My paternal cousin was buried in Kahondo ka Byamarembo this past Saturday, the day of her death from a devastating stroke. Her name was Tibareijukire ba Kakitaahi kya Butamanya bwa Nyakashaija ka Ruhuuma rwa Mugasha wa Byamarembo.
Born in 1941 to Kyakwera and Kakitaahi, she had less than a year of formal education, dropping out of school because her father, the chief county clerk of Kinkiizi, developed a severe mental disability in 1946. It was said Kakitaahi’s illness was induced by witchcraft.
Her life’s trajectory changed. Besides a brief basic literacy course that enabled her to read the Bible, she grew up a peasant in Kahondo ka Byamarembo, Kigyezi, where the family, including her two sisters and three brothers, resettled. It is there, at age 18, that she met and married Nshekanabo, a member of the Basyaba clan, with whom she had nine children.
Until recently, Kahondo was not easily accessible by road. It had no formal health services and was a generally challenging place to live. Tibareijukire raised her children, set them on a good path towards independent living, before slowing down in old age.
Widowed for many years, she soldiered on, a highly respected member of her community, albeit on the periphery of Ugandan society, with minimal access to services that she was presumably entitled to as a citizen. As she made her contribution to her country, an enemy gnawed at her, pushing up her blood pressure until symptoms delivered her to a doctor, who diagnosed hypertension and started her on medications.
Armed with her pills, perhaps of uncertain quality, she did her best to live with her illness. Two weeks ago, her luck ran out. Stricken with an obvious stroke, Tibareijukire was first taken to a dispensary at Kakatunda, Bukinda, 13km away, before transfer to Kabaare Regional Referral Hospital. Three days later, paralysed and immobile, she was discharged home to her village. Ten days later, she died as the cocks crowed in the morning.
My cousin was one of 1.4 billion adults, a full 30 per cent of the world’s population, afflicted with hypertension, the leading cause of death today. A study published in the Lancet last August, which looked at the state of hypertension care in 44 low-income and middle-income countries, found that 25 per cent of Ugandans aged 18 to 69 years were living with the disease.
Ideally, an adult’s blood pressure should be maintained at a maximum value of 120/80 mmHg, and certainly not more than 130/80 mmHg. We should take note of an important study by Dr Andrew K. Tusubira of Mulago Hospital and his colleagues that was published in the Lancet Global Health last month. They found that whereas the majority of patients with hypertension and/or diabetes mellitus at the three study centres in Nakaseke District adhered to the recommended behavioural changes that helped them with their disease, they “were limited by the inability to obtain medicines.”
Many of the patients did not regularly monitor their illnesses and, alarmingly, many reported “use of herbal remedies, soaking swollen feet in saltwater, and coping with stress through prolonged sleep, social isolation and alcohol use.”
Hopefully, the Covid-19 scare has jolted us into rethinking our priorities. Every Ugandan should have access to high quality, knowledgeable clinicians that offer state-of-the-art treatment and monitoring of their patients.
Why is all this important? Undetected, untreated or undertreated hypertension can result in serious complications, including heart failure, heart attacks, small blood vessel disease, and rupture of the aorta, erratic electrical activity of the heart, end-stage kidney disease, stroke, dementia and death.
When I last saw her in Kahondo on Sunday, November 24, 2019, Tibareijukire showed no sign of ill-health. At 78, she looked like one who still had a lot of miles to go before slowing down.
However, behind her beautiful smile, lurked a silent killer that would strike hard and fast like a thief in the night. Six months after that beautiful reunion, she was gone.We mourn with her brother Joseph Rukeijakare of Kasese, her other siblings, her children and all Abakonjo b’Abatenga ba Nyanga ya Kahondo.