When Joseph Rukelibuga was just about to land a new job with a big international organisation, he got the shock of his life. As part of the requirements to join the organisation, he was required to present a medical certificate to be allowed to commence work. “I went for a medical check-up, at the back of my mind knowing that all is fine since I had never been sick. I was shocked when the physician told me that I have diabetes and hypertension, both diagnosed at the same time,” he says. Rukelibuga, a retired veterinarian, public health specialist, and stroke survivor, narrates that previously, he used to work with a higher learning institution for eight years, and he never had any signs or symptoms that prompted him to seek medical attention. “Due to my busy schedule, I used to have fatigue, which is normally associated with too much work, just as many people would think,” he adds. Nine years down the line, Rukelibuga had a cerebrovascular accident/stroke), and upon check-up, it was discovered that he suffered from an ischemic stroke. Luckily, he was able to survive because of the immediate medical attention he received. He has been living with both hypertension and diabetes. In addition, the stroke also left him paralysed on one side of his body. Hypertension and diabetes While a big number of NCDs can be prevented, they still account for 44 per cent of all deaths in Rwanda, according to findings from Rwanda Biomedical Center (RBC), issued by officials last week during the NCDs Conference in Kigali. A two-day conference gathered over 500 participants including policymakers, non-governmental organisations, advocates, academia, and physicians as well as private sector players under the theme “Shaping an East Africa free of NCDs through people-centered interventions and transformative development”. Diabetes and hypertension are among a group of four major NCDs worldwide, including Rwanda. Hypertension is the most prevalent NCD in Rwanda with 16 per cent of the population having it. Three per cent have diabetes according to the nationwide studies conducted recently. Also, hypertension is one of the five leading causes of mortality in the world and a major risk factor associated with more than 40 per cent of deaths related to cardiovascular and renal diseases. The prevalence of hypertension in Rwanda is estimated to be 15.9 per cent and is expected to increase to 17.78 in 2025 due to existing risk factors that include imbalanced diets, physical inactivity, tobacco use, alcohol abuse, and other non-modifiable risk factors like age and family history. Because of its asymptomatic nature, Dr Francois Uwinkindi, the head of Non-Communicable Diseases at RBC, says many people with the disease remain undiagnosed and untreated thus resulting in increased premature and sudden deaths due to direct or indirect complications. Dr Uwinkindi says most people live with hypertension without knowing it, and that an estimated 46 per cent of adults with hypertension are unaware that they have the condition. Less than half of adults, 42 per cent, with hypertension are diagnosed and treated. Meanwhile, Dr Everiste Ntaganda, the cardiovascular disease officer at RBC, says the common complications of diabetes and hypertension are stroke, cardiovascular diseases, and kidney failure. “Getting treatment for hypertension and diabetes is important as they are also the risk factor for heart diseases, kidney failure, and stroke. When you treat hypertension and diabetes well, you are delaying those complications (heart, kidney failure, and stroke),” he points out. People who do not have hypertension or diabetes, Dr Ntaganda says, should avoid abuse of alcohol, smoking, physical inactivity, and obesity. Why physical rehabilitation is needed Since hypertension and diabetes can lead to many complications including stroke, Dr Christian Ntizimira, the founder and executive director of African Center for Research on End-of-life Care (ACREOL), says a patient might end up needing physical rehabilitation intervention as part of their continual treatment for life. He says physical rehabilitation interventions address functional deficits caused by impairments that affect someone’s performance. According to officials, the rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. It is also evident that strategies to address these issues include developing triage protocols and training community health workers and families. Dr Ntizimira says physiotherapy plays a big role when it comes to treating stroke. Studies have shown that stroke-related disabilities benefit from physiotherapy, and patients themselves tend to have high expectations of the extent of recovery they can achieve through physiotherapy. In Rwanda, physiotherapy (PT) services are available at 53 hospitals and four semi-private specialised rehabilitation centres. According to the Rwanda Allied Health Professional Council (RAHPC), 360 PTs are registered to practice in Rwanda, 88 of whom are employed at public facilities (Ministry of Health-Rwanda) whilst the others likely work in private hospitals or international non-governmental organisations. Also, prosthetic and orthotic services are available at four public hospitals and at four specialised rehabilitation centres.