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Co-Design is Key to Health Education

By Chika Odioemene

A loving son sent a text to me saying, “Mrs. Chika, good evening. Thank you so much for reaching out. I appreciate it. Me and my family have been really trying hard to help with my dad’s recovery. Now he needs physical and speech therapy. We are unable to find a speech therapist in Nigeria. My younger brother sent me a video of them feeding him, and I wanted to get your feedback.”

I watched a video of a young-looking man, likely in his late 50s to early 60s, sitting up at the end of his bed. He had an IV catheter on his left hand. It was apparent by the way he held the cup he drank out of that he was using his non-dominant hand. His presentation was a classic presentation of Left Middle Cerebral Artery (LMCA) stroke: right arm paralysis, drooling his sips of drinks, and speech disturbances.

Two weeks later, I received another text from his son: “My dad passed away Sunday night. We kept begging the doctor to put him on a ventilator, because I saw a video indicating that he was in severe respiratory distress. However, when the ventilator finally arrived, it wasn’t working properly. So, we paid for an ambulance to take him to a different hospital, but the ambulance didn’t make it on time.”

It wasn’t the stroke that killed him. Given his presentation on his last day, he likely died from aspiration pneumonia, a known and preventable complication of stroke, often mitigated with speech evaluation and therapy.

Stroke is a global burden and a leading cause of disability and functional dependency in most industrialized nations, with 5.5 million deaths attributable to stroke in 2016. In Africa, stroke has been established as a leading cause of death among non- communicable diseases, though the incidence and prevalence are not well documented in Nigeria or Africa as a whole.

This chart illustrates an example of the difference between the care available in stroke programs in developed nations and some low- and middle-income countries (LMICs).

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