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Stroke. The agony of poverty and ignorance.

Stroke. The agony of poverty and ignorance.

Stroke is one of the leading causes of mortality and morbidity globally. Many African regions have done little to mitigate the condition whose risk factors are modifiable. Some Africans (Ugandans) still attribute stroke to sorcery or evil spirits: the agony of poverty and ignorance that continues afflicting pain and suffering among the sons of Adam on African soil.

A stroke occurs when an acute compromise of the cerebral perfusion happens: one or more blood vessels supplying the brain are occluded or ruptured. No blood supply to the brain tissues beyond the affected part of the vasculature occurs.

It is prudent to recognise a stroke early enough to institute appropriate treatment: to prevent devastating complications that can ensue due to irreversible brain damage. However, we cannot achieve such endeavours when society cannot identify a single sign of stroke. If they can, they will call a religious cleric first and sprinkle anointed oil onto the patient to chase the evil spirits.

When a patient suffers a stroke, we have approximately 4.5 hours to delineate the nature of the stroke and therefore act accordingly. Outside this window, whatever we do next may not help the patient attain their previous normal state. Once a stroke occurs, it becomes incumbent upon the people next to the patient to rush them to the hospital, to have a quick but thorough assessment and have, at the bare minimum, a brain computed tomography (CT) scan as soon as possible. If the blood vessel blockage is due to a clot, clinicians institute appropriate therapy to disintegrate the clot and restore cerebral perfusion. All this must occur within four and a half hours following the incident.

We all agree on how few CT scans are in our community. Even if they were abundant, society is still ignorant about identifying people with stroke. Society attributes it to evil spirits. It is always an act of Satan and sorcery.

Hypertension (blood pressure) accounts for most cases of stroke. It is a modifiable risk factor, yet many people in our communities have never dared to measure their blood pressure at least once. They only wait to visit the hospitals when they are sick. Either they are poor, ignorant or both. No hospital charges you for a blood pressure measurement.

Other risk factors include diabetes, smoking, obesity, atrial fibrillation, and illicit drug use. The African man wants a Quran or biblical verse to quit smoking and live a sensibly healthy lifestyle. A healthy lifestyle will probably prevent all the risk factors above. It is cheap and affordable.

Because stroke is a sudden, acute event, it is imperative to understand its salient features. Symptoms include – a droop or an uneven smile on a person’s face, numbness or weakness in the arms, slurred speech or difficulty in understanding speech, and an altered level of alertness. These are crucial symptoms that everyone must understand and recognise on their relatives, colleagues, or bystanders. Additional symptoms include sudden confusion, severe headache, troubled walking, blurry vision, or inability to stand.

A stroke can occur in any blood vessel supplying the brain: from the internal carotid artery to the most minute branches of the middle cerebral artery: and this correlates with the symptoms with which the person presents. It’s prudent not to miss any.

Several conditions that can mimic a stroke exist. They are: – hypoglycaemia, hyponatraemia, transient ischaemic attack, brain abscess, encephalitis, hemiplegic migraine, cerebral tumours, syncope, and conversion disorder. You cannot assort them while in the community waiting for anointed oil and water: it is the work of your clinician to diagnose and manage them.


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As a community member, it’s your responsibility to identify the sick and promptly take them to the nearest hospital for assessment and management. Once they reach the facilities, the clinicians will sort them and triage those who need an urgent referral for specialised care. Stop taking people with a sudden loss of consciousness, abrupt seizures, inability to speak or walk to the religious clerics first. The religious clerics can, however, escort you: prayers continue as the doctors do their part. Otherwise, any contrary will lead to more mortality and morbidity among people with suspected or confirmed stroke. Let us not allow the agony of poverty and ignorance to prevail amongst us.

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MBChB (MUK), Graduate Fellow, Department of Physiology, Makerere University Founder and Content Creator Peer reviewer, Associate Editor

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