The plight of stroke victims in Uganda

With the help of her nieces, Josephine Emoru tentatively takes baby steps around the courtyard of the Stroke Rehabilitation Centre (SRC) in Wampeewo, Kasangati Town Council, Wakiso District. 

The 49-year-old is barefoot and walks with the aid of a tri-walking cane in her right hand. Although she can walk to a chair and sit in it, she cannot lift herself out of it. Instead, her sister-in-law holds the back of her neck and helps her up. 

It has been one month and a week since she was found lying face down in her garden in Kibale sub-county, Pallisa District by a group of children. 

“I remember I stopped digging, straightened up, and looked at the sun. I felt something hitting me on the forehead and I decided to sit down. Instead, I fell down,” she says.

Emoru’s speech is very slow and one has to move closer to hear what she is saying. She does not know how long she lay prone in the garden, but at one point, she felt herself being lifted by many people. 

“They took me to my home and that is all I remember. I do not know what happened next. I know I could not sit and there was a nonstop flow of saliva from my mouth,” she adds. 

Emoru’s sister-in-law, Stella Olinga, says she was alerted to her condition at around midday on that day. 

“When I saw her, unable to get up, I knew she had suffered a stroke. I had been hearing about that disease for some time. I called a man who owned a vehicle and we rushed her to Pallisa (General) Hospital,” she explains. 

They were referred to Mbale Regional Referral Hospital, where they were told to go for a CT scan at CURE Children’s Hospital of Uganda. 

“After we got the results of the can, we were instructed to take the report back to Pallisa Hospital. All this time, my sister-in-law had not received any kind of treatment. In Pallisa, the doctor informed me that the hospital could not handle the problem. He advised me to take her back home,” Olinga says. 

The results confirmed that Emoru has indeed suffered a stroke. She could not move or feed herself. 

“She could not control her bladder or bowels. For a whole week, we cared for her at home, wondering what to do next. She is very heavy and turning her on the bed took a lot of effort,” Olinga adds. 

The problem

Henry Kayanja, a senior physiotherapist at SRC, says although the facility has 20 resident patients, many more check into the outpatient department. 

“Stroke is a major health concern in Uganda. Every day, we get 25 victims walking through the outpatient department seeking treatment. According to the World Health Organisation, annually, about 15 million people suffer from stroke,” he says. 

Of these, five million die annually, while another five are incapacitated and cannot take care of themselves. There are two types of stroke; hemorrhagic stroke, which is caused by the rapturing of a blood vessel in the brain, and ischemic stroke, which is a result of an obstruction within a blood vessel supplying blood to the brain. 

According to the 2022 Global Stroke Fact Sheet of the World Stroke Organisation (WSO), globally, high blood pressure (including high body mass index, and high cholesterol) is the largest single risk for stroke, accounting for 71 percent of all victims. 

Behavioural factors such as smoking, poor diet, and low physical activity, account for 47 percent of the victims. Kayanja says although stroke is uncommon for people who are below 40 years of age, people at risk should always look out for the signs. 

“If you have sudden numbness or weakness on one side of the body, especially in the face, arm, or leg, have trouble speaking or seeing, and feel suddenly dizzy, you should seek immediate medical attention,” he says. 

He adds that stress is one of the risk factors that can bring on the condition. 

“If you are stressed by any condition in your life, make arrangements to see a professional who will counsel you to reduce the stress levels. Stress and depression are big factors that can precipitate the onset of a stroke,” Kayanja says.

Stress as a risk factor

For many years, Emoru was a victim of domestic violence. Her family lived in Malaba Town and the couple owned a wholesale shop. They have seven children.

“She developed misunderstandings with her husband and he chased her out of the home. She came back to us in Pallisa with nothing; only the clothes on her back. But she had been severely beaten. Although she never complained to us, she was miserable all the time,” Olinga says. 

Emoru had left behind six of her children and returned to her brother’s home with her last born. However, her husband followed her and took the child away from her. 

“That man did not give her a single coin yet they had made a lot of money together. He is now married to a younger woman. From a woman who had everything at her disposal, my sister-in-law started begging for something as small as vaseline. She would cry all the time,” Olinga adds. 

Olinga says Emoru’s children always called her, telling her how their new stepmother was mistreating them and this further depressed her. 

“We tried to calm her down, but every time the children called, she would break down and cry. I think at some point the stress led to the stroke,” she explains. 

Kayanja advises people going through stressful episodes in their lives to have a social network of people they can trust who will listen to their challenges and advise them. 

“A social network is one of the most important things in one’s life. You need people who believe in you, even when you are at the lowest point in your life. At this point, a stressed person should avoid a negative mindset. Instead, immerse yourself in activities that draw attention away from the problem,” he says. Some of these activities include watching plays or movies, or even simple aerobics. However, he cautions against finding solace in alcohol.

“Contrary to what many people think, alcohol does not reduce stress. Instead, the more you drink, the more the stress levels increase. Instead, strive to have a healthy diet. If the stress is caused by a problem that can be solved in the courts, get legal advice,” Kayanja says. 

Coming to SRC

Luckily for Emoru’s family, one of their neighbours had suffered from a stroke the year before.

“We consulted his son about what to do. He told us about SRC in Wampeewo and told us his father could now walk on his own and even drive a car. But, he cautioned us about the expenses,” Olinga says. 

Depending on the severity of one’s illness, SRC charges between Shs30,000 and Shs50,000 per day of treatment. 

“Now, I see the changes. She no longer uses adult diapers. She can scrub herself and brush her teeth. I noticed that they counsel her, trying to instill hope in her that the future is bright even if she lost everything,” Oling adds. 

Emoru was enrolled in Stroke Foundation Uganda and she attends skills training that equip stroke victims with soap making and baking skills. In case one gets better, they can use the skill to earn a living. 

“We advise recovering patients to continue with the rehabilitation programme to manage the disability that comes as a result of the stroke. They should have constant medical follow-ups to check on their blood pressure and blood sugar, and they should exercise and maintain a healthy diet,” Kayanja says. 

Avoiding renewed stress

Emoru’s husband has never called to ask about her welfare, even though her family informed him that she had suffered a stroke. He does not contribute to the recovery bills, either. 

“I started taking tentative steps recently and I do not want to regress. I try not to think about him. I pray that God gives me the courage to bear what I am going through. There is nothing impossible for him,” Emoru says. 

She plans to return to the business world after she gets back her health. 

“I hope I will get the capital from my relatives to start a produce-selling business. I advise people who are in the same condition as I am and have suffered a stroke to take heart because things will get better. They should think about only the positive side of life,” she adds. 

Olinga attributes her sister-in-laws’ recovery to divine providence. 

“I keep telling her that even if she is a single woman now, she can work out life on her own. Even single people can survive this life. Supposing she was a widow, would she not have survived? That is the advice I give her now,” she says. 

Kayanja calls for more awareness about stroke, its causes, and how it can be avoided. 

“Early diagnosis and treatment are key in preventing the debilitating effects of stroke and death. We need more health centres where people can access treatment and rehabilitation services,” he advises. 

According to the WSO, 101 million people worldwide are living with stroke aftermath, a number that has almost doubled over the last 30 years. One in four people will have a stroke in their lifetime. This number has increased 50 percent over the last 17 years. The Organisation estimates that the total worldwide cost of stroke in 2017 was $451b.

NOTE

When to see a doctor According to www.mayoclinic.org, seek immediate medical attention if you notice any symptoms of a stroke, even if they seem to come and go or they disappear completely. Think «FAST» and do the following: • Face. Ask the person to smile. Does one side of the face droop? •Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise? •Speech. Ask the person to repeat a simple phrase. Is the person’s speech slurred or different from usual? •Time. If you see any of these signs, call 911 or emergency medical help right away. Call your local emergency number immediately. Do not wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. If you are with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.