High Blood pressure cuff

Esther Okaya has a health problem that is a growing concern in Sub-Saharan Africa: high blood pressure. Gregory Warner/NPR hide caption

toggle caption Gregory Warner/NPR

Esther Okaya has a health problem that is a growing concern in Sub-Saharan Africa: high blood pressure.

Gregory Warner/NPR

Some blame witchcraft. Others think it's a bad batch of moonshine.

But Esther Okaya, who lives in Korogocho, a slum in Nairobi, Kenya, says even teetotalers are falling victim. One minute quarreling with a neighbor; the next minute, dead.

And it's happened to her.

Okaya's husband left her. He took the money for her children's school fees. A few mornings later, her 9-year-old son shuffled home after being turned away by the teacher.

And then she felt it. It was as if her heart seized up. She could not breathe.

At the health clinic the next day, a nurse did something to Okaya that she hadn't seen before: wrapped a rubber cuff around her arm that squeezed and beeped and spit out a number.

The number was 148.

148 over 90, her blood pressure. Esther Okaya, age 39, had hypertension, which made her more susceptible to heart attack or stroke.

While hypertension is a condition we might more readily associate with a 55-year-old office worker in an American city, it's actually more prevalent in Sub-Saharan Africa, affecting nearly 1 in 2 residents over the age of 25. Genetic proclivity to salt-retention may play a role. 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.

If you live near Helen Onyango, odds are she's knocked on your door and asked to take your blood pressure. The community health worker herself suffers from hypertension. Gregory Warner/NPR hide caption

toggle caption Gregory Warner/NPR

If you live near Helen Onyango, odds are she's knocked on your door and asked to take your blood pressure. The community health worker herself suffers from hypertension.

Gregory Warner/NPR

"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, " says Dr. Catherine Kyobutungi, health director for the African Population Health Research Centre (APHRC) in Nairobi.

The concern about Africa is not just that so many people 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. Kyobutungi was using them back in medical school.

"In Uganda, yes of course, " she remembers. "It was routine, it was part of the general examination. But now? You'd be lucky if your blood pressure got measured in a public hospital."

Today, she says, in any given African hospital you're more likely to find out your HIV status and get tested for malaria. Those are the diseases around which foreign donors have poured in money, supplies and training.

Kyobutungi came up with what seemed like a simple plan to solve this. In 2008 she sent out health workers to screen a bunch of people, tell them their blood pressure numbers and offer free medication if they needed it.

"Free, completely free, " she emphasizes. "For about 18 months."

Of the nearly 1, 000 hypertensive patients she found in Korogocho, fewer than 3 percent accepted the free treatment. They didn't think it was important.

"So you need someone who can constantly reinforce the message that if you don't get treated, even though you don't fall sick... things are happening in your body, " the doctor says. "Your kidneys are getting damaged, your eyes are getting damaged. Your heart is getting damaged."

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