The plight of stroke victims in Uganda

With the help of her nieces, Josephine Emoru carefully walks in small steps in the courtyard of the Stroke Rehabilitation Center (SRC) in Wampeewo, Kasangati Town Council, Wakiso District.

The 49-year-old woman is barefoot and walks with the help of a triple cane in her right hand. Although she can walk to a chair and sit on it, she cannot get up from it. Instead, her daughter-in-law holds her by the neck and helps her up.

It has been a month and a week since a group of children found her lying face down in their garden in Kibale sub-county of Pallisa County.

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

Emoru’s speech is very slow and you have to get close to hear what she says. She doesn’t know how long she lay prone in the garden, but at some point she felt many people lifting her up.

“They took me home and that’s all I remember. I don’t know what happened next. I know I couldn’t sit up and my mouth was drooling non-stop,” she adds.

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

“When I saw her unable to get up, I knew she had had a stroke. I have been hearing about this disease for some time now. I called the man who had the car and we rushed her to Pallis Hospital,” she explains.

They were referred to Mbale Regional Referral Hospital where they were told to undergo a CT scan at CURE Children’s Hospital in Uganda.

“After we received the test results, we were directed to return the report to Pallis Hospital. All this time, my daughter-in-law did not receive any treatment. In Pallis the doctor told me that the hospital could not cope with the problem. He told me to take her home,” Olinga says.

The results confirmed that Emoru had indeed suffered a stroke. She could not move or eat.

“She couldn’t control her bladder or bowels. We took care of her at home for a whole week, wondering what to do next. She is very heavy and it took a lot of effort to turn her over on the bed,” Olinga adds.

Henry Kayanja, senior physiotherapist at the SRC, says that while the facility has 20 patients at any one time, many more patients attend the outpatient department.

“Stroke is a major health problem in Uganda. Every day 25 victims come to our clinic seeking treatment. According to the World Health Organization, about 15 million people suffer from stroke every year,” he says.

Of these, five million die every year, and another five become disabled and cannot take care of themselves. There are two types of stroke; hemorrhagic stroke, caused by a ruptured blood vessel in the brain, and ischemic stroke, caused by a blockage of the blood vessel supplying blood to the brain.

Globally, high blood pressure (including high body mass index and high cholesterol) is the biggest risk for stroke, accounting for 71 percent of all victims, according to the World Stroke Organization (WSO) 2022 Global Stroke Fact Sheet.

Behavioral factors such as smoking, poor diet and physical inactivity account for 47 percent of victims. Kayanja says that while stroke is rare in people under 40, people at risk should always be on the lookout for signs.

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

He adds that stress is one of the risk factors that can cause this disease.

“If you’re feeling stressed about something in your life, make an appointment to see a professional who can help you reduce your stress levels. Stress and depression are important factors that can accelerate the onset of stroke,” says Kayanja.

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

“She had a misunderstanding with her husband and he kicked her out of the house. She returned to us in Pallisa with nothing; only the clothes on your back. But she was brutally beaten. Although she never complained to us, she felt bad all the time,” says Olinga.

Emora left her six children and returned to her brother’s house with her last child. However, her husband followed her and took the child from her.

“This man did not give her a single coin, although they earned a lot of money together. He is now married to a younger woman. As a woman who had everything at her disposal, my sister-in-law started begging for something as small as Vaseline. She cried all the time,” Olinga adds.

Olinga says Emoru’s children always called her and told her how their new stepmother was treating them badly, which made her even more upset.

“We tried to calm her down, but every time the children called, she would lose her temper 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 people in their social network they can trust who will listen to their problems and advise them.

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

“Contrary to what many people think, alcohol does not reduce stress. Instead, the more you drink, the more your stress levels increase. Instead, try to eat a healthy diet. If the stress is caused by a problem that can be resolved in court, seek legal advice,” says Kayanja.

Luckily for the Emoru family, one of their neighbors suffered a stroke a year ago.

“We consulted with his son on what to do. He told us about the SRC in Vampeevo and said that his father can now walk on his own and even drive a car. But he warned us about the costs,” says Olinga.

Depending on the severity of the disease, SRC charges between Sh30,000 and Sh50,000 per day of treatment.

“Now I see changes. She no longer uses adult diapers. She can bathe and brush her teeth. I noticed that they were giving her advice, trying to give her hope for a brighter future, even if she lost everything,” Oling adds.

Emoru has been enrolled in the Uganda Stroke Foundation and is attending advanced training courses that teach soap making and baking skills to stroke victims. If someone gets better, they can use this skill to make a living.

“We advise recovering patients to continue a rehabilitation program to cope with the disability resulting from the stroke. They should undergo ongoing medical monitoring to check their blood pressure and blood sugar levels, as well as exercise and maintain a healthy diet,” says Kayanja.

Emoru’s husband never called to ask about her well-being, even though her family told him she had suffered a stroke. He also does not contribute to the cost of restoration bills.

“I’ve recently started taking cautious steps and don’t want to regress. I try not to think about him. I pray that God will give me courage to endure what I am going through. Nothing is impossible for him,” says Emoru.

She plans to return to the business world after she recovers.

“I hope I can get capital from my relatives to start a grocery business. I advise people who are in the same condition as me and have had a stroke to take courage because everything will get better. They should only think about the positive side of life,” she adds.

Olinga attributes his daughter-in-law’s recovery to divine providence.

“I keep telling her that even if she is a single woman now, she can make her life on her own. Even lonely people can survive in this life. If she had been a widow, wouldn’t she have survived? That’s the advice I give her now,” she says.

Kayanja is calling for increased awareness of stroke, its causes and how to prevent it.

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

According to the WSO, 101 million people worldwide are living with the consequences of a stroke, and this number has almost doubled over the past 30 years. One in four people will have a stroke during their lifetime. Over the past 17 years, this number has increased by 50 percent. The organization estimates that the total cost of stroke worldwide in 2017 was $451 billion.

When to Call Your Doctor According to www.mayoclinic.org, seek medical help immediately if you notice any symptoms of a stroke, even if they seem to come and go or disappear completely. Think “QUICKLY” and do the following: • Face. Ask the person to smile. Is one side of your face sagging? • Weapon. Ask the person to raise both hands. Is one hand going down? Or one hand can’t rise? •Speech. Ask the person to repeat a simple phrase. Is the person’s speech slurred or different from normal? •Time. If you notice any of these signs, call 911 or emergency medical services immediately. Call your local emergency number immediately. Don’t wait for symptoms to stop. Every minute matters. The longer a stroke goes untreated, the greater the likelihood of brain damage and disability. If you are near someone who you suspect is having a stroke, monitor them closely for emergency help.