Nowadays, strokes can happen at any age, even among young adults. According to the Centres for Disease Control and Prevention (CDC), stroke prevalence has increased for young adults (18 to 44) and middle-aged adults (45 to 64) by up to 15.7 percent. While the causes are known, such as high blood pressure, diabetes, obesity, and a sedentary lifestyle, for some people, such as Josephine Nakanwagi, deep emotional stress and heartbreak can be a risk factor, as Gillian Nantume writes.
Today’s society expects a 30-year-old woman to be settled in her job, probably with a husband and children. But the expectations sometimes do not meet the reality. Instead of sitting in an office somewhere, Josephine Nakanwagi sits on the verandah of her parents’ home in Namukozi Village, Mityana Town Council, Mityana District.
Her eyes are on a small stall near the dusty road, where she has placed Irish potatoes in small baskets, onions, and tomatoes, hoping that villagers will stop by to purchase them.
Although her speech is a bit slow, she is coherent. She takes tentative steps in the black high stilettos that were once her pride, bought for Christmas Day in 2023. She can only walk so far. However, she is comfortable in flat shoes.
Nakanwagi suffered a stroke on March 16, 2024, three months after she had given birth to a baby boy. Before her maternity leave, she had been working as a procurement officer for Sipro Educational Services Limited.
‘There was no sign that showed that I was heading towards a stroke. I was not stressed. However, two weeks before, I had experienced shortness of breath to the extent that I would step out of the house at night to try and get enough oxygen,’ she narrates.
When she visited a hospital, after carrying out some tests, the health workers informed her that her pulse rate was very high. Her blood pressure was also high. They gave her an appointment to see a specialist on Saturday, March 16, at 3pm. Unfortunately, she had a stroke at noon, three hours before her appointment.
‘I decided to wash my clothes before going to the hospital. Before I hung them, I went to check on my baby, who was sleeping. As I lifted him, I felt something hit me hard on the forehead. I put the baby down and walked to the bedroom. That thing hit me again on the forehead,’ she says.
Extremely dizzy, Nakanwagi went outside the house and called to her neighbours. As they came towards her, she fell forward into their arms. She was still conscious and told them to take her to a nearby clinic.
‘I was put on a drip. The nurse called my sister, but by the time she arrived, my tongue was becoming heavy. I was losing the ability to speak. At 6pm, I was driven to Mengo Hospital in Kampala. My sister had come with the baby and asked me to breastfeed him. I put him on the breast and then, I blacked out,’ she says.
Nakanwagi regained consciousness as she was being wheeled into the ward. She was placed on several drips, and a catheter was inserted into her after she failed to urinate.
‘I was admitted for three days, but there was no change in my situation. I could not lift my arms. My mouth was tightly shut. I could see and know the people who visited me, but I could not talk. I was given medication that dried up the milk in my breasts,’ she adds.
An MRI scan showed that Nakanwagi had a tear in one of the nerves in her brain. She was referred to Mulago National Referral Hospital.
‘Every time the ambulance hit a pothole, my teeth would bite my tongue. It was painful. At Mulago, part of the procedures included hitting my legs with a small hammer, but I could not feel them. After two weeks and three days in the ward, without any change, I was discharged,’ she notes.
Attending a rehabilitation centre
Justina Nankumbi, Nakanwagi’s mother, decided not to take her daughter back to her rented home in Kampala City. Instead, she took her to the family home in Namukozi, with the knowledge that she was going to spend the rest of her life caring for her.
However, among the several visitors who came to commiserate with the family were a group of girls whom Nakanwagi had studied with at Mityana Secondary School. One of them, Faith Nakigudde, proved to be a lifesaver.
‘I thank her because if it were not for her, my life would be a mess now. She advised my mother to take me to the Stroke Rehabilitation Centre in Wampewo (on Gayaza Road) and offered to pay for all the expenses I would incur during my stay there. I spent two months at the Centre,’ Nakanwagi recalls.
She underwent physiotherapy every day. On Fridays, the patients would be taken for a gym session, and in the afternoon, they would have outdoor activities.
‘I felt dizzy the first time I was put in a wheelchair because I had spent months lying down. But after a week, I could sit with support, and my neck could remain in one position. When the doctor told me I would walk again, I did not believe him. However, after two weeks at the centre, I could sit on my own in a chair, and I could move my arms slightly. I could also crawl,’ she says.
Within a month, Nakanwagi could stand and walk short distances. She had also started talking, and the nurses could understand her. Part of the exercises that enabled her to use her arms and hands again was sorting beans.
‘I had to sort small beans, pick them one by one, and drop them into a bucket. At first, it was so difficult because my fingers could not move even when my brain commanded them to move. The doctors kept telling me to relax and not force myself. But by the time I left, I could easily pick up the beans,’ she explains.
Nakanwagi was also taught how to speak again using words from the alphabet.
‘Words with the letters s, p, and x were so difficult to pronounce. Even today, I still have difficulty writing. However, I am improving,’ she says.
Nankumbi praises her daughter’s strength and resilience in the face of an almost impossible situation.
‘We saw a change in her condition after three days. When she urinated on the bed, we were so happy. Previously, she had been urinating through a tube. Later, she could point to the toilet instead of doing everything on the bed. She did not pity herself, pushing herself to do the physiotherapy as guided by the doctors. Instead, I was the one who would cry. I tried to hide my tears from her,’ she explains.
Several people had told me that Josephine had become a vegetable and would grow old like that. But the doctors at the centre consoled and counselled us. They even brought pastors to pray for us,’ she says.
What caused the stroke?
It is now one year and a month since Nakanwagi was discharged from the Stroke Rehabilitation Centre. Although she insists that nothing prepared her for the stroke she suffered, her mother, Justina Nankumbi, tells a different story.
Nankumbi says her daughter was too young to suffer a stroke. She was in love and had just had a baby – every young woman’s dream.
‘She came to live with me after giving birth so that I could take care of her and the baby. During that time, my other daughter called me and told me she was going to reveal the secrets of Josephine’s boyfriend. I begged her not to,’ she says.
Nankumbi adds that her daughter’s dream had always been to complete her studies, get married, and have children. Nakanwagi’s boyfriend had promised to marry her if she gave him a child. Unknown to her, her ‘boyfriend’ was a married man.
‘That man had informed my other daughter that he could not marry Josephine as he had promised, since he was already married. But he would take care of the child. My daughter decided to keep the information to herself until Josephine gave birth,’ Nankumbi notes.
She adds that her daughter’s boyfriend had even suggested to her sister that Nakanwagi should abort the child because he had enough children.
‘When I returned from an errand in town, I found Josephine crying desolately. I asked why she was crying, but she told me there was no problem. I called my other daughter, and she told me she had let out the secret. I blamed her. How can you tell a new mother that the father of her child does not want the child?’ Nankumbi asks.
Two days after the episode, Nakanwagi returned to Kampala, but after a few days, she called her mother, telling her that she was feeling a lot of heat in her chest. The next call Nankumbi received was to inform her that her daughter was admitted to Mengo Hospital.
Nankumbi believes the heartbreak that resulted from getting to know her boyfriend’s true colours is what caused Nakanwagi’s stroke.
‘I think the stroke came from her depression. I had always advised my daughters not to go for married men because they are not responsible towards the children they have outside marriage. Married men are always compelled to lie. Josephine did not know that the man had a wife,’ she says.
Her life today
An enterprising young woman, when she was discharged from the Stroke Rehabilitation Centre, Nakanwagi knew that she had to continue with her physiotherapy at home, if she was to get better in record time.
‘The stroke changed my outlook on life. Many people know about stroke, but those who are victims do not know how to go about it. They think their life is over. They admire those who can talk and walk. At some point, I feared talking with people I did not know. I could not sit with them or look at them. I thought they would be judging me,’ she says.
As a procurement officer, the mother of one used to be a confident young woman. However, the incapacitating stroke took her confidence and self-esteem. However, she is trying to regain her confidence.
‘When I am at home, I walk confidently. But when I am in a strange place, I have difficulty walking because I have a feeling that people are looking at me and judging me. This makes me fail to walk. Sometimes, I wait for people to walk away before I can slowly cross the road,’ she explains.
To keep herself busy, Nakanwagi opened a stall in front of her parents’ home, which allows her to interact with people she is not familiar with.
‘Besides selling Irish potatoes, tomatoes, and onions, in the evenings, I fry emamba (marbled lungfish) and cook porridge. People, especially those who do not cook at home, flock to the stall. I buy a big fish at Shs50,000 and sell it in small pieces of Shs1,000. My neighbour boils cassava, which people eat with the fish. I find myself talking to people every evening,’ she says.
The stall is by the roadside, and several people pass by it on their way home after work. Nakanwagi hopes to look for a formal job next year.
‘Most employers require experience before they can hire you. Unfortunately, I do not have that, but I still remember how I used to do my procurement job. I spent 10 years working in procurement. I also have a certificate in software engineering. I can now focus on a computer and even code a website,’ she says.
Advise to caregivers
From experience, Nakanwagi has advice for caregivers of stroke patients. She calls on them to be encouraging to their charges, who in most cases, are also suffering from depression.
‘It is not easy to look after a stroke patient. Besides doing everything for them, they also need to be counseled that they are still useful in life. Encourage them to adhere to their physiotherapy to get better, and keep telling them that they are improving. If not, you will kill their self-esteem,’ she explains.
In most cases, immediately after the stroke, patients regress, and it takes time, hard work, and determination to get back to where they were before they fell ill.
‘I used to be a hands-on person, doing my own house chores. Nowadays, I make sure to follow the physiotherapist’s advice because I do not want to be a burden to my family. I force myself to try out things until I perfect them. For instance, washing a handkerchief was a challenge, but I kept trying and within a week, I could wash it clean,’ Nakanwagi notes.
Before the stroke, as a firstborn, Nakanwagi used to pay her siblings’ school fees. They paid her back with love, caring for her unceasingly until she got back on her feet.
Nakanwagi’s need for a formal job is to go to a place where people do not know her. In such a situation, no one will feel sorry for her when she makes mistakes or when she is slow. They will not be concerned about what happened to her.
She believes this will give her the courage to take on tasks that her family would otherwise tell her not to perform, because they fear she will be straining herself.
Since she gave birth, Nakanwagi’s boyfriend abandoned her and their son.
Stats
According to the World Health Organisation, annually, 15 million people worldwide suffer a stroke. Of these, five million die and another five million are left permanently disabled, placing a burden on family and community. Stroke is uncommon in people under 40 years; when it does occur, the main cause is high blood pressure. However, stroke also occurs in about eight percent of children with sickle cell disease.
High blood pressure and tobacco use are the most significant modifiable risks. For every 10 people who die of stroke, four could have been saved if their blood pressure had been regulated. Among those aged under 65, two-fifths of deaths from stroke are linked to smoking. Atrial fibrillation, heart failure and heart attack are other important risk factors.
The incidence of stroke is declining in many developed countries, largely as a result of better control of high blood pressure and reduced levels of smoking.