Who Can Afford A Stroke?

In the news recently, the Delta State commissioner for culture and tourism, Mr Richard Mofe-Damijo, blamed “excessive stress” as the cause of the death of veteran actor, Sam Loco Efe. His death, many experts have speculated, may have been due to a stroke.

Death had also stealthily crept into the Yoruba movie community and plucked actress Yemi Yusuf in 2010. Yusuf, who had featured in several movies, died in Ogun State, apparently after a stroke.
A consultant neurosurgeon at Cedarcrest Hospital, Abuja, Biodun Ogungbo, disclosed that the incident of stroke causes significant disability and death in many countries and places a huge financial burden on health services.

According to him, stroke is now the third leading cause of death in most industrialised countries among adults aged 65 years or more, adding that younger people also suffer strokes in Nigeria.
“The population of Nigeria exceeds 150 million people. If we assume an average stroke incidence of 116 per 100,000 of the population in Nigeria, then 174,000 people suffer a stroke in Nigeria yearly. Using figures from Sagamu, Nigeria, it can be estimated that roughly 34% (n = 59,160) will die within a month and 60% (n=104,400) within six months. This, therefore, is a huge problem in Nigeria,” he said.

Though many people often wondered at the cost implication of treating a stroke, Ogungbo observed that the impact on the local economy and the financial burden of stroke on Nigeria has not been estimated.

He said the size of the problem appears to be underestimated by the government, as no publications or statements exist acknowledging the impact of stroke on the health of the nation.

“More up-to-date information on the magnitude of the stroke problem in Nigeria is needed. Most of the cost of treatment for stroke is borne by individual families. There is the need to evaluate the percentage of patients dependent on carers and the yearly expenditure on hospital stay, home rehabilitation, as well as information on the loss of income for the patient and carers. No one, no matter how rich, can afford to have a stroke.

“This is one problem that medical tourism to India, South Africa or the United Kingdom cannot solve. Once you have had a stroke, you are at risk of further strokes and early death.”

Speaking further, an editorial board member of the Nigerian Health Journal, said that stroke is a significant economic, social and medical problem all over the world.

“Politicians and entertainers have significant economic and social power in Nigeria. It should be possible to utilise these similarities in stimulating the development of management strategies for stroke, customised to the unique health structure in Nigeria.

Analysing the prevalence and impact of stroke on politics in Nigeria may inform, educate and stimulate responsible people to look inwards and enact health policies of benefit to all.

“Stroke is a medical emergency and immediate medical treatment can go a long way in repairing and salvaging the brain at risk; stroke causes injury because vital nutrients are not delivered to the brain and so the tissue dies. Medical people have been promoting the need for quick presentation and early treatment using the slogan ‘time is brain’; you waste time, you lose brain. In fact, many developed communities have a system of getting the patient to the doctor in the shortest possible time. This time is called the ‘door to needle’ time and should be less than 3 hours. It is the time from when the person suffering a stroke gets to the doctor and has an injection to treat the stroke. Many patients in Nigeria present late, but even if they do present in good time, many hospitals cannot administer the required medications for a whole lot of reasons,” he said.

He attributed limited resources, manpower shortage, lack of an organised stroke unit, poor neuro-imaging facilities, lack of ambulance services, poor education of patients and general practitioners, as well as the impracticable use of thrombolytics as factors contributing to the lack of proper stroke management in the country.

The neurosurgeon emphasised that training of stroke experts in collaboration with experts in the developed world, with provision of neuro-imaging facilities, would improve the outlook of stroke management in Nigeria.

But the overriding question on the minds of health watchers is how to harness the power of the political cadre and encourage their interest in stroke care.
Ogungbo responded thus, “We initially thought that providing data on the incidence, prevalence, morbidity and mortality rates of stroke in Nigeria would be of benefit. However, despite numerous publications in medical and lay media, we are no further forward. Therefore, perhaps a more interesting statistic would be to analyse the incidence of stroke among politicians.

“The key questions would be to find out how many politicians have suffered a stroke directly related to the high stress levels and the impact of politics on their lives. Where was the stroke care carried out? What was the outcome of the care received? What was the cost and continuing recurrent expenditure following the stroke? Have they been able to return to work? Are the survivors empowered to improve stroke care delivery in their communities?”

Experts hold the view that though stroke is a preventable and treatable condition, the management of stroke patients in Nigeria is sub-optimal. While specialised stroke units are not available, neuro-imaging centres are very few and access limited by cost and distance.

However, Ogungbo is of the opinion that the main focus in Nigeria must be on preventive strategies and ways to harness local resources in the acute treatment of stroke patients.

“Health education of the community with emphasis on control of the predisposing factors, especially hypertension, would reduce the burden of stroke in the country. Risk factor management should begin in childhood, with emphasis on exercise, nutrition, weight and blood sugar control, avoidance of tobacco and excessive alcohol.

“Public awareness programmes are very important. Studies have shown that delays in presentation are caused mostly by lack of awareness of stroke. All patients within the age range and with a high stroke risk should know the symptoms of stroke. A Nigerian neurologist, Dr Olajide Williams, is making huge impact in America by involving musicians and children in stroke knowledge. Using Hip Hop music, children now know that FAST - face drooping, arm weakness and slurred speech indicate stroke and they must telephone the doctor immediately. We need several media organisations to educate the people in ways they will understand. The entertainment industry and politicians must partner with doctors.

“The need to present early for evaluation, treatment and prevention of further attacks must be discussed at various levels. Information about stroke should be made widely available to the public. The local press, celebrities and television personalities should be educated on the risks of stroke and the importance of wide public awareness. Stroke issues should be introduced in schools, churches, mosques, plays on television, in the theatre and brought to national attention. Health talks as well as the use of posters and radio jingles would assist in re-education of relatives of stroke patients and the community at large,” the brain specialist said.
Patients deserve timely access to quality services appropriate to their needs. There are significant deficiencies in the provision of services such as diagnostic, treatment, rehabilitation and support services.

In the words of Ogungbo, “Patients and their care givers want to be looked after by knowledgeable personnel that understand the full range of their needs. The diagnosis and treatment should be explained to patients and relatives by competent staff. There should be provision for regular communication and sharing of information should be encouraged between staff and patients and their relatives through constant health talks, radio jingles and the use of flyers. Patients need to be closely involved in the development of local services and lobbying of government officials for assistance.

“No one person can claim to understand the full requirements of the patient and multidisciplinary care is of importance. Medical personnel should seek information and advice from colleagues and other staff without prejudice.”

Ogungbo added that, “This is one of the major topics up for discussion and advocacy at the neuroscience meeting coming up in October. Doctors from Nigeria and America, with other specialists interested in neurosciences, will deliberate on and create advocacy on issues such as stroke. We need help in lifting the phobias and stigma surrounding the stroke patient and others with hydrocephalus and epilepsy. We are inviting all entertainers and politicians interested in health issues to honour our invitation.”