'I was eating supper with my family when I had a stroke'

One evening at around 7pm, Stephen Phinehas, a father of two and a pastor, was eating supper his family when he sensed something was amiss.

"I just suddenly started having trouble speaking. I couldn't understand what my children and wife were saying. I felt confused, my speech was slurred. I suddenly lost my balance," Stephen a 53-year-old resident of Makueni County narrates. 

“I fell down helplessly a lot of questions ringing in my mind. 'What was happening to me?" Stephen narrates. 

"In the few minutes of confusion, my wife called neighbors who helped us with a vehicle and I was rushed to the hospital," he says. 

At the facility’s emergency room, medics attended to Stephen. They checked his blood pressure and learned that is was abnormal.

Referring to his sudden signs like the slurred speech, loss of balance, they thought it was necessary for him to have a Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI) to check if the high blood pressure had caused stroke which shows similar signs.

After all the tests were done, Stephen doctors concluded that Stephen had suffered an Ischemic Stroke, which also caused his left side of the body to be paralysed. They said that high blood pressure was the main cause.

Stephen says this was like a ‘thunder strike' to him because, as far as he knew, he had no history of high blood pressure. 

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According to Dr Khalif Abdifatah, Consultant Neuroendovascular Neurosurgeon, there are many causes of stroke, but hypertension and diabetes are the leading causes.

"The buildup of plaque in the arteries of the brain result in ischemic stroke. Rupture of vessels in the brain cause hemorrhagic stroke. Obesity, smoking increasing age and male gender increase the risk of stroke, “ says Dr Abdifatah, a consultant at the Nairobi West Hospital.

Dr Abdifatah says the major signs of stroke range from face drooping, arm and leg weakness, slurring of speech.

"If you see any of these symptoms call for help," he says. I

According to Dr Abdifatah, in Kenya, stroke incidence is at 300 per 100,000 persons. Its treatment is not standardised due to poor health infrastructure and a lack of specialists.

"Hospitals in Nairobi and Mombasa are now setting stroke teams and protocols to improve outcomes. Globally, there are 12.2 million new stroke cases every year. This figure is expected to go up, due to the ageing population, urbanisation and lifestyle changes, “ adds Dr Abdifatah.

He adds that high blood pressure is the leading cause of both ischemic and hemorrhagic stroke worldwide.

"The reason is that high blood pressure damages the blood vessels of the brain. This leads to vessel occlusion or rupture resulting stroke with high morbidity and mortality, “ Dr explains.

In reference to Stephen’s back pain, Dr Abdifatah says this symptom may be resulting from muscle spasm which is seen after ischemic stroke. The affected limbs become weak and spastic leading to painful contractures. This can be prevented with early neuro-rehabilitation and physiotherapy.

Following his diagnosis, Stephen was treated and discharged from hospital after eight days. "Not because I was getting better following the paralysis, but the hospital bills were increasing sharply," he says.

Doctors advised him to attend physiotherapy sessions and also prescribed some medication which they promised would help him get better if he adhered to it.

Stephen went back home still in pain on the left side of his body (the paralyzed side) but optimistic that he would recover.

“After a few days back at home, I started experiencing abnormal pain in my back. This was not giving me even a single moment of peace. I had to seek further medical attention. As a man of God, I believe the doctor treats and God heals," Stephen narrates. 

“I visited a private facility here in Nairobi and after digging deeper in my pocket, an X-ray was done so that the neurologist who attended to me that day could understand why I was having intense pain in my back. It was discovered that muscles had been weakened by the stroke, “ Stephen says.

He says that he was advised by that neurologist, that a lasting solution for him was to go for surgery which could stop the back pain he is living with to date.

“Pain post-stroke can happen due to some reasons. When the Thalamus (a deep part of the brain) which is the principal relay centre of sensory information from one half of the body is damaged. Now the misfunctioning Thalamus is misinterpreting a piece of normal sensory information into pain, say a gush of wind on the skin will feel like severe pain in that part of the skin if there is a severe spasm of muscles on the affected part of the body," explains Dr Mahendra S. Chouhan, a Consultant Neurosurgeon at Nairobi Neurocare.

“I was given some painkillers that were to offer a temporary solution. I was advised to go to frequent occupational therapy clinics so that my stroke would not advance to a threat full stage. I knew going for surgery would not be easy  expensive charges, “ Stephen says.

From 2018 to date, Stephen had been in and out of several facilities just handling temporary solutions to the pain which was caused by sudden ischemic stroke. Out of these multiple hospitals visit, they still advise the same - he should go for surgery to relieve back pains.

Ischemic Stroke, changed life of Stephen to worse, which he didn’t even expect to happen in his life. As a Man of God, he used to travel from one place to another to spread gospel and was also aggressive business man but now, has no energy to do that.

“The day I had a happy and joyful supper with my family was when I experienced first signs of this strange condition. But look at me now, I’m bedridden, cannot perform my work like before to bring something in the table. I used to have my own money to support my family but I’ve turned a beggar nowadays. Calling my friends and relatives to send me whichever amount so that I can buy food, “ Stephen painfully recalls.

“I’m passing a lot of pain which is giving me sleepless nights. I was visiting my friends to discuss business matters and also spread the word of God but now I’m not able - whatever the short distance it will be, the higher chances of experiencing stab pain in my back, “ The 53-year-old man adds.

“One of the standing challenges this condition has negatively affected my life is the issue of movement and sitting posture. I cannot sit for more than 30 minutes because I will get pain all over the body which will force me to move at a snail pace to my bed and lay there. I can say I’ve spent more time in my bed that other places since I was diagnosed to have Ischemic Stroke, unlucky me, “ Stephen says.

“Nowadays no one is exempt to Strokes. We have seen stroke even in children, though the cause of Stroke in children are very different from adults. Children can get stroke even after Head injury while it is rare in adults. In younger ages like 20s/30s a hemorrhagic stroke may represent some vascular disease like vasculitis or congenital malformation like Arterio-Venous malformation (AVM), “ explains Dr Chouhan.

“I’ve never faced stigma in my life but it exists in a lot of people who have this condition or any other chronic conditions. I have been getting support from my family and relatives since I was diagnosed with Stroke but one issue has remained, I need to go for surgery to silence this pain. In this case, I call upon the government, different bodies, Good Samaritans and any helper who can provide a source of funding to pursue medication for the stated surgery, “ Stephen says.

Stephen is required to have around 1M to facilitate medical bills in the effort of recovering from this disease which is giving a lot of Kenyans a headache in the course of managing its strange signs.

“It’s my message to the government together with other concerned stakeholders to intervene and help me to recover from this condition which has been a threat for me in the last six years. They should use this chance also to spread awareness about this Stroke because less people have facts surrounding it - advocacy and awareness should be their priority, “ Stephen observes.

“I’m passing a lot due to this condition but I’m optimistic, I will recover tomorrow. No matter how many years I’ll go through pain, how many people will run away from me, how the society will treat me, I’m confident that God will finally give me a call and say Stephen you are now free from slavery, “.

“To all people going the same outside there should also be prayerful, seek medical attention and believe that they will be okay, there’s no end of road as many people wrongly puts it. Let people go for frequent blood pressure checkups because in my case, I was diagnosed to have high blood pressure without having warning signs so that possible treatment can be done to stop stroke issues, “.

“Currently the gold standard of stroke management is admission of patient into Stroke unit, followed by early detection of source with an Angiogram through CT/MRI scan. If there is a clot in any of the Blood vessels, then ENDOVASCULAR procedure can be done by putting wire into blood vessel to reach in brain so the clot can be removed and blocked flow can be restored. However, that can be done only within first 4-6 hours of stroke attack, “ Dr Chouhan recommends.

“A very good physiotherapy department is mandatory along with Robotic Aid is a gold standard but currently lacking in Kenya. The best way to prevent further stroke is a regular visit to a neurologist or neurosurgeon and follow instructions apart from controlling the risk factors, “ Dr Chouhan adds.

“Most Kenyans are aware of the symptoms of heart attack but very few understand the symptoms of stroke. A lot needs to be done to create awareness of stroke. The most important factor is timely care. Patients present to hospitals many days after the symptoms. Time is brain, the earlier the patients are treated the better the outcomes, “ Dr Abdifatah says.