Africans Are Introduced To The Blood Pressure Cuff : Goats and Soda Esther Okaya is one of a growing number of Africans suffering from hypertension. New efforts to fight the condition include a $1 bonus for health workers who identify and bring in a patient.

Africans Are Introduced To The Blood Pressure Cuff

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There's a killer disease in Africa that's even more deadly than Ebola, more prevalent than HIV or malaria. And what makes this disease so hard to fight is that so few people know they have it. Our East Africa correspondent, Gregory Warner, has the story.

GREGORY WARNER, BYLINE: Some blamed witchcraft, others a bad batch of moonshine. Esther Okaya, who lives in Korogocho - it's a slum in Nairobi, Kenya - says that even teetotalers are falling victim. One minute quarreling with a neighbor, the next minute, dead. Okaya, herself, felt some symptoms last year. It was the same week her husband had left her, taking the money for her children's school fees.

ESTHER OKAYA: (Swahili spoken).

WARNER: She says it was just a few mornings later that she was obliged to watch her youngest son, nine years old, shuffling back home. He was turned away by the teacher for not paying the fee. And then that's when she felt it. Like her heart seized up, and she couldn't breathe. At the health clinic the next day, a nurse did something to Esther that she'd actually never seen done before. She wrapped a rubber cuff around her arm that squeezed and beeped and spit out a number.

UNIDENTIFIED WOMAN: One hundred forty-eight.

WARNER: One hundred forty-eight over 90 - her blood pressure. She had hypertension which makes her more susceptible to heart attack or stroke when activated by stress. While hypertension is a condition that we might more readily associate with a 55-year-old office worker in Memphis, its' actually more prevalent in sub-Saharan Africa. It affects nearly 1 in 2 Africans over the age of 25.

And while genetic proclivity to salt retention may play a role in this, another factor is economic good news. As Africans earn more and move to cities and spend more on food, their risk factors start to look more Western. Dr. Catherine Kyobutungi is the health director for the African Population Health Research Center.

DR. CATHERINE KYOBUTUNGI: People eat either too many calories or they eat things that have too much salt in them. Or they eat things that have too much fat in them. And these are really prevalent in Western societies. But then if you go within those countries, actually that prevalence is higher among the poor, not the rich.

WARNER: Wealthier people in the West have access to better food, but also to better nutrition information. And that's the concern about Africa - not just that so many people here have dangerously high blood pressure, but that so few are told they do. And it's not like blood pressure cuffs are some exotic new technology here. Dr. Kyobutungi was using them 20 years ago in med school in Uganda.

KYOBUTUNGI: In Uganda - yes, of course. It was you routine. It was part of the general examination. But now you would be lucky if your blood pressure got measured in the public hospital.

WARNER: Today she says in any given hospital, you're more likely to find out your HIV status and get tested for malaria because that's where foreign donors have poured in the money and the supplies and the training.

So Dr. Kyobutungi came up with what seemed like a simple plan to solve this. People don't know they're hypertensive. So in 2008, she sent out health workers to screen a bunch of people, tell them their blood pressure numbers and offer them free medication.

KYOBUTUNGI: Free - completely free for about 18 months.

WARNER: Out of nearly 1,000 hypertensive patients she found in Korogocho slum, less than 3 percent accepted the free treatment. They knew they had hypertension, but they just didn't think it was important.

KYOBUTUNGI: So we need somebody who can constantly reinforce, you know, the message that, you know, if you don't get treated - even though you don't feel sick, but actually things are happening in your body. Your kidneys are getting damaged. Your eyes are getting damaged. Your heart is getting damaged.

WARNER: Like when you go to the doctor, and you have the talk about high blood pressure. And then you go home, and you hear the exact same message on some drug commercial on TV. Kenyans, she felt, needed that level of professional nagging. And she found someone to pull it off.

HELEN ONYANGO: (Laughter) We talk with people one-by-one to tell them you are ready to get paralyzed. You are ready to get stroke.

WARNER: That's what you tell them? You're ready to get paralyzed?

ONYANGO: Yes because the number is high.

WARNER: Helen Onyango is a community health worker. She lives in Korogocho slum. And if you're over 35 years old and happen to live anywhere near Helen, she has knocked on your door carrying a blood pressure cuff. She'll talk her way in, and explain to you what a blood pressure number is.

ONYANGO: And then you take the measurement there. You tell her yours is 200 over 100. You are sick.

WARNER: Now a pressure reading of 200 over 100 is comfortably in the zone of a hypertensive emergency. In the United States you'd be advised to immediately call 911. But Onyango's neighbors look at her, and then they look at her machine. And they say, me?

ONYANGO: Yeah? You, me - I'm OK. I'm not sick.

WARNER: Of course it's hard for anybody to take seriously a problem that you can't feel and that nobody is putting money into. So Catherine Kyobutungi at the Health Research Center decided that they themselves could add the economic incentive. They promised to pay community health workers an extra 100 shillings - about a dollar - for every patient they screened that actually showed up at the clinic, 50 cents if they came back a second time which health workers, like Mary Wanjiru, thought was a really great deal until she tried to earn it by getting these patients to the clinic.

MARY WANJIRU: I keep on going back to call them. They either not come that day. Maybe she shall or he shall come the next month. So you have to wait for him to come so that you can be paid for.

WARNER: And most patients, especially the men, kept them waiting forever. Helen Onyango, the first health worker we met, says she called and visited one high risk guy for months until the day he collapsed dead in the road. And even then she didn't quit.

ONYANGO: If somebody fall down and died, I take advantage to call another one.

WARNER: So if you got that, she says when one neighbor collapsed in the street with the apparent stroke or heart attack, Onyango would turn tragedy into opportunity, summoning another neighbor who boasted similar blood pressure numbers to the dead guy. And she'd tell them.

ONYANGO: You see John is dead. What about yours? Ah, take me to the doctor.

WARNER: That's pretty hard line tactics.

ONYANGO: Yeah. You see?

WARNER: It really is.

WARNER: And this kind of persistence went way beyond the $1 incentive. This was personal. Helen would've opened up her own rib cage if it were possible to show these men the blood clot impinging her aortic artery. It's the result of her own lifelong undertreated hypertension.

ONYANGO: When I walk, I'm feeling like - I'm feeling too tired.

WARNER: What makes hypertension such a killer in Africa is that if Helen Onyango were to have a stroke or heart attack tomorrow, there's no ambulance that's going to show up in time to save her. And though she's scheduled for bypass surgery, she admits that neither she nor her adult children can hope to afford it. When the surgery day comes, she's just planning to stay home in her one-room house of corrugated tin.

ONYANGO: 'Til now, I didn't get someone to help me. So they told me if not, your life is to be falled.

WARNER: Doctors don't give her long to live. And the same is true for millions of others. WHO scientists predict that in the next 15 years as African populations age, the death toll from chronic diseases like diabetes and cancer and, especially, hypertension will exceed the death toll from HIV and malaria combined.

But while Onyango no longer has much strength to knock on doors, she's proud that over the last two years, she and about a dozen community health workers - through nothing but the enduring power of badgering - increased the number of hypertensive patients under treatment in the slum from 3 percent - what it was in 2008 - to 17 percent today.

And that success has attracted the attention of people that have an even greater economic incentive than the community health workers. It's a group of people who, in the states, have perfected the art of schooling us in diseases we didn't know we had. Pharmaceutical executives are in talks with APHRC about scaling up the next group of Kenyans targeted for blood pressure screening from 8,000 households to 1 million. Now that's a market. Gregory Warner, NPR News, Nairobi.

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