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Script 109.6

Notes to broadcasters

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Stroke is a leading cause of death and disability globally, and the prevalence of stroke in the Global South is increasing. Today, two-thirds of all individuals who have suffered from a stroke live in developing countries where health systems are often challenged to the limit, and support for individuals and their families affected by stroke may be minimal.

Strokes can happen to anyone at any age, and impact everyone: stroke survivors, family and friends, workplaces, and communities. But there are many actions that people can take to prevent stroke, and there are many things that stroke survivors and their families can do to make life better and easier for all.

In simple terms, a stroke occurs when the supply of blood to an area of the brain is blocked due to a variety of causes. When that happens, the cells of the brain begin to die because of lack of oxygen. This leads to problems in moving limbs, eating, talking, and many other issues.

According to the World Health Organization, almost 6,000 people die from stroke every year in Zambia, making it the fifth most common cause of death in the country.

This script tells the story of a man suffered a stroke that rendered him so helpless that he lost his job. It explores what might have led to him getting a stroke and its traumatic impact on his life. The script describes the role his wife and main caregiver and the rest of his family continue to play to help him cope with his new situation.

You might choose to present this script as part of your regular health program, using voice actors to represent the speakers. If so, please make sure to tell your audience at the beginning of the program that the voices are those of actors, not the original people involved in the interviews.
You could also use this script as research material or as inspiration for creating your own programming on stroke in your country.

Talk to stroke survivors, their families, and health professionals who have experience or expertise with stroke. You could ask them:
• How can family best help stroke survivors with practical tasks and with psychological support?
• How can health professionals best support stroke survivors and their caregivers after a stroke?

Estimated running time for the script: 15 minutes, with intro and outro music

Script

FILIUS:
Mr. Whiteson Daka, you survived a stroke. Please tell me what you think caused you to suffer a stroke.
WHITESON:
I think it was the huge work overload at the office and pressure from my family.
FILIUS:
Please explain in full.
WHITESON:
I was a senior manager of a big development project for more than ten years. I had a very good salary and was quite comfortable. However, I was responsible for a big workforce. As a result, I was always on my toes every day to ensure that everything was right. Sometimes I worked late into the night compiling crucial reports for my superiors. Consequently, I had no breaks or holidays. Eventually, I was diagnosed with high blood pressure, which I think also contributed to my stroke.
FILIUS:
Earlier, you told me that your family may also have contributed to your situation. Please explain this could be so.
WHITESON:
As Africans, we are gregarious by nature. It was worse for me because my relatives knew that I had a good salary. So they became over-dependent on me. Many were very poor and needed support.
FILIUS:
Why did they think that you could support them?
WHITESON:
I have a small family, so this might have made them think that there was room for them to pour their problems on me.
FILIUS:
What sort of problems?
WHITESON:
Some of them needed food or clothes while others wanted assistance to educate their children. Some of them even moved in with us and would not go away. This increased our domestic bill. My younger brother even brought his wife who had terminal cancer to live with us. This was traumatic for us because she was always in and out of hospital. I believe that all this pressure contributed to my situation.
FILIUS:
Did you notice any signs that indicated you were likely to have a stroke?
WHITESON:
Not at all. In fact, I never imagined a stroke would happen to me because, for me, this was something that happened to someone else. However, on the day before my stroke, there was more than that usual pressure at work. So I worked all day and half the night. When I decided to take a break and finish the work in the morning, my wife told me that the condition of my younger brother’s wife had deteriorated. So we took her to hospital immediately and came back at cockcrow. I then took a cold shower to freshen up and finished my report over a cup of hot coffee.

When I was ready to go to the office, my wife said there was no money for food and we had the hospital bill to pay. So I drove over to the nearest ATM for some money. Back home, I felt slightly giddy and just slumped onto the floor. Alarmed, my wife tried to get me to stand and discovered that the whole of my left side would not respond. So she called our neighbour to drive me to the hospital.

PHYSIOTHERAPIST:
Although I prescribed some physiotherapy sessions for Whiteson, the best strategy for him to get better is in his head.
FILIUS:
What do you mean?
PHYSIOTHERAPIST:
Whiteson was in a very responsible position both at work and at home. So the loss of his job and his ability to fend for his family could hinder his chances to recover fully.
FILIUS:
In your professional opinion, what then could have caused Whiteson to suffer from the stroke?
PHYSIOTHERAPIST:
Stroke is caused by a cluster of factors that may arise from a person’s lifestyle. In medical circles, we also call this condition CVA.
FILIUS:
What does that mean?
PHYSIOTHERAPIST:
CVA is short for Cerebrovascular Accident. Stroke is like an accident: you must follow all the rules to avoid it. For this reason, I attribute suffering from stroke to lack of information about the impact of our lifestyles on our health. People should know how to take care of themselves. They should be careful what they eat or drink—and try to avoid smoking by all means. These lifestyle choices can result in risk factors that lead to a person suffering a stroke.
FILIUS:
What are these risk factors?
PHYSIOTHERAPIST:
Risk factors that come from poor lifestyle choices include suffering from diabetes and hypertension. Poor eating habits sometimes result in overweight and impaired blood sugar levels. This can cause someone to suffer from diabetes. A person can also suffer from hypertension, which is commonly known as high blood pressure. It can damage blood vessels, which can lead to a stroke. Poor diet is a contributing factor to both diabetes and hypertension.
FILIUS:
So what is your advice for people to avoid suffering a stroke?
PHYSIOTHERAPIST:
Everyone should be concerned about their health. No matter how healthy they may feel, they should go for regular check-ups at the hospital. They must also eat healthy food, minimize on alcohol, and completely avoid smoking. It’s as simple as that.
FILIUS:
What about stroke survivors? What is your advice for them?
PHYSIOTHERAPIST:
They should not give up fighting because stroke is not the end. They can still recover and become productive. But their caregivers play a major role in their rehabilitation.

Before we discharged Whiteson from the hospital, I had a one-to-one chat with Mrs. Daka to prepare her for the sometimes onerous task of caregiving. Then the three of us spoke, and I made it clear to Whiteson that he had a role in his own recovery by being positive-minded and not pessimistic about life.

Whiteson needs to be assured that it’s a very positive thing that he has survived a stroke. Many people die. So his dependency should not pull him down.

But the best therapy can only come from close members of his family and caregivers. The physiotherapy I have prescribed might restore movement in his disabled limbs. But he needs a lot of love and care from everyone around him. His wife is his best caregiver. She has been quite exemplary as a caregiver—isn’t that right, Mrs. Muzilachi Daka?

MRS. MUZILACHI TEMBO:
You are right. However, I must confess that it hasn’t been easy to take care of my husband. The stroke left him completely dependent. But I love him and that is what gives me courage to overcome my distress. In my opinion, the whole family should be involved in caregiving—don’t you think so?
PHYSIOTHERAPIST:
That’s right, madam, because if caregiving is left to one person, there is danger of burnout. People should share the burden of attending to the stroke survivor.
MUZILACHI:
We all depended on him so much as a provider, and we were not ready for this. Our daughter is in senior secondary school, but suddenly the carpet has been pulled from under her. Everyone who pretended to be my husband’s relative has gone away treacherously and everything is upon my shoulders. I have to find the school fees for our daughter, food for us all, and give my husband the attention and care that he needs.
FILIUS:
As the main caregiver, what do you do for him, Mrs.
Daka?
MUZILACHI:
First, I provide for my husband’s physical needs. I bathe him, massage him, and feed him. Feeding him is not easy because his lip muscles are slack and swallowing food is difficult. Then I must attend to his toilet.
FILIUS:
What are the prospects concerning his situation?
MUZILACHI:
He is going to recover. However, as the physiotherapist said, it needs rebuilding his will and it’s such an uphill battle. He feels so sorry for himself and says he should have died rather than become a burden on us.
FILIUS:
Sad for him and for you, too. Just how do you manage to accomplish all that you do?
MUZILACHI:
Love is the key. Every caregiver must have love. Without love, it is not possible to have strength and perseverance. It is also the only thing that can make you convince the patient that all is not lost.
At the end of his prescribed physiotherapy sessions, my husband still could not walk properly. His left arm is still useless. So I massage him every morning, noon, and at bedtime. I also assure him that everything will work out for the better and he is going to be alright one day.
FILIUS:
Do you really believe things will work out for the better one day?
MUZILACHI:
Of course they will. If I didn’t believe that, I would break down too—and our family could wind up with two key people suffering from stroke. I might not be as lucky as my husband and I might die. What would happen to the children if I died? What would happen to my husband?
FILIUS:
Are you not afraid that your constant worrying can be a recipe for you to suffer a stroke?
MUZILACHI:
I am a positive-minded person and keep such thoughts far at the back of my mind. Every caregiver must be positive-minded in order to give courage to the stroke survivor. Remember, the physiotherapist said I am the best caregiver.
FILIUS:
But how do you manage to encourage your husband that things will be better one day?
MUZILACHI:
It’s because I believe it. I don’t tell him about the challenges we are facing to survive with him out of work. His employers paid out his termination benefits, and I tell him how I have invested in a restaurant business. I also tell him how well our daughter is managing at school. When the whole family is around, we sit with him and chat with him. Nobody shows sadness or pity for his condition. Instead, we always include him in making our plans for a better future.
FILIUS:
What positive things have come out of your sad situation?
MUZILACHI:
I wouldn’t call it a sad situation at all because it has actually given us strength and made us come together as a family. Further, it has shown us that, no matter how large a number of relatives there are, a family basically consists of a father, a mother, and children who must keep together as one unit.
So when things are good, it may be wise to prepare for when things become bad. My husband’s stroke has increased love in our family and given us a vision for our future.

Acknowledgements

Contributed by: Filius Chalo Jere, Farmer Radio Producer, Breeze FM, Chipata, Zambia
Reviewed by: Allen Chimfulunganya, Head of Physiotherapy Department, Chipata District Hospital, Zambia.

This script was produced with the support of the Triskeles Foundation.

Information Sources

Interviews:
• Whiteson Daka, stroke survivor and former extension manager, COMACO, Chipata, Zambia, February, 2018.
• Mrs. Muzilachi Mphande Daka, caregiver, Chipata, Zambia, February, 2018.
• Allen Chimfulunganya, Head of Physiotherapy Department, Chipata District Hospital, Zambia, Chipata, May 16, 2018.
• Titus Mwangala, Physiotherapy Technologist, Department, Chipata District Hospital, Zambia, Chipata, May 16, 2018.