interprofessional working.

Sociologist Wilkinson (1996) raises the question of what are the features of a healthy society and goes on further to provide answers which points to societies that exhibit high social cohesion. These societies adds Wilkinson (1996), places emphasis on mutual aid, narrow differences in income, avoidance of obnoxious political differences and a shared sense of purpose or belief. The ultimate aim is for the health and social care workforce to be more responsive to each other and to the users of the services provided. In this vein of thinking, I sincerely thank the organisers notably, Dr Robert “Bruce” Montgomery, Dr Stephen Tosi, Dr Jean Boucher and many others. I am most grateful for this, for it has enhanced my belief that, we learn to cope through knowledge and hope by sharing and caring.

Interestingly, I asked my 11 years old son, Baguasim whether he has ever heard of the word ‘stress’. In a warm response he replied affirmatively that, ‘…dad, it’s something that will rip you apart into pieces‘. One is reminded of the work of the late Psychologist Sigmund Freud one time leading psychologist who developed some psychological knowledge through studying the behaviour of his daughter Anna Freud many, years ago. However, Master Baguasim should not be seen as a ‘guinea pig’ in the development of this feature article!

This brief personal experience demonstrated above now brings me to one of the issues discussed during the symposium - stress! Often defined as a threat which can be real or implied to homeostasis (balance), the term ‘stress’ is full of ambiguities. It is often used to mean the event (stressor) or, sometimes, the response (stress response). In the negative sense however, stress is referred to as ‘distress’ and used for instance in chronic state of imbalance.

Stress is a very common symptom which can be present to a degree in many types of problem (as well as in almost everyone). I will be naïve to ask you as to how stressed our political leaders are currently experiencing the challenges ahead, such as Prof. John Atta Mills (NDC) as well as the contenders for the NPP leadership campaign. I might equally be seen as a naïve Lecturer in relation to human needs if I were to ask you how stressed your son or daughter were while waiting for the postman to deliver their exam results. Also, imagine feeling nervous because you are waiting to see your dentist for your wisdom tooth to be extracted under a local anaesthetic. The mere sight of your dentist entering his surgery constitutes in you some trigger factors such as, palpitations, breathlessness, sweating, and frequency (constantly wanting to pass urine). These are examples of what is referred to as physical symptoms. On the other side of the coin, you may develop some fear/s, irritability, and feeling of unreality. These constitutes psychological symptoms of stress. Let me emphasise that these symptoms are not unique but there is a need to consider individual differences- for example, age, gender, educational, cultural and many others..

While many of our health problems and diseases have a specific cause or, at most, a limited set of causes and risk factors, stress and stress related problems are not looked at by ones physician in quite the same way. Your physician might be looking for specific relationships-for example, the conditions at your work place - how well are your talents or skills being utilised, any promotion which you feel that you might have been sidelined, your domestic problems for example, marital issues, nuclear/extended family dichotomies (please see feature articles of 2007-07-20 and 2007-08-04) respectively.

To be diagnosed as suffering from stress by your doctor involves a broad-based strategy. In other words, an ‘open-lens’ approach. Your doctor will show a keen interest in your life history events that may be triggering some of the problems. During this period of investigation, please, be frank with your doctor as hidden agendas can or may delay the diagnosis and treatment.

It is reasonable to remember that stress will cause extra work for your heart, the blood vessels and kidneys. To put it mildly, this will cause wear and tear of the system. I think this was in relation to what Master Baguasim meant what he said, above. Thus, repeated activation would cause fatigue to the heart and major systems. In this case, we should then experience heart problems after many years and very late in life. In others, a stressful situation could ‘earn’ one, ‘stomach ulcers’ or in scientific term, ‘peptic ulcer’.

One important extreme form of stress that one can be subjected to, consciously or unconsciously is social isolation. It has been shown that obviously, depriving a person of this basic human need is a cruel punishment. I am not surprised that, even the most hardened armed robber within our society today dread the prospect of ’solitary confinement’. Social interactions can have a positive effect and would be one of the strategies best suited for stress reduction. It is worth noting that the fewer social relationships a person has, the shorter the life expectancy and higher the impact of various infectious diseases. Additionally, people who are socially isolated are more stressed and lack sufficient interaction to ventilate their feelings and lack support.

We need to recognise that stress is a major risk factor for many of our health problems. However, marital stress has been identified by social-psychologists as the biggest hazard as compared to other type of stress simply because it’s so hugely personal. One can’t run away from marital stress the way you can other types of stress. I will end this part of the article by saying that it is important to note that stress as a killer disease is everywhere! The issue surrounding prostate cancer was discussed and warmly received by almost all participants in the conference hall. As one participant yelled out very loudly - “…it’s man’s world…”, which simply means that the condition can only be diagnosed in men-anatomically, no female has prostate gland! How does anyone-particularly a person who never thought about cancer before and hoped he’d never have to-make sense of all this? My thoughts at this stage goes to the death of our leading Urologist in a road traffic accident recently (RIP) on the Accra-Kumasi road. I do not want some readers to accuse me of using technical language in this section but just try to be with me for while. Just try to make sense out of this in order to be of help to yourself or to a loved one!

You may wish to know what the prostate gland is and what it does. I want to remain very basic in this section so please I beg your pardon.

Elaine Marieb (2005) points out that it is not a single gland; rather it’s composed of a collection of glands that are within a sack called capsule. A gland is an organ that produces a substance that is used in another parts of the body. The prostate gland lies below the bladder, circles the tube that one urinates through, referred to as the urethra and lies in front of the rectum. Because it lies just in front of the rectum, the back aspect of the prostate gland can be assessed by the doctor by examining the rectum. The normal size of the prostate gland is like a walnut. In summary then, the prostate glad has areas known as zones, that is found in more than one area, and that it is capable of being felt during a physical examination by an experienced doctor. Should the doctor suspect any abnormality, he/she will discuss the findings with you-please, remain patient still!

Telling it as it was: the doctor might order certain routine examinations such as personal history and PAS which stands for prostate specific antigen-I will explain this in a moment: From the person’s perspective, he might experience awakening at night with the desire to urinate, urinating more frequently than every two hours during day time, feeling that you have to urinate-but when you attempt to, finding that it takes a while for the urine to come out. Furthermore, one may be straining or pushing to get the urine stream started and/ or to maintain your stream. One may say that he dribbles urine near the completion of urinating.

About the PAS (Prostate Specific Antigen), this also helps the doctor or preferably the Urologist to find out what is actually happening in ones prostate gland. If there is an infection in the prostate gland, the PAS will rise as well as in prostate cancer. If you are interested to know more about these factors, please see your doctor or Urologist as having a rise in PAS according to your blood examination does not necessarily mean that you are suffering from cancer of the prostate gland. In doing so, you could prevent stressing yourself up.

In telling it as it was: while all men are at risk for prostate cancer, prostate cancer has been shown to be more common in some racial and ethnic groups than in others, but medical experts do not know why. However, prostate cancer is said to be more common in African-American men than in white men.

In conclusion, it is important to note a few things. Stress is everywhere. Every twinge of dysfunction in our bodies is not a manifestation of stress-related disease. It is true to argue that the world is full of bad things that we can cope with by alerting our outlook and psychological makeup but it is also full of awful things that cannot be eliminated by a change in attitude no matter how heroically, fervently or ritualistically we may wish. Once we are actually sick with the illness, none of stress management techniques that I have attempted to discuss can provide immediate relief.

Once prostate cancer (in men) or breast cancer (in women) for example, have been diagnosed by your doctor there is an urgent need to turn to our health care professionals to provide treatment and relief without any impediment to the client or patient. Written from a humanistic view point, we have to recognise how the factors triggering stress can affect man’s health as well as the support needed by men with prostate cancer in our country today. Adequate provision of health needs are essential with well prepared health care professionals to manage it without any political interference.

A democratic party must be seen to have enshrined health care issues within the party’s election manifesto and must adhere to it on entering office. That is a natural commitment, and NOT a political one in my view.

Asigri, D.Z.

Senior Lecturer Practitioner Researcher Middlesex University London