Stroke, also known as the Cerebral Vascular Accident (CVA) is the second leading cause of death and the third leading cause of disability. It is reported that over 15 million people suffer from stroke each year; 5 million are left permanently disabled, while a further 5 million die due the disease, according to the World Health Organisation.
In South Africa nearly 240 people will suffer a stroke, of which it can claim nearly 70 lives (The Heart and Stroke Foundation South Africa). Statistics South Africa in 2018 reported that cerebrovascular diseases contributed to 6.1% in females and 4.0% in males. Unfortunately these numbers are expected to rise in the absence of public health response.
Though a small proportion of people who survive stroke may recover fully, a large number of stroke survivors may be left with permanent disability that can affect the quality of life they will have. The impact of stroke also depends on the time a person receives medical help. The delay in seeking medical help when attacked by stroke may result in permanent disability and even death. It is therefore very important for a person or a bystander to recognise the symptoms of stroke.
Dr Mhlari's research developed a decision making tree model for stroke survivors, which was outlined by Galdwin in 1987. In the case of this study, it was used to explore and give predictions on the decision-making pathways, thought process and decision pattern of stroke survivors.
"This is very important in that it always acknowledges the people expertise, knowledge, experiences and beliefs when dealing with any life events and decisions they make. This study was influenced by a growing prevalence of stroke and the delay in seeking medical assistance," she says.
“Stroke is a prolific health problem and a well-known psychological consequence that many stroke survivors experience is post-stroke depression. Stroke demands drastic change to the life of a person with the introduction of a new routine that an individual needs to get used to. The routine includes taking medication at certain times every day, exercise, the type of food to eat, and being dependent on people. These routines for those who were suddenly attacked in particular can have a detrimental effect on the quality of life of the survivor."
She also adds that after a stroke, a lot of mental emotions arise and call for immediate action to prevent the stroke from persisting. A positive mind has always been seen as aid that an individual can have for a speedy recovery of illnesses. However, anger, anxiety and frustration are very common emotions witnessed among stroke survivors. If these emotions are not well managed, they can cause post-stroke depression.
The significance of this study, titled: The Development of an Ethnographic Decision-making Tree Model for Stroke Survivors in Polokwane Municipality, Limpopo Province, was to contribute towards the effort aimed at educating and creating awareness about stroke in the communities, especially in the rural areas.
The study found that there is little knowledge of stroke and its symptoms among communities. The symptoms of stroke are often associated with other illness individuals are familiar with, like diabetes, hypertension and blood pressure.
"This also happens with people who are diagnosed with other illness prior to the stroke. Some perceive stroke as being caused by supernatural powers engineered by people who are jealous of survivors or some generational curse befalling a certain household.
Lastly, stroke at an acute phase has been associated with exhaustion. Hence, there should be a concerted effort to provide health education and awareness to communities on stroke and related conditions. Spirituality is part of the African people which is embedded in many parts of African communities. Most of the mental illness is understood as being caused by supernatural powers. Likewise with stroke. Often when the symptoms attack, it is regarded as communication between them and those who are no longer alive (the victim and their ancestors)," says Dr Mhlari.
This results in consulting traditional healers for an explanation of what the ancestors are trying to say to them. Many symptoms are understood as communication from the ancestors and only people who have a special gift are consulted for an explanation. Also, traditional healers are regarded as a very important part of the community, in that they are easily accessible and often cheaper when consulting.
“During the study, we found that lack of knowledge, proper health facilities in rural areas, and religious affiliation played a role in how stroke survivors and their families navigate their decision making pathways. Living in a rural area in a developing country like South Africa has a serious effect on stroke in that there are no sufficient or appropriate medical resources for dealing with this kind of illness. The available medical resources are found in the cities and are not easily accessible to stroke patients residing in rural areas.
Dr Mhlari further stated that other stroke survivors and their families opted to deal with stroke-related problems by consulting with traditional healers and churches instead of health facilities simply because they (churches and traditional practitioners) were easily accessible in every village compared to healthcare centres.
The study further revealed that some opted for multiple interventions to deal with the condition as they used herbs, church and Western medication.
Immediate medical assistance
Dr Mhlari emphasised the need for educating communities about stroke and its symptoms. She noted that there is little knowledge of stroke and its symptoms among communities as its symptoms are often associated with other illnesses that individuals are familiar with, like diabetes, hypertension and blood pressure.
“This also happens with people who are diagnosed with other illnesses before the stroke. Lastly, stroke at an acute phase has been associated with exhaustion. Hence, there should be a concentrated effort to provide health education and awareness to communities on stroke and related conditions.”
People suffering from stroke or who survived the disease must immediately go to their nearest healthcare centre because their lives are in danger, the study cited.
“We are dealing with delay in seeking medical help and stroke becoming a major public health problem. It is very important to receive immediate medical assistance because the longer stroke stays untreated the higher the chance of permanent disability, depending on the number of cells and the part of the brain affected.
Dr Mhlari continues that stroke survivors and their families constantly need psychological support, easy access to physical training, social support, and more information on how to conduct themselves when living with the aftereffects of stroke.
“To reduce the delay in seeking medical help, you need to understand what influences stroke victims to act the way they do. Because understanding the thought process and reasons why people take certain decisions helps in developing an informed intervention and an intervention that will be well received by the people you will be dealing with.”
Psychological aftermath of stroke
Dr Mhlari notes that many stroke survivors experience post-stroke depression. She says the disease demands drastic change to the life of a person with the introduction of a new routine that an individual needs to get used to.
“The routine includes taking medication at certain times every day, exercise, the type of food to eat, and being dependent on people. These routines for those who were suddenly attacked in particular can have a detrimental effect on the quality of life of the survivor," she adds.
"After a stroke, a lot of mental emotions arise and call for immediate action to prevent the stroke from persisting. A positive mind has always been seen as an aid that an individual can have for a speedy recovery of illnesses. However, anger, anxiety and frustration are very common emotions witnessed among stroke survivors. If these emotions are not managed, they can cause post-stroke depression.”
Stroke not only affects the wellbeing of stroke survivors but also of family members who have to carry the burden of caring for them. It is emotionally draining to care for a disabled person because even the routine of the caregiver changes, she adds. The recovery process of stroke survivors happens at home, and many of these survivors require timely care from a member of the family because of the disability effect of stroke.
“Unfortunately, many of the psychological rehabilitation interventions available focus on stroke survivors and less on caregivers. To improve the health outcomes for stroke survivors, rehabilitation services also need to be extended to caregivers. This is because caregivers carry a heavy burden of taking care of stroke survivors. They need to be emotionally prepared to handle this task.”
As the study revealed that some stroke survivors and their families use traditional healers, African herbs, churches to deal with the conditions, while others use everything including western medicine suggests that health practitioners and traditional health practitioners must work together to address stroke-related problems.
“The model proposed by this study looked at the decision criteria in seeking medical assistance and what influences people on what form of medical assistance they resort to. This model, therefore, revealed that cultural and religious orientation plays a very important role in how the community perceives illness.
The foundation of an African being is embedded in a lot of spiritual beliefs that the individual uses as a form of their identity. This belief, therefore, cannot be ignored in any psychological intervention that is introduced to help stroke survivors.
The study proposes a new approach to the medical facilities to collaborate with traditional practitioners, spiritual healers and western medical practitioners in developing a better intervention that will apply to every individual in terms of the spiritual belief that a community affiliate with.”
• Dr Rudzani Mhlari is a Psychology Lecturer at the School of Social Sciences, University of Mpumalanga. The study was conducted as part of her PhD in Psychology, which she obtained from the University of Limpopo.
@ Story by Lisa Thabethe. Picture: Supplied.