Stroke: Why Uganda is experiencing an upsurge

Sulaiman Sewanyana, 69, a resident of Kampala, is undergoing rehabilitation following a stroke which left him paralysed.  

His left side of the body was totally disabled and he is having difficulties in speaking and writing due to the attack.

The frail-looking Sewanyana, who is currently receiving care at Stroke Rehabilitation Centre (SRC) in Wakiso District, says the tragic attack, which has upset his life, happened when he was at work.

“Three weeks back, I was seated in my office, doing office work. But I started feeling as if my head was spinning and I could see things moving,” he narrates with difficulty.

He continues: “When I tried to stand up, I realised I had lost balance and I collapsed on the floor. I hit the floor so hard that my arm was badly bruised.” 

Sewanyana works in Kampala as the deputy secretary for external affairs at Ahmadiyya Muslim Organisation in Uganda.
It took the intervention of friends at his workplace to rescue and rush him to a hospital where he was diagnosed with stroke.

“Some colleagues who use the same floor where my office is, noticed I was inside the office for a very long time (which was abnormal). So, they got a key and opened the door, lifted and took me through the staircase, up to the parking yard,” Sewanyana recalls.

“I was rushed to Nsambya hospital. Here, they did a scan on my brain and the heart. They found that I had a stroke and they gave me medicine. Paralysis and headache were too much, but after the medication, I felt a bit of ease,” he narrates.
The doctors at the hospital referred him to SRC at Wampeewo in Wakiso District a few weeks later. 

Although Sewanyana thinks he has greatly improved, he needs someone to lift him off the ground and support him to limp to do physical exercise.

He reveals that his stroke could have been triggered by personal and family issues which left him too stressed.
“Stress has been building up again about two days ago. I am afraid it could cause a repetition of the stroke. But right now, I have started feeling parts of my left side of the body which was paralysed,” he says.
 
Unlike Sewanyana, who was at his workplace and has taken a shorter time to start showing signs of recovery, Susan Nakafeero, 77, another patient at the SRC, may have a longer journey to recovery.

She got stroke at a meeting to solve land disputes and after several months, there is only mild improvement in her condition.

“It (stroke) happened two months ago when I was in a meeting to sort out issues with people who wanted to grab my land. I started stammering while pronouncing simple words [in Luganda] and people who were listening became concerned and they thought it was because of high blood pressure,” Nakafeero says.

“I realised I was also paralysed on the left side of my body. So they [my family members] decided to rush me to St John Bosco Hospital in Gayaza, Wakiso District,” she recalls.
When the hospital diagnosed her with stroke and gave her primary medication, she was referred to SRC.

Although Nakafeero is hopeful she will recover fast due to the good quality care, Lawrence Lwasa, her son, is worried about the rising medical bills and endless disruptions in his life as the mother’s caretaker.

“We have so far stayed here for one and half months. We pay Shs40,000 each day and right now, the bill has reached Shs1.5 million. My work has been disrupted because I have to take care of her. There are children at home, who need school fees,” he says.

At the centre, patients are counselled and helped to relearn skills that were lost when part of the brain got damaged due to stroke. 
The skills include coordinating leg movements in order to walk, help them learn how to communicate or new ways of performing tasks to circumvent or compensate for any residual disabilities, according to management of the SRC. 

Upsurge in stroke cases
Sewanyana and Nakafeero are part of the rising numbers of Ugandans who are experiencing stroke attack each year.
Dr Joel Kiryabwire, a neurosurgeon and the president of the Neurosurgical Society of Uganda, says the rise in stroke cases is worrying.

“As an association, we have noted with concern, the number of patients who are getting stroke. Over the last 10 years, we have seen a 30-per cent increase in the number of cases. And currently, stroke is the sixth commonest cause of death in Uganda,” he says. 

Dr Ibrahim Bukenya, the principal physiotherapist and SRC director, says the number of patients they received in the last three years is more than double the number registered from 2007-2014. 
“When we started (SRC) in 2007, we had two patients, but the number went on increasing and by 2014, they were 230 patients.  From 2018 to 2020, we had registered 300 patients,” Dr Bukenya reveals.

He adds: “There is an increase in the stroke cases. There are those who don’t know that the centre exists. There are many patients dumped in shrines. Recently, we got a patient from Kamuli [District] who suffered a stroke last year until someone who knew this centre talked to the patient.”

Research done by the Ministry of Health shows that non-communicable diseases, of which stroke is a major player, account for 40 per cent of all deaths in the country. 

What is stroke?
“Stroke is medical condition which occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. This causes cells in the brain to start dying,” Dr Bukenya explains. 

“If this happens to the part of the brain that controls the arm, the arm will get paralysed, the same to parts of the legs or eyes,” he further explains.

Top signs of stroke
Dr Bukenya reveals that one can tell they are about to get a stroke when the balance is not okay and they feel dizzy when standing or walking.

“When you start experiencing blurred vision or a black out [total inability to see]. If your facial feature surprisingly becomes uneven. You can get a facial drop where the mouth turns one side or your eyes stop to blink or you fail to raise your eyebrows,” he says.

Your hand may either fail to hold things or if you try to lift something, it falls off due to weakness in the arm, according to the expert. 

“Usually, people completely fail to speak or say a word that can be understood [they have difficulties pronouncing words correctly]. They speak with slurred speech,” Dr Bukenya explains.

All these things may happen at different times until you eventually get a serious attack, according to the physiotherapist. 
He, however, says a very mild form of attack that lasts a short time may happen to someone as a warning.

“There is what we call a transient ischemic attack (TIA), a stroke that lasts only a few minutes, about 1 minute to an hour. It is a pre-stroke, it alerts you that you are in danger. You can get numbness in parts of your body for a brief moment but then it disappears,” Dr Bukenya reveals.

He adds: “After this, you can be hit and you get paralysed completely. It happens when the blood supply to part of the brain is briefly blocked. Symptoms of a TIA are like other stroke symptoms, but do not last as long.”

TIA manifests as a sudden numbness or weakness, especially on one side of the body; vomiting, diarrhoea, severe headache, getting confused or easily irritated, according to the expert.
Risk factors for stroke
Dr Bukenya says the top risk factors for stroke in Uganda include high blood pressure, stress, diabetes, high levels of cholesterol in the body and cancer. 

High cholesterol is when you have too much of a fatty substance called cholesterol in your blood. It is mainly caused by eating fatty food, not exercising enough, being overweight, smoking and drinking alcohol, according to available scientific information. 
Other risk factors of stroke include diseases that affect blood vessels (pathways) and lack of physical exercise, according to Dr Bukenya.

Prevention
According to Dr Atwine, however, the success in prevention of stroke lies in everyone knowing their body [health] status through doing body check-ups. 
“Many people are moving with high blood pressure and they don’t know, many people have high cholesterol  levels and they only get to know when they collapse or get heart problems,” she says.

“Many people don’t know that they are overweight [whether they are in the normal range or past]. People should do regular check-ups. When you get to know early enough what is in your body through check-up, you [can] treat it,” Dr Atwine adds.
Dr Atwine advises people who are undergoing treatment to adhere to the medication and consult the doctor regularly.
She, however, says modifying your lifestyle or diet can be the best tool, beside medication, to avoid stroke.

Dr Atwine says: “In some diabetic conditions or pre-diabetic condition where your blood sugar is high, when you modify your diet, you will normalise your sugar level so you won’t need medication,” she says.

She adds: “Those who have high cholesterol levels, the moment they modify their diet and leave red meat such as beef and oily food, their cholesterol levels normalise and they will not need to rely on medication.”
Smoking and alcohol consumption are the decisions we make that predispose us to the risk for stroke attack, Dr Atwine says.
She advised people to develop the habit of being happy and avoid stressful condition.
 
“Some people are full of stress and they are frowning all the time. Every time you are under stress, your body produces stress hormones that can make you get conditional high blood pressure. Those who know God should trust Him and feel nice. Just live a happy life, you don’t need to be very rich to live a happy life, even in your simple ways, just live a happy life,” Dr Atwine advises.

Dr Kiryabwire, says to avoid getting stroke, people should exercise regularly and avoid junk food or food with too much salt. 

“Let us rest regularly and let us avoid stress. (Lack of) rest and stress are some of the commonest causes of stroke. Visit a doctor even when you are feeling well so that they will be able to check and know your medical condition early,” he says.

Recovery
Recovery can take months or even years, according to Dr Bukenya.
“The level of damage that happened in the brain [also] determines how fast you will recover. Some people can take a month, a year or more to recover. Some patients take up to five years to recover,” he says.
“The longest a person ever stayed here [SRC] was one year. But we keep on doing follow-ups when they go back to their homes,” he adds.

Challenges
Dr Bukenya says they are engaging government to establish rehabilitation centres for stroke patients in several parts of the country.
Currently, there is only one centre (SRC) which is dedicated to stroke rehabilitation, according to Uganda Stroke Foundation.

This means the rising numbers of stroke cases could soon overwhelm the facility or leave people who are upcountry with no option of accessing rehabilitation care after attack.