My paternal cousin was buried in Kahondo ka Byamarembo this past Saturday, the day of her death from a devastating stroke. Her name was Tibareijukire ba Kakitaahi kya Butamanya bwa Nyakashaija ka Ruhuuma rwa Mugasha wa Byamarembo.
Born in 1941 to Kyakwera and Kakitaahi, she had less than a year of formal education, dropping out of school because her father, the chief county clerk of Kinkiizi, developed a severe mental disability in 1946. It was said that Kakitaahi’s illness was induced by witchcraft.
Her life’s trajectory changed. Besides a brief basic literacy course that enabled her to read the Bible, she grew up a peasant in Kahondo ka Byamarembo, Kigyezi, where the family, including her two sisters and three brothers, resettled. It is there, at age 18, that she met and married Nshekanabo, a member of the Basyaba subclan, with whom she had nine children.
Until recently, Kahondo was not easily accessible by road. It had no formal health services and was a generally challenging place to live. Tilling fragmented pieces of land, some of them high up in the hills, was a daily chore that sapped the energies of even the most resilient Bakiga women.
Tibareijukire raised her children, set them on a good path towards independent living, before slowing down in old age. Widowed for many years, she soldiered on, a highly respected member of her community, albeit on the periphery of Ugandan society, with minimal access to opportunities and services that she was presumably entitled to as a citizen.
As she laboured away, making her contribution to her country, an enemy gnawed at her, pushing up her blood pressure, doing damage undetected, until symptoms delivered her to a doctor, a long distance from her home, who diagnosed hypertension and started her on medications.
Armed with her pills, perhaps of uncertain quality, she did her best to live with her illness. Did she consistently take her medication? Was her blood pressure regularly, properly and correctly monitored? Or did she just live at the mercy of her disease? Although we shall never know, we can guess the answers.
Two weeks ago, her luck ran out. Stricken with an obvious stroke, Tibareijukire was first taken to a dispensary at Kakatunda, Bukinda, 13 km away, before transfer to Kabaare Regional Referral Hospital. Three days later, paralyzed and immobile, she was discharged home to her village.
Ten days later, she died as the cocks crowed in the morning, and escaped the extraordinary suffering that would have been her fate had she continued in a vegetative state, in a village without even the most basic health care services for one in her condition.
My cousin was one of 1.4 billion adults, nerly 20 percent of the world’s population, afflicted with hypertension, the leading cause of death today. A study published in the Lancet last August, which looked at the state of hypertension care in 44 low-income and middle-income countries, found that 25 percent of Ugandans aged 18 to 69 years were living with the disease.
Like other non-communicable diseases, hypertension afflicts and has, so far, killed more Ugandans than COVID-19. At a minimum, it needs the same robust attention that has been given to the more newsworthy and dramatic pandemic.
Ideally, an adult’s blood pressure should be maintained at a maximum value of 120/80 mmHg, and certainly not more than 130/80 mmHg. These values must be determined using an appropriate modern blood pressure machine, in an appropriate setting, including 24-hour ambulatory blood pressure monitoring, which is not as expensive as one might imagine.
The same is true of the treatment that all patients, regardless of their socio-economic station or geographical location, must access at minimal or no cost to them.
We should take note of an important study by Dr. Andrew K. Tusubira of Mulago Hospital and his colleagues that was published in the Lancet Global Health last month. They found that whereas the majority of patients with hypertension and/or diabetes mellitus at the three study centres in Nakaseke District adhered to the recommended behavioural changes that helped them with their disease, they “were limited by the inability to obtain medicines.”
Many of the patients did not regularly monitor their illnesses and, alarmingly, many reported “use of herbal remedies, soaking swollen feet in saltwater, and coping with stress through prolonged sleep, social isolation and alcohol use.”
Hopefully the COVID-19 scare has jolted us into rethinking our priorities. Every Ugandan should have access to high quality, knowledgeable clinicians that offer state-of-the-art preventive education, diagnosis, treatment and monitoring of their patients.
Patients should be guaranteed access to high quality, effective medicines, not the cheap but often fake stuff that comes from places like India, Pakistan and China. Of course, patients and non-patients need to alter lifestyles to those that enhance healthy diets (including avoidance of excessive salt consumption), reduced alcohol consumption, quitting smoking, regular exercise, weight reduction and decreased mental stress.
An approach that facilitates a lifelong partnership between the patient, her healthcare provider and her medicines is necessary to achieve the recommended target blood pressure levels.
Why is all this important? Undetected, untreated or undertreated hypertension can result in serious complications, including heart failure, heart attacks, small blood vessel disease, rupture of the aorta, erratic electrical activity of the heart (atrial fibrillation), end-stage kidney disease, stroke, dementia and death.
Bear in mind that these things can and often occur in the silent darkness of our invisible inner body functions, unknown to us until it is too late. When I last saw her in Kahondo on Sunday November 24, 2019, Tibareijukire showed no sign of ill-health. At 78, she looked like one who still had a lot of miles to go before slowing down.
However, behind her beautiful smile, lurked a silent killer that would strike hard and fast like a thief in the night. Six months after that beautiful reunion, she was gone.
We mourn with her brother Joseph Rukeijakare of Kasese, her other siblings, her children and all Abakonjo b’Abatenga ba Nyanga ya Kahondo. She now belongs to the borderless universal clan of those whose memories we hold dear, those who left the world without debt, not the financial kind, but the moral and social capital that she handled well to the end.