“My eyes were bulging, frozen in the state of a glazed stare. My hands were limp. My mouth was misaligned, and I was frothing,” she writes.

Her husband assessed her and concluded that she had suffered a stroke. She was rushed to hospital, where doctors began trying to establish what had happened. They asked about her medical history and lifestyle. Hellen had no history of diabetes or depression. She did not drink alcohol or smoke, and she did not eat red meat. In fact, she was a vegetarian.

Yet after a series of tests and scans, she was diagnosed with an ischaemic stroke. For Hellen, the diagnosis brought grief and disbelief. Like many people, she had associated stroke with certain familiar risk factors and could not easily reconcile the diagnosis with her own life. She writes about how stroke is often associated with obesity or poor eating habits, while others attribute it to witchcraft.

For her, however, the prayers of friends and family became an important source of strength as she remained in hospital receiving treatment.

Recovery did not end when she left hospital. She later attended physiotherapy and speech therapy sessions as she worked towards regaining her abilities. There was also the question of medication and the fear that came with it. As a nurse who had worked in the United States, Hellen was aware of the possible effects of some medicines when taken for long periods.

“I recalled that some drugs had adverse effects on organs like the liver and kidney if taken for too long,” Hellen writes.

But perhaps one of the clearest indications of what the stroke had taken from her came a week after she was discharged.

“A week after my discharge from the hospital, I went into the home office to catch up. To my horror, I soon realised that while the computer looked familiar, I couldn’t remember how to turn it on. The keyboard didn’t make any sense. I felt stuck. It was the first time I realised the grave damage the stroke had inflicted on my brain.”

The experience also changed how Hellen viewed stroke, particularly in women: “I was already in my early 50s. The research I have done since the stroke attack has revealed to me that that’s a time most people, especially women, are prone to being attacked by stroke. It is a time of hormonal turbulence in the female body, leading to psychological, physiological, and associative kinds of adjustments that, if not carefully managed, can trigger a stroke,” reads part of the book.

Her experience comes against a backdrop of findings showing a notable burden of stroke among women.

A recent study by the Stroke Association of Kenya (SAoK) conducted at the Kenyatta National Hospital and the Moi Teaching and Referral Hospital found that more women were diagnosed with stroke than men, at 58 percent and 43 percent respectively.

The same study found that ischaemic stroke accounted for 56 percent of the stroke cases, with women being the most affected at 58 percent and men at 41 percent. Haemorrhagic stroke accounted for 56 percent of cases in females and 44 percent in males.

The chairperson of the Kenya Stroke Society, Dr Kuria Waweru, a neurosurgeon and stroke specialist, defines stroke as a sudden occurrence that causes obstruction or damage to the blood vessels that supply the brain.

“And so if there’s any lack of oxygen, however limited in time, it causes significant damage. The second thing that is a huge problem is that the nerve cells, or neurones, hardly regenerate. They do not grow back,” he explains to BD Life.

Unlike the skin, which can heal after an injury, damaged nerve cells in the brain do not simply grow back to their previous function: “Time is brain; for every hour you lose, about four years of your life. And for every hour that passes when somebody has a stroke, they are losing time.”

The aim, Dr Waweru says, is to restore blood flow as quickly as possible, particularly to brain cells that have not yet died but remain at risk.

He says there are two main types of stroke. An ischaemic stroke happens when a blood vessel supplying the brain becomes obstructed, cutting off the flow of blood and oxygen to the cells beyond the blockage, while a haemorrhagic stroke occurs when a blood vessel tears and bleeding occurs in the brain. Both can cause significant damage, although through different mechanisms.

“Once you have an obstruction, then the cells downstream get destroyed because they depend entirely on the oxygen that is coming through the blood. And on the other hand, when you have this bleeding, then you have the cells that are clogged with blood or that are flooded with blood.”

Still, ischaemic strokes account for about 85 percent of cases and haemorrhagic strokes 15 percent in the West, as Dr Waweru puts it. In this region, however, there are higher cases of haemorrhagic strokes.

These have been attributed to a higher proportion of untreated vascular risk factors. Hypertension remains one of the biggest risk factors. Others include diabetes, high cholesterol, lack of exercise, smoking, too much alcohol and, sometimes, genetic risk factors. HIV is also a risk factor.

“Up to 20 percent of patients with a previous stroke come back with another stroke because the earlier risk factors have not been addressed,” Dr Waweru says, adding that having survived one stroke does not necessarily mean the danger has passed.

“Stroke can be sudden. Someone may be speaking normally and then, within moments, become unable to speak. Their face may droop, or they may suddenly develop weakness in an arm or leg on one side of the body.”

These are the signs to look for first if a stroke occurs: FAST. F for face, A for arms, S for speech and T for time, a reminder to seek emergency medical attention.

Yet people sometimes wait because they believe the symptoms will pass. Others turn to alternative medicine, spiritual healing or herbal options before seeking medical attention.

Dr Waweru points out that sometimes a stroke may appear with a transient ischaemic attack, or TIA, sometimes described as a warning or minor stroke. A person may experience weakness on one side of the body and then regain normal function within the same day after the blocked blood vessel opens on its own.

He notes that some patients commonly make a mistake by first going to smaller facilities and then spending considerable time waiting for imaging.

Dr Waweru says that while stroke can be more common in men at younger ages, the pattern changes in this region. Women tend to live longer overall and are also more likely to seek medical care.

One factor is pre-eclampsia and hypertension during pregnancy. Another is hormonal contraception, particularly combined oral contraceptives containing both oestrogen and progesterone, which can increase the likelihood of clotting and raise blood pressure.

“With the decrease of oestrogen levels, especially in menopausal years, the blood vessels can become stiff and get more prone to damage.”

The risk also increases as people move beyond their 40s, particularly among those with a family tendency towards high blood pressure. Children with conditions such as sickle cell disease may be particularly predisposed to stroke.

“There’s this huge misconception that stroke is for old people, which is very wrong. I have treated very young stroke patients, as early as 13 years. So it’s best to just keep on the lookout, regardless of the age.”

For everyone, some of the measures are straightforward: stop smoking, exercise more, reduce alcohol intake and avoid a sedentary lifestyle.

For primary prevention, reducing the risk among people who have never had a stroke, such as those with high blood pressure, diabetes or high cholesterol, needs to ensure these conditions are identified and controlled.

Dr Waweru cautions against giving aspirin or other medication at home before the person has been assessed. “When a stroke happens, there is little that can safely be done at home because it is not immediately possible to know which type of stroke a person has suffered.”