As Kogi State and other Nigerians mourn the unexpected death of Prince Audu Abubakar, the man who was on the verge of making history in Nigerian politics as a governor elected on three different occasions to lead his state, one particular narrative seems to be lost in this tragedy.
He had been unwell the day of the election and had developed stroke-like symptoms initially, which worsened the next day, with him vomiting “blood’ at some point prior to his death.
Whether this story is true or not, one recurring story line is the possibility of him having suffered a stroke prior to his death.
The fact is that this scenario actually fits a pattern of stroke referred to as hemorrhagic stroke; in simple terms, a stroke resulting in bleeding within the brain.
Unfortunately, stroke continues to be a neglected but leading cause of death among Nigerians.

Despite recent efforts to address basic deficiencies in Nigeria, the healthcare sector has continued to suffer. Nigeria continues to perform very poorly in several health indicators including, mortality, morbidity, disability, social and mental health indicators.
In recent times, Nigeria has adopted an economic regime of strict foreign exchange control through various interventions midwifed by the Central Bank, often in the background and Commercial Banks the poster child. Sadly as we plug a major hole through the ban of importation of essential goods and services, we neglect a major drain in our foreign exchange through medical tourism.
It is estimated that about 5,000 Nigerians travel abroad every month for medical treatment, with an annual efflux of about N250 billion spent on medical tourism. Despite this huge amount (in today’s exchange rate of more than $ 1 – 1.5 billion), these figures pale, when you catalog government expenditure and allowances paid to politicians, who often prefer to quickly jet out of Nigeria at the slightest hiccup.

Unfortunately, not all health problems will afford you the opportunity to quickly jet out to Europe, as in the case of stroke: a disease with a limited time line (3 – 4.5 hours only) for one to receive prompt emergency therapy with a drug called "tissue activated plasminogen" (tPA). Treatment with this drug often nick named "Clot buster" is necessary for a patient to have a meaningful chance of recovery/survival. An immediate neurosurgical intervention may also be required in the case of a bleeding stroke. Even more concerning is that although this year marks the 20th year that this powerful “clot buster’ (tPA) was approved and has been widely used world over, no hospital in Nigeria has ever been able to utilize this medication for emergency treatment of stroke till date.

Before several distractors begin to underscore the purpose of this huge healthcare problem in Nigeria and the purpose of this write up, here are the facts based on research and data from several Nigerian teaching hospitals (authors) collected over the years.

1. Unlike in the developed world, case-control and retrospective studies in several Nigerian hospitals suggest that stroke appears to occur mainly in persons between 40 – 60 years in Nigeria
2. Studies suggest that approximately 1 million years of productive life is lost in Nigeria, due to stroke deaths and long term disability from stroke.
3. The case fatality (meaning the probability of dying if you have suffered from stroke in Nigeria) is about 28% at 7 days, 40% at 30days and 46% at 6 months – “Stroke in South West Nigeria, A 10 year Review. SA.Ogun et al"
4. About 200,000 Nigerians suffer from stroke each year, and based on the above data; more than 56,000 die within 7 days and a total of 80,000 deaths within the first 30 days.
5. This age group comprises the most active and productive persons, policy makers in Nigeria; including doctors, lawyers, politicians, bankers and the "common man”, who is often the sole bread winner in his family.
6. The significant economic, social and medical consequences in our country, is too immense to ignore.
7. Stroke and stroke related illnesses unfortunately are often blamed on spiritual attack and “juju”, from innocent family members and associates.
(Acknowledgement to several authors of above data offered and available upon request)

Today Prince Audu Abubakar is gone; tomorrow it will be one of us: unless something is done timely to address stroke care in Nigeria. Keep in mind that “time is brain” and stroke is one of those emergencies that there will be no time to “jet” to India, USA or Europe.

I will appeal to Prince Audu Abubakar’s family, many friends and political compatriots to immortalize his name by setting up a fund to build a world class Stroke hospital in Nigeria, that will treat, educate the public and provide training to doctors nationwide on the best practices for stroke care. There are many qualified Nigerian professionals willing to rise to the occasion, to save the many lives lost to stroke each day in our country. There are also many rich Nigerians that can partner with these specialists to make a difference. Remember no amount of money or personal standby air ambulance can save the day, when a massive stroke strikes.
Think about it this way, even if a patient survives a trip to Europe, the treatment window would have closed. Health is Wealth; help us make a difference.

I invite you to enrich your knowledge about stroke:

What is a stroke?

Like a heart attack, a stroke is a serious medical condition often resulting from a sudden cessation of blood flow to the brain. As a result of this, the nerve cells are deprived of oxygen and the energy that they need to function. If this continues for a prolonged period of time, usually hours but sometimes minutes, the affected part of the brain could suffer irreversible damage. If the patient gets to a specialized stroke hospital on time, this can possibly be reversed. Because of the devastating effect of stroke it is sometimes called a “brain attack” and is a medical emergency.
Unlike in the developed world, case-control and retrospective studies in several Nigerian hospitals suggest that stroke appears to occur mainly in Nigerians between 40 and 60 years.

Are there different types of stroke?

Yes. There are different types of stroke, and the effects and treatment are dependent on the type. The most common type of stroke is an Ischemic Stroke (non bleeding stroke), resulting from blood clots or “other particles” that lead to blockage of blood flow in the brain.
Other types of strokes include Hemorrhagic stroke, which results in bleeding within the brain. Depending on the size, this type of stroke has a higher fatality rate than a stroke caused by clots. In addition to these two major types of strokes, there are other vascular problems that may present with symptoms of a stroke. These include, Subarachnoid Hemorrhage which results from a ruptured brain aneurysm, Subdural and Epidural Hemorrhage occurring often from brain trauma. All of these may look similar at first, but their diagnoses and treatments are very different.

What causes stroke?

This depends on the type of stroke. Generally speaking the risk factors of stroke can be modifiable (things we can change) or non-modifiable (things that we can’t change). Some of the non-modifiable risk factors include race, age gender and family history. Stroke is more common in blacks, the elderly and among males. If someone in your family has had a stroke, you are at increased risk. Unfortunately we cannot change our genetic make up, our age or gender.
The modifiable risk factors include: Hypertension, Diabetes Mellitus, Dyslipidemia, Smoking, Sickle cell disease, Alcohol abuse, Atrial fibrillation and Heart disease.

What are the symptoms of Stroke?

If someone you know may be having a stroke, act F.A.S.T and do this simple test:

Face: Ask the person to smile. Does one side of the face droop?

Arms: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask them to repeat a simple sentence. Are the words slurred?

Time: If the person shows any of these symptoms, time is important. Take them to the nearest hospital.

Other symptoms of stroke include, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance and sudden severe headache.


What should I do if someone has had a stroke?

If someone you know has had a stroke, take them to the nearest hospital immediately. Note the time of the first symptom, this information is very important to the treating doctor.
Please don’t take them to the spiritual healer or traditional doctor. Stroke is a very well understood disease. It is not caused by “juju” or spiritual attack. You need a doctor who understands and can treat this disease. Despite the short comings in our healthcare system in Nigeria, a medical doctor is your best option.
There are several other types of acute treatment such as intra-arterial tPA, clot embolectomy and retrieval etc, that are unavailable in Nigeria, but can be offered in a specialized stroke hospital. Also several neurosurgical options exists. Patients with massive stroke often will require neurocritical care management and treatment in neuroscience intensive care units, unavailable in Nigeria. This can be changed, help us advocate for this.

Why is this important and what is the treatment of stroke?

“Time is brain”, every minute counts! The longer blood flow is cut off to the brain, the greater the damage. The most common kind of stroke, ischemic stroke, can be treated with a “clot buster” known as tPA. Unfortunately this treatment is not available in Nigeria.
Despite this, going to the nearest hospital remains your best option.

In the developed world, this medication has to be given within a 3 – 4.5 hour window from the time the symptoms began. To receive this drug, the person needs to be in the hospital within 60 minutes of having a stroke. Unfortunately, this short time window does not allow you time to fly abroad. We have to do something to change this in Nigeria. Stroke is a life-changing event that affects not only the person who may be disabled, but the entire family and other caregivers as well. Don’t take your care for granted!

How do I prevent stroke?

The most effective way to (treat a stroke is to) prevent it; “prevention is better than cure”. Pay attention to the modifiable risk factors above. There are many people with uncontrolled blood pressure within our community, and several who are unwilling to take medications. If you don’t have money to see a doctor, try and at least check your blood pressure once a year. The upper number needs to be less than 140 and the lower number less than 100. This can make a huge difference. Check your blood sugar and cholesterol annually if you can afford it.
If can’t afford it, at least cut your salt intake, exercise regularly, cut your palm oil intake. Stop smoking and avoid excessive alcohol consumption. If you have a family member who has had a stroke, you should know that you are at risk of having one yourself.
If you have had a TIA often called a mini-stroke, your chances of having a major devastating stroke is very high.

As a general rule, I will recommend that you take Aspirin 60 mg daily if you are over 40 years, unless contraindicated. It is always advisable to see a doctor who can diagnose some of these risk factors of stroke, which may otherwise not be apparent. Take charge of your health and prevent stroke in our community. Be and advocate today and share this article among your friends and family.



Original article by:
Dr. "BA"
Board Certified Stroke and Critical Care Neurologist
Chief of Neurology and Medical Director of Neuroscience Critical Care Unit
Winston-Salem, North Carolina

enuguneuro@gmail.com

Interesting

long thing

More than interesting. Nigeria is quick to attribute any death to handwork of enemy. Forgetting that no one can cheat death. Either someone caused one death or natural, one will still die at the appointed time.

Be informed

Very Informative. This is a front page material. Lalastica do the needful.

Joniboi:
Very Informative. This is a front page material. Lalastica do the needful.

I agree

omayeecp:
maybe EECP treatment is an alternative for heart surgery.no side effect.

What has External Counterpulsion have to do with Stroke?? Why can't you start a different topic and advertise your product. Why do you have to mislead people??

Quite long a piece but very informative. Stroke is fast becoming a menace in our society. So many young ones coming down with stroke, no thanks to the stress and tension faced by us, all in abid to put food on the table. No wonder the lifespan of an average nigerian keeps on depreciating.

Thanks once again for this informative piece.