Stroke remains one of the foremost causes of mortality and severe disability across the globe. As highlighted by the American Heart Association, it’s predicted that one in four individuals will experience a stroke at some point in their lives. Disturbingly, every three seconds, someone is impacted by this serious condition.
Annually, around 12 million people suffer a stroke, leading to approximately 6.5 million deaths. For women, stroke is the third leading cause of death, resulting in more fatalities among females than males. Various risk factors contribute to the likelihood of experiencing a stroke, including hypertension, smoking, and elevated levels of depression.
Nevertheless, it’s noteworthy that 90% of strokes could be averted by effectively managing risk factors like physical inactivity.
Nestled in the heart of Vihiga County lies the village of Vokoli, home to Esther Kahandari. As a matriarch, mother, and grandmother, Esther’s life is a tapestry woven with both happiness and hardship. She embodies a unique blend of cultural heritage and the challenges presented by chronic illness.
Born in 1928, her formative years were spent in the family homestead, embraced by the verdant hills of a region celebrated for its agricultural abundance. In this vibrant community, farming is a way of life, with two planting seasons and an emphasis on small-scale tea production. Esther’s existence in Vihiga is deeply intertwined with the traditions handed down from her ancestors. Renowned for her culinary talents, she brought joy to her family through meals that showcased local vegetables such as mrenda, kunde, managu, terere, and sagaa.
What distinguished Esther wasn’t just her choice of ingredients, but also her unique approach to their preparation. True to traditional practices, she shunned artificial additives like bicarbonate, opting instead for “omukereka,” a natural softening agent sourced from agricultural waste. This mineral-laden seasoning, when mixed with water and strained, lent a rich, smoky flavor to her culinary creations, reflecting her deep-rooted relationship with the land and its resources.
Beneath the tranquil rhythms of Esther’s rural existence lay a silent struggle that would forever alter the fate of her family. In 1993, she suffered a stroke, the first alarming indicator of the severe consequences hypertension had inflicted on her health. Like many families in rural Kenya, hers faced significant barriers to healthcare access, leaving her chronic condition unchecked for years and silently wreaking havoc on her well-being.
“Hypertension, often referred to as high blood pressure, is a significant risk factor for stroke,” notes Dr. Eric Anyira, a cardiologist based in Kakamega. “It greatly heightens the chances of both ischemic and hemorrhagic strokes. An ischemic stroke occurs when blood flow to the brain is blocked, usually by clots, while a hemorrhagic stroke involves the rupture of blood vessels in the brain, resulting in bleeding. The latter can be fatal, often leading to quick mortality within minutes or days. Chronic high blood pressure causes damage to blood vessels, increasing their susceptibility to clots and ruptures, thus raising the risk of stroke.”
Hypertension is classified into two primary categories: primary (or essential) hypertension, which develops gradually over time without a clearly identifiable cause, and secondary hypertension, which arises from underlying health conditions such as kidney issues, hormonal imbalances, or specific medications. Secondary hypertension can manifest suddenly and tends to be more severe in nature.
The Consequences of Hypertension
For Esther, living with hypertension posed significant risks that heightened her chances of experiencing a stroke. This debilitating condition ultimately left her paralyzed on one side and dependent on her family for daily care. Her granddaughter, Beatrice Andesia, vividly remembers the moment they received the news of her illness, saying, “I was in elementary school when it happened. We later found out that Grandma had been struggling with hypertension, a condition we were not then aware of.” She reflects on the day she stood by her grandmother’s gravestone, cherishing memories of Esther, who passed away in 2012.
During the 1990s, awareness surrounding hypertension was alarmingly low, particularly in rural regions. Even in urban areas that had some access to modern healthcare resources, managing chronic illnesses like hypertension proved to be a daunting challenge. In Vihiga, where healthcare facilities were scarce, obtaining the necessary treatment was nearly impossible. Esther’s stroke served as a stark illustration of the dangers associated with untreated health issues.
According to the World Health Organization (WHO), cardiovascular diseases, including hypertension and strokes, are responsible for 13% of all fatalities in Kenya. These conditions are especially common in rural locales like Vihiga, where healthcare infrastructure is often inadequate. Without access to routine medical check-ups, diagnostic services, and essential medications, many families in these areas struggle to manage such critical health problems effectively.
The Weight of Caregiving
As Esther’s health declined after her stroke, her family faced the need to make considerable lifestyle adjustments, including changes to their diet. The primary responsibility for her care fell on her second daughter, Nancy Mmbone, along with her daughter-in-law, Rebecca Andia. Both women, now retired educators from Sabatia in Vihiga County, grappled with the challenge of addressing Esther’s needs while also managing their own lives.
Nancy, a widow raising her children, undertook the enormous responsibility of caring for her bedridden mother. “I would come to help with her bedding about once a week, or sometimes every two weeks, depending on my schedule,” Nancy remembers. “I would wash her linens, cook meals for her, and make sure she had everything she required.” As Esther’s condition worsened, she was fitted with a catheter, which eventually became problematic, prompting the family to stop using it altogether. This experience underscores the significant emotional and physical toll that chronic illness can impose on family caregivers.
The commitment shown by Nancy and Rebecca exemplifies the broader societal expectation that women will provide care, often without sufficient support or acknowledgment. For over 20 years, Esther received care primarily from her family, both at home and in the hospital, with Nancy at the forefront of this effort. This situation illustrates the unpaid caregiving work that underpins many families in Kenya, where overwhelmed healthcare systems frequently leave families to manage long-term care on their own.
The Kenya National Bureau of Statistics (KNBS) revealed in their 2021 Kenya Time Use Survey that women in the country engage in five times more unpaid caregiving work than their male counterparts. This encompasses responsibilities such as taking care of children and supporting the elderly and ill. Such vital labor remains overlooked and unpaid, even though it plays a crucial role in the community’s overall well-being. Nancy and Rebecca, despite the heavy demands of their caregiving roles, never voiced their frustrations.
For them, attending to their family member was a profound expression of love and commitment, even if it came at a significant personal price. “It was exhausting,” they confessed. “But that’s what family is all about. We look after our own.” Their experience highlights the profound sacrifices caregivers often endure, typically at the cost of their own economic prospects. In face of Esther’s advanced age and health challenges, the family actively sought solutions to help her regain her mobility and independence following her stroke.
Physical rehabilitation is essential for stroke survivors dealing with paralysis, a fact highlighted by John Luchwala Masinde, a physiotherapist at the National Spinal Injury and Referral Hospital. He notes, “In a hospital environment, physiotherapy and occupational therapy play significant roles in addressing movement challenges, restoring coordination, and building muscle strength.”
Early in the recovery process, range-of-motion exercises, which involve gently mobilizing paralyzed limbs to avert stiffness, are particularly important. As some mobility returns, strengthening exercises—like leg lifts, arm raises, and resistance training—assist patients in regaining their muscle power. Furthermore, balance and coordination training are integral, enabling stroke survivors to enhance their stability and overall functionality.
In cases similar to Esther’s, task-oriented training, which focuses on practicing daily activities such as reaching for objects or getting dressed, can significantly improve muscle coordination and foster a sense of independence. However, once patients are discharged from the hospital, they often return to communities where access to professional rehabilitation services may be scarce. Subsequently, families frequently step in as caregivers to support the rehabilitation process.
Esther’s family, despite lacking formal training, diligently provided her with consistent care. “She required assistive devices like a wheelchair, and later we devised makeshift toilet aids to assist her at home,” Beatrice recounts. Masinde underscores the importance of ongoing rehabilitation, even in the home setting. “It’s crucial for patients to adhere to their medication regimens and continue their physical therapy at home. With adequate management, many individuals can cope with the long-term effects of a stroke,” he advises.
Emotional and Physical Burden
As Esther’s health declined, her fragile husband was unable to lend his support. Consequently, it fell to her daughter-in-law Rebecca to help Esther settle into bed each night. This act was motivated by love and a strong sense of obligation. While this display of selflessness is commendable, it highlights a larger societal issue: the expectation for women, especially in rural communities, to engage in unpaid caregiving roles without acknowledgment or assistance.
This situation is a common reality for many families in Kenya. Women frequently carry the majority of caregiving responsibilities, often putting their own aspirations on hold for the sake of their relatives. Unfortunately, this labor goes largely unnoticed, excluded from the formal economy, and overlooked by policymakers.
As Esther approached the end of her life, the burden of caregiving began to take a significant toll on the family. For over twenty years, Nancy and Rebecca navigated the emotional and physical difficulties of caring for a loved one suffering from a chronic illness. Through their challenges, these two women have emerged as symbols of resilience, representing countless others across Kenya who provide vital care for their families without recognition or compensation.
Their experience underscores a significant societal challenge: the assumption that women will assume unpaid caregiving responsibilities without sufficient recognition or support. This perspective is especially relevant in Kenya, where countless families encounter similar struggles. Esther’s story, characterized by resilience, commitment, and sacrifice, highlights the profound effects of chronic illness on families, particularly in rural areas like Vihiga County.
As the caregiving responsibilities disproportionately fall on women, it is essential to acknowledge their invaluable contributions and advocate for policies that assist families dealing with chronic health issues. Although Esther is no longer with us, her legacy endures through her family. She serves as a reminder of the extraordinary strength of women who persist in caring for their loved ones despite myriad challenges. These unsung heroes deserve recognition and support as they navigate the arduous journey of caregiving.
Their experiences illuminate the urgent need for improved healthcare access, comprehensive support systems, and acknowledgment of the unpaid caregiving work prevalent in rural Kenya.
