Stroke, when it occurs in an individual as the word suggests, is like when one has been struck. This terminal disease used to be associated with elderly people in their 60s, 70s and 80s.
However, experts including neurosurgeons and other health care givers in Nigeria have said that stroke is no more a disease of the aged as it is killing and disabling Nigerians in their prime.
Their major fear is that many Nigerians who would develop stroke in the next 10 years are not aware of it now.Those that have seen symptoms continue to dismiss them due to ignorance, poverty, socio- cultural beliefs and denial.
They also attributed the increasing population of Nigerians developing stroke to the growing cases of undiagnosed, unmanaged hypertension (high blood pressure) and diabetes.
They may not be far from the truth. Sharing his experience with our correspondent in Lagos on Wednesday, Mr. Segun Oyasanya, a civil engineer, said he had his first episode of stroke while preparing for a service to mark his 40th birthday.
Oyasanya said, “I have always been healthy all my life, the last time I had a fever was when I was 20 years old. I had never been admitted to the hospital or experienced anything much more than tiredness or headache.
“I was trying to pull my trousers that morning when I noticed I could not move my fingers, my hand went numb.I felt some pains through my chest and that was it. Luckily for me, my family that lived abroad had come for the party. My wife came to usher me out but she saw me lying on the floor.”
He said he was rushed to the General Hospital in Surulere where the doctor confirmed he had just had his first episode of stroke.
Though the family was taken by surprise by this diagnosis, Oyasanya confessed that he had been warned five months earlier, when he took his friend to the hospital.
“While waiting for my friend to come out of the doctor’s office, a nurse approached me to take my blood pressure. After the test, she said she could not release me until I had seen the doctor because my blood pressure was not only high but abnormal.
“This almost turned to an argument, the doctor and my friend had to intervene. After seeing the result, the doctor told me I must start taking anti-hypertensive drugs immediately to reduce my blood pressure.”
Oyasanya said two months after that visit; he stopped taking the drugs because he was convinced it was an attack from spiritual forces after speaking with his pastor.
“I stopped because I was not physically ill but just the usual tiredness. We were also convinced it was spiritual attack. But three months after I stopped taking my medication, I suffered a stroke,” he said.
“The doctor told me that if not for the drugs I had been taking, I would have been totally paralysed by stroke.”
Apart from his wife and his three children that have had to relocate from the United States to care for him in Nigeria, Oyasanya said he had to abandon some building contracts he was to execute since he had stroke in March.
According to the Consultant Neurosurgeon and Stroke specialist, Abuja, Dr. Biodun Ogungbo, about 40 per cent of Nigerians are living with factors that could predispose them to developing stroke.
These factors include obesity, alcohol consumption, smoking, lack of exercise, poor diet rich in salt and fat, high blood pressure and high blood sugar levels.
He said, “Nigerians in their 30s, 40s and 50s are developing and dying of stroke due to the increasing population of hypertensive and diabetic patients in the country.”
Ogungbo, who noted that there were no quality statistics to go by in Nigeria, raised the alarm that unlike in other climes where most stroke patients were elderly people, in Nigeria, there were more patients in their productive years developing and dying of stroke,.
He stated that stroke, a preventable disease, occurrs when there is either too much blood in the brain (wet stroke) or when no blood is going into the brain (dry stroke) and it is usually due to unmanaged and undetected hypertension.
Ogungbo said, “The incidence of hypertension is high in Nigeria. Almost half of patients I see for the first time in clinic for other problems such as back pain have high blood pressure.
“Hypertension is common in black people. We do not know why. It is therefore common in Nigerians and some statistics say over 40 per cent of adults in Nigeria have hypertension.
“Unfortunately, for some reasons, younger people in Nigeria are becoming hypertensive and suffering the consequences and also increasing the incidence of stroke and heart failure in people in their productive years.”
Ogungbo described stroke as a brain attack that could result in loss of speech, paralysis, urinary incontinence, mental disability, physical disability, blindness, loss of body movement and even death in most cases.
“We do not have credible statistics in Nigeria. We do not know how many people are affected, living with or dying from hypertension. But we have some evidence that over 60 per cent of patients with stroke die within three months. That is significant and makes stroke almost a certain death sentence in Nigeria.” he stated.
Ogungbo noted that there was need for urgent awareness among Nigerians on the fact that stroke is a preventable disease if hypertension and diabetes are detected early.
He said, “Anyone with a pressure consistently above normal has high blood pressure. The cut off is pressure above 140/90 mmHg. It does not give any warning and usually no one knows if their pressure is high or not until they do a test. By the time you have definite symptoms such as headaches, organs such as the heart, brain and kidneys may have been damaged.”
Ogungbo stressed that the only treatment for stroke was prevention which should start from formative years in order to save the younger generation from the severe consequences of stroke which include loss of livelihood, death and disability.
He said, “The real prevention must start from childhood. We need to encourage healthy living and healthy
“Fat forms layers in the blood vessels and causes them to become narrow. This increases the work of the heart in pumping blood through the vessels leading to high blood pressure.
“Eat plenty fruits and vegetables. Do not smoke and avoid alcohol. Lose weight. That 20 minutes walk or exercise daily may just save your life.
“If you need medication for blood pressure control, please use it and do not stop because a pastor or preacher tells you to. Hypertension is for life and does not go away. It cannot be cured but can be managed and controlled.”
Ogungbo, a member of Stroke Action Nigeria, added that a major reason why people should prevent stroke was the shortage of experts in the country to care for stroke patients and the high cost of treatment.
According to him, there are just about 35 neurosurgeons and 50 neurologists in the country.
Ogungbo noted, “We do not have enough trained medical and nursing experts to manage hypertension and its consequences such as stroke. A patient suffering from the first episode of stroke would spend almost N3m to be a bit stable. Most Nigerians can’t really afford to manage stroke.”
Also, the Executive Director, Stroke Action, United Kingdom, Mrs. Rita Melinfonwu, stated that a challenge facing early detection was that stroke was still being regarded as traditional or spiritual attack.
Melifonwu said a lot of patients diagnosed with high blood pressure, high glucose level or high cholesterol levels often refuse to comply with their medications.
She added that another group does not know they are at risk until they had an episode of stroke because they have never been diagnosed.
“When a Nigerian experiences his/her first stroke, the family members would say an arrow was fired at the leg or spine. They are rushed to a native doctor or herbalist to remove the arrow or stone. Then, they suffer more strokes instead of recovering from it.
“Also, when patients are diagnosed and given hypertensive drugs, they refuse to take them, they say God has removed it and stop taking their medication, and then they suffer a stroke. Stroke does not occur due to wickedness,” she said.
The nursing expert in stroke management noted that Nigerians should reduce their chances of developing stroke because the country lacked physical structures and a social system that could help stroke patients to pick up their lives again.
“Who cares for you when you have stroke in Nigeria? It is the wife, husband or the children that has to drop out of work, school to take care of that person, definitely not government or the society.
“As a stroke patient in Nigeria, you are already out of the society, you cannot go to the bank in a wheel chair or cross the road so why not prevent it?, she asked.
Melifonwu, who is the founder of a stroke care organisation in the United Kingdom, charged the Federal Government to implement disability access laws in all sectors, to ensure that Nigerians who had suffered stroke and other disabilities are not ostracised from the society.
She stated, “Imagine a husband who can no longer be husband, a managing director who can no longer manage or an individual who cannot go shopping or attend a meeting because of stroke. How can they move around in Nigeria?
“By this lack of social care, the society is telling them to hide and drop dead. But in the UK, a stroke patient is managed to the level that he/she does not have another one and they can eventually live an independent life. Government should be able to say no, if you do not have this in place in your church, mosque, supermarket, bank, office for the physically-challenged, we are sorry you cannot operate.”