Many Ugandans are ignorant when it comes to stroke, according to Dr Ibrahim Bukenya, the head physiotherapist at the Stroke Rehabilitaion Centre in Wampewo, on Gayaza Road. He says, “While stroke is not new, few people know what it is. Sensitisation is needed because this disease is manageable.”
According to Dr Gerald Mutungi, head of non-communicable diseases, prevention and control in the Ministry of Health, one of the major causes of stroke is high blood pressure.
“High blood pressure is mostly caused by too much inactivity that comes with modernity and economic development. Findings show that one in four Ugandan adults has high blood pressure and 60 per cent of those do not know that they do. Some common symptoms of high blood pressure such as headache, blurred vision, dizziness, and shortness of breath are often ignored by many Ugandans and so, they do not seek medical attention until it causes them to suffer a stroke,” he says.

What is stroke?
“Stroke, in my observation, is a defence mechanism of the brain to protect itself from dying. It is simply the brain shutting itself down because of specific threats. When oxygen stops reaching the brain because of a blockage due to a clot or a burst vein, brain cells start to die very fast; specifically, the size of a soya bean every three minutes,” says Dr Ibrahim Bukenya, the principal physiotherapist at the Stroke Rehabilitation Centre.
Dr Bukenya stresses that it is crucial to prioritise rushing a patient to hospital because recovery is dependent on it. Doctors have created a simple formula that anyone can memorise to help one identify a stroke.

Main signs of stroke
That formula you can use to recognize stroke is the word F.A.S.T.
The first letter stands for face. Here, you should carefully read the person’s face taking care to recognise whether it is uneven. Also ask; is saliva flowing freely or is the patient failing to blink normally?
The second letter stands for arms. Here you should ask whether the person is failing to raise both arms normally or if they are losing the ability to hold things?

The third letter stands for speech. Is the patient all of a sudden failing to talk or having slurred speech?
And the fourth letter represents time because time is of essence when it comes to stroke. The patient has to be rushed to a health facility because it is a medical emergency.

“While these might be the main signs of stroke, they mostly happen in advanced stages. Other signs you should highly suspect are unexplained severe headaches, vomiting for no apparent reason, lack of balance for no apparent reason, and bouts of sudden confusion,” Dr Bukenya says.

The doctor is quick to add that the brain scan done at the hospital might show that there is no stroke which is sometimes erroneous. So to be sure, he advises one to request for a neck scan as well, because apparently if a stroke is not detected in the brain, it will be detected in the neck.

“A stroke either happens in the brain or in the blood stream specifically between the chest and the head,” he adds.

Risk factors
Dr Bukenya says although there are risk factors you cannot control, like old age or heart disease or a genetic predisposition, many other risk factors can be controlled.

“The biggest risk factor is inactivity. Whether you are overweight or not, inactivity causes blood to clot, arteries to be filled with fat and the result of all this is an eminent stroke. But because of lack of sensitisation, people will still think they have been bewitched when one morning they try to get out of bed and realise they have lost the ability sit up or when they collapse at the workplace,” the doctor says.

Dr Bukenya says work stress and or extreme financial hardships can cause stroke. “Many of my patients are in their 30s and 40s. Financial stability probably means more to this group than any other age group.

A well-paying job that is suddenly no more or a promising business that falls flat can have catastrophic consequences. This kind of pressure, if not taken care of can cause high blood pressure and this can cause an artery to burst in the brain, hence a stroke,” says Dr Mutungi.

Is there hope?
What must be stressed here is that stroke is manageable if diagnosed early. Dr Mutungi says, “Our chance at winning this battle is prevention. On top of physical fitness, one of the biggest preventative measures against stroke and other non-communicable diseases is to go for regular checkups.

That means that even if you have never fallen sick in your life, you need to develop the habit of going for medical checkups, at least once a year. If we all did medical checkups, then all those who have high blood pressure or blood clots would know about it in time and get help and consequently stave off a stroke.”

Sensitisation is also crucial and the ministry has already started this process with the Members of Parliament and cabinet, according to Dr Mutungi. The ministry has also retrained health workers across the country and told them about symptoms of a stroke and how to give the initial help at health center IIIs.
Post stroke treatment
Luckily, save for the fact that many Ugandans will mistake a stroke for witchcraft and go looking for help in shrines; stroke is manageable even after one has suffered it. Dr. Bukenya says, “Every patient that enters the doors of Stroke Rehabilitation Centre for instance is carried by family members or friends.

Usually both the patient and the caregivers have lost hope, but the good news is that in a few months, depending on how bad the stroke was, the patient will have regained control of their limbs or bowels or whatever else they lost when they suffered the stroke.”

On average, five new patients seek treatment at the Stroke Rehabilitation Center every month. Considering that the centre has been running for ten years, the numbers are staggering.

The patients cut across class, age and region. According to Dr Bukenya, on top of the physical exercises, the treatment seeks to retrain the brain. During a stroke, a part of the brain that is responsible for controlling particular parts of the body dies. These dead brain cells do not resurrect to resume their roles, in fact they remain as a scar on the brain.

New brain cells have to be trained to take on the roles of those that died. Dr Bukenya says these two factors are fundamental to recovery but the most important factor of recovery is the patient’s will.
“This is why it is crucial that a stroke patient is not allowed to lie at home waiting for a miracle. A patient has to regularly see the progress in other patients. When they visit a rehabilitation centre regularly, they meet people that have recovered and this has a tremendous effect on their will to fight,” Dr Bukenya says.

The state of nation
Research done by the Ministry of Health already shows that non communicable diseases, of which stroke is a major player, account for 40 per cent of all deaths in the country. (It is 70 per cent globally).

But unfortunately, our capability as a country to manage stroke cases is still very limited, according to the ministry of health. Our hospitals can only scratch the surface and there is only one organisation in the country; the Stroke Rehabilitation Centre, to support stroke victims and caregivers. This can only mean one thing; that the numbers are going to go high.

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