High Blood Pressure, the silent killer

When I migrated to the United States from Kenya 12 years ago, I had no idea that the health system in Kenya was inadequate. I was required to have a routine pre-employment physical, which quite frankly, felt was a waste of time and resources. I was healthy, in my 20’s, exercised, and never felt better in my life. And back in Kenya, we never had any wellness checks or annual physical exams. Healthcare services in Kenya are very expensive and not that accessible, or as in my case, adequate. You basically went to the doctor if and when you got sick. So you can imagine my shock when the doctor told me my blood pressure was over the roofs. The doctor had me go take a walk, eat lunch and come back in an hour to be re-evaluated. I now know that he wanted to rule out white coat syndrome whereby a patient's feeling of anxiety in a clinical setting results in an abnormally high blood pressure.

When I finally went back for my re-evaluation, my BP was still sky-high, sky high like in the 180’s systolic. He looked at me again and said, “How long have you had high blood pressure?” Say what? I thought he was crazy. I did not even know what high blood pressure was and what the numbers meant. Noting my bewildered look, he assumed this was a case of the white coat syndrome. He advised me to visit the CVS drugstore near my house twice a day and record my blood pressure and then see him in a week. I almost ignored his directives but I needed a job. A girl has to eat....right? I made sure to go to CVS twice a day and kept a log of my readings.

Within a week, I was diagnosed with essential hypertension or high blood pressure. “Blood pressure” is the force of blood pushing against the walls of the arteries as the heart pumps blood to our vital organs. Essential hypertension refers to high blood pressure with no identifiable cause, or the cause of essential hypertension is multifactorial. This basically means that the elevated BP is due to combined effects like high salt intake, obesity, hereditary (genetics), stress, renal insufficiency, or lack of physical activity. Which is why I was perplexed. Here I was, in my twenties, barely weighs a 100 lbs, heart full of expectations of embracing a new life in America , so may I say (stress free)?. So why was I being slapped with a medical diagnosis I had no idea existed? The doctor was convinced it was hereditary. Hello genes….

The doctor wanted to know whether my BP was ever high before. I shook my head. I honestly didn't know how to tell him that no one had ever screened my blood pressure before my visit with him. Despite many encounters with doctors in Kenya for common ailments, no one had ever checked my blood pressure. I had no idea what hypertension was let alone the fact I had it. The doctor was convinced it was hereditary, but I felt positive that neither of my parents were hypertensive. Surely they would have mentioned it. I will never forget the phone call I had with my mother that night. I was crying, asking her if she or Dad was hypertensive, which they both vehemently denied. I insisted they go see a doctor and get checked, just to be sure. They reluctantly agreed. I followed up a couple of days later and they delightedly informed me that they got a clean bill of health. I could hear it on their voice; almost like they were accusing me of making them spend the money and time for an un-necessary doctor's visit. So I asked curiously, "did the doctor check your blood pressure and was it normal?" And they both responded that he must have since he told them all was well. I continued, "did the doctor or nurse place a cuff around your arm that squeezes tight?". There was a pause. Then my dad responded; "now, why would he want to do that?". I knew then that they had no idea what I was talking about. I asked them to go back again and specifically request to have their BP checked. A week later, I got the call. My Dad’s systolic blood pressure was dangerously above 200’s and he was immediately placed on medications. The hypertension diagnosis on both me and my dad made me painfully aware of how little I knew about the human body and its functions. I was also hit with the realization of how inadequate the Kenyan health system was. It was then that I decided to go to nursing school. I knew I wanted to make a difference.

On my next trip to Kenya, I brought a small home glucometer and an electronic blood pressure machine with me. The morning after Christmas, I gathered everyone before they had their breakfast and checked their glucose levels and blood pressure readings. It was during this trip that I discovered that my older brother was a diabetic and had no idea. I referred him to a doctor for follow up and he has since been managing his diabetes. Word spread in the village like wild fire and the next day when I woke up, there were about twenty people in my parents’ compound waiting for me. They too wanted their blood pressures and glucose levels checked. My mother had also told some of her colleagues from the local church and they too started tickling in one by one. Each time I thought I was done, someone else would stop by. I screened everyone I could until I ran out of glucose strips and had to send them away. The experience was an eye-opener for me. I discovered that more women were more hypertensive than men, though to be fair, more women showed up. I referred all of those whose BP or blood glucose was elevated to the local hospital. I also took the time to discuss diet modification, meditation and incorporating an exercise regime. One of my neighbors in the village who was super hypertensive that I had to share my medications with died shortly after my visit and I always wonder whether she ever followed up with a doctor.

And the pattern was set. Every time I was in Kenya, my neighbors in the village would wait patiently for their screening. And each year, the numbers grew. I suspect my mom recruited more patients for me. Though I felt humbled to be of assistance, I have realized it is not very helpful to tell someone they may have a disease and then send them on their merry way without any medications to take before they are able to see a doctor. Plus the numbers were getting bigger for me to handle all by myself. I resolved the next time I go home, I will at least have some basic medications with me and will take a group of fellow nurses and doctors to aid in diagnosis and treatment. And that is how MMK was born.

Like me or my Dad, most people do not exhibit symptoms of hypertension, and that is why it is called a silent killer. Untreated hypertension can lead to serious health conditions like kidney failure, stroke, coronary heart disease, heart attacks, aneurysms, blood vessel damage, loss of vision....you get the drill. But Hypertension is an easily manageable disease with lifestyle modifications, diet, exercise and medications. Kenya however, has no programs in the community for educating the public about such modifiable diseases.

There are other many people like me or my Dad that are walking around the rural villages of Kenya with no idea that they have a time bomb that can explode at any minute. Medical Missions Kenya will be organizing trips to screen people in the rural community areas for modifiable chronic diseases like hypertension and diabetes. Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood; a metabolic disease that result from defects in insulin secretion, or action, or both. Diabetes can lead to kidney failure, heart attacks, blindness or gangrene leading to infections and amputations.

MMK is committed to promoting health, conduct medical health screenings for diabetes and hypertension, teaching modifiable lifestyle changes, teaching women how to perform self breast exam, and making referrals. I am very excited about what this organization can achieve, the lives of people for whom we can make a difference, and the social changes we can implement in Kenya. I believe that in partnering with local organizations and clinicians, we can change the culture and get everyone screened for these chronic diseases during routine visits.

Notes by Millicent Mucheru