# Honoring Theodore Roosevelt: His Contributions and Health Struggles

In 2025, the world will commemorate 77 years since the passing of one of the most impactful presidents in American history, **Theodore Roosevelt**. As the **26th and youngest president of the United States**, Roosevelt was celebrated for his vigorous leadership, progressive reforms, and skillful diplomacy. His role in mediating the Russo-Japanese War earned him the **Nobel Peace Prize** in 1906, underscoring his dedication to international peace.

Beyond his political life, his personal experiences serve as a remarkable example of perseverance. Despite enduring serious **chronic health issues** and various systemic ailments, he lived a life filled with joy, laughter, and zeal—earning the title of “*the first president that smiled*.” Even while grappling with severe asthma, Roosevelt’s broad, self-assured smile became emblematic of hope and resilience. However, his existence was ultimately truncated by a **pulmonary embolism (PE)**—an affliction that remains a growing health concern worldwide today.

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## The Increasing Global Challenge of Pulmonary Embolism (PE)

Pulmonary embolism, frequently resulting from **venous thromboembolism (VTE)**, has emerged as a significant public health issue, especially in **high-income countries (HICs)**. In the last 20 years, the prevalence of PE has escalated due to:

– Enhanced **diagnostic capabilities** and the widespread use of **CT pulmonary angiography**.
– Better **survival rates** in high-risk groups such as cancer victims and those with **chronic obstructive pulmonary disease (COPD)**.
– Heightened **clinical awareness** among healthcare professionals.

Even though the occurrence of cases has risen, in-hospital death rates and age-standardized mortality rates from PE have stabilized. This trend likely reflects progress in **early detection**, **treatment approaches**, and overall **global health advancements**. Nevertheless, PE linked to **hemodynamic instability** still poses a significant risk of in-hospital mortality.

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## Pulmonary Embolism in Low- and Middle-Income Countries (LMICs)

While **high-income countries** have made significant progress in managing PE, **low-resource environments**, especially in **Africa**, continue to confront the challenges posed by this condition.

### PE Management in Africa:
Research by **Danwang et al.** indicates that **25% of at-risk patients in Africa** do not receive VTE prophylaxis. Studies conducted within the hospitals of Ghana’s **Ashanti Region** categorized **thromboembolic disease (TED)** as a **medium risk** across different healthcare settings, with frequent reports of cases in **inpatient facilities**.

### Key Observations:
– **Deep vein thrombosis (DVT)** and **ischemic stroke** were the most commonly encountered conditions.
– **Pain** emerged as the most reported symptom.
– **Low-molecular-weight heparins** and **warfarin** were the primary treatments for TED.
– **Financial constraints** posed the greatest challenge to accessing treatment.
– **Bleeding** was the most prevalent side effect of treatments.

This situation emphasizes the crucial need for financial backing and **accessible treatment options** to alleviate the burden of this disease in areas with **limited healthcare resources**.

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## Ethiopia’s Healthcare Challenges in PE Patient Care

Ethiopia contends with additional healthcare hurdles, particularly in **critical care infrastructure**. Research by **Fitsum Kifle** reveals a **marked shortage of ICU beds**, uneven resource distribution, and a deficiency of **essential equipment** like oxygen and monitoring tools. The lack of **advanced life support technologies** greatly restricts healthcare workers’ capacity to effectively diagnose and manage **PE and DVT**.

### Consequences of Insufficient Health Infrastructure:
– **Delayed or missed diagnoses** resulting from the absence of imaging and monitoring devices.
– **Inefficient management tactics** for PE due to insufficient ICU and **organ support systems**.
– **Limited ability to perform thrombolysis**—a vital intervention for severe PE instances.

The deficiency of adequate intensive care in Ethiopia and similar countries underscores the **urgent need for enhancements to the health system.**

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## Tackling the PE Crisis in Africa

Numerous African nations, including Ghana and Ethiopia, grapple with **significant disease burdens, delayed recognitions, and healthcare deficiencies**. A major hurdle is the **scarcity of medical specialists** trained in pulmonology. In Ghana, merely **two pulmonologists were trained over the past decade**, leading to healthcare providers being overwhelmed by patient demand.

Health experts assert that the **true prevalence of PE** in Africa **surpasses the estimated figures** due to **lacking diagnostic resources** and **underreporting**. Confronting this issue necessitates:

1. **Boosting Healthcare Workforce** – Educating more **pulmonologists** and specialists.
2. **Enhancing Diagnostic Resources** – Granting hospitals access to **CT pulmonary angiography**.
3. **Improving Treatment Accessibility** – Lowering the prices of **anticoag