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Image: Archi Banal
Image: Archi Banal

SocietyJuly 31, 2023

Too many, too young: what’s behind the Pasifika stroke crisis?

Image: Archi Banal
Image: Archi Banal

The high number of Pasifika people experiencing strokes is a concern, but it’s also a symptom of a much bigger and more complex problem, as Sela Jane Hopgood writes.

When a 43-year-old father of Pacific descent had a mild stroke, he was prescribed high blood pressure medication and advised to live a healthier lifestyle, to hopefully avoid having another one. He began going to the gym and signed up for an eight-week weight loss challenge to keep him accountable. Things seemed to be going well. But on the last day of the challenge he suffered a more severe stroke and he was rushed in an ambulance to the hospital. The man has since not been able to return to the workforce and his family are now living in transitional housing.

Tai Faalogo, senior Pacific advisor at Stroke Foundation NZ, says there was a misunderstanding over the information given to the man, and that he stopped taking his medication as he assumed exercising daily was enough to manage his blood pressure.

Faalogo says this case is one of far too many. A concerning  number of Māori and Pacific people suffer from stroke, often at a relatively young age. Among Pasifika people, strokes have been known to occur in people aged as young as 20, with a significant number occurring in middle-age, whereas the European population generally starts experiencing strokes in the 70 to 75 age range.

A stroke, as the Foundation describes it, is a “brain attack”. It happens when a clot is blocking the blood flow to the brain or when a blood vessel bursts, resulting in bleeding into the brain. Over 9,500 strokes occur each year in Aotearoa, making stroke the country’s second biggest killer and the highest cause of severe adult disability. 

The issue of stroke in Aotearoa and within the Pacific community needs immediate attention, Stroke Foundation NZ believes, starting with an improved programme for blood pressure monitoring and targeted support for Pasifika people experiencing the impacts of stroke. Faalogo says many Pasifika people are either not having regular health checks (at least once a year) at their GP, therefore not detecting high blood pressure, or they chose to not take their medication for life. “Our people are so busy with large families, church, cultural responsibilities, and so finding the time to go see the doctors for a health check is a struggle until they end up really sick,” Faalogo says. The recommendation from the foundation is to prioritise getting a yearly health check for peace of mind.

The busy lives of many Pasifika people can lead to high levels of stress and not enough sleep, both of which can negatively impact one’s blood pressure. There is also a lot of salt found in processed food, as well as much-loved Pacific island dishes such as povi masima or beef brisket with a salty brine, an issue that disproportionately impacts poorer people. “A high moderation of salt in our diet can cause high blood pressure and stroke, and our Pacific families enjoy a lot of salt in our meals, and it’s cheaper to buy a large tray of takeaways to feed everyone when you’re tired from your day,” Faalogo says. Where you live, your economic situation and access to support services all play a part in the stress levels many Pasifika people face, so the complexity of strokes in the Pacific community is more than simply a health story.

Stroke Foundation NZ says that funding for their work is very low, and risks allowing vulnerable communities to fall through the cracks. The systemic underinvestment and inequity for Pacific communities in Aotearoa continues, and stroke prevention and care is an example of that. “The sooner we can address the problem, the sooner we can ensure we build healthier communities throughout the motu,” a statement from the Foundation reads. The group is working to encourage the government to put limitations for salt in place for food industries. “We want every food item produced in New Zealand to have a maximum limit of salt added, so that families don’t have to work it out for themselves,” Faalogo says. She adds that she spoke to Aupito William Sio, former Minister for Pacific Peoples, before he moved out of that role and Sio was supportive of the idea. But he is only one voice and they would need more than half of the government’s buy-in for it to have a chance of becoming law.

Most of the funding that Stroke Foundation NZ do receive is from their own fundraising, with the money going towards implementing healthcare solutions, running messaging campaigns, raising awareness and supporting families affected by strokes. “A common theme I hear from Pacific people who have strokes is that they wish they knew about the consequences of having a stroke and how it can change your life dramatically to the point where you could potentially not be able to talk clearly, which is called aphasia. [That’s] a language disorder where parts of the brain that control speech are damaged, [resulting in] paralysis of limbs, difficulty of gripping or holding items and so forth,” Faalogo says. “If we have more financial support, we can undergo community engagement initiatives and presentations to groups to raise awareness of stroke and risk factors.” There are poster materials on how to tell if someone is having a stroke in Sāmoan, Tongan and Cook Islands Māori.

Raising awareness in the community includes what happens when someone does recover from their stroke. “Some experience fatigue on a daily basis, and so sitting down at an office job won’t be ideal for that person,” Faalogo says, meaning that the foundation’s work also involves “assisting carers and family members of people who have had a stroke and making families understand the new normal and how to assist with recovery.”. Faalogo spends two of five working days in the blood pressure van that goes out into the community offering free blood pressure checks. “I encourage our people I see to ask questions if you don’t understand something,” she says, “whether it’s to their doctor or pharmacist regarding their blood pressure, wraparound support, medication and side effects, so that they don’t have an unexpected danger to their health.”

This is Public Interest Journalism funded through NZ On Air.

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