Indwara Y'Umutima

Indwara z'umutima zivuga ibyiciro byinshi by'uburwayi bugira ingaruka ku mutima. Indwara z'umutima zirimo:

• Indwara z'imijyana y'amaraso, nka arteriosclerosis ya coronary.
• Gukubita kw'umutima kudakozwe neza, bizwi nka arrhythmias.
• Uburwayi bw'umutima wavukanye, bizwi nka uburwayi bw'umutima bwavutse.
• Uburwayi bw'imikaya y'umutima.
• Uburwayi bw'amavavu y'umutima.

Uburyo bwinshi bw'indwara z'umutima bushobora gukumirwa cyangwa kuvurwa hifashishijwe imibereho myiza.

Ibimenyetso by'indwara y'umutima biterwa n'ubwoko bw'indwara y'umutima.

Indwara y'imitsi y'umutima ni indwara y'umutima igaragara cyane ikaba igira ingaruka ku mitsi minini itanga amaraso ku gikomere cy'umutima. Akenshi indwara y'imitsi y'umutima iterwa no kubura amavuta, cholesterol n'izindi ntungamubiri mu bice by'imitsi no ku ruhande rw'inkuta zayo. Iyo mibiri itera ikibazo cyitwa plaque. Kugira plaque mu mitsi bita atherosclerosis (ath-ur-o-skluh-ROE-sis). Atherosclerosis igabanya umuvuduko w'amaraso ajya ku mutima n'ahandi mu mubiri. Bishobora gutera ikibazo cy'umutima, kubabara mu gituza cyangwa gucika intege.

Ibimenyetso by'indwara y'imitsi y'umutima birimo:

• Guhumeka nabi.
• Kubabara mu ijosi, mu menyo, mu munwa, mu nda hejuru cyangwa mu mugongo.
• Kubabara, kubabara, intege nke cyangwa gukonja mu maguru cyangwa mu maboko niba imitsi y'amaraso muri iyo bice y'umubiri yagabanutse.

Ushobora kutamenya ko ufite indwara y'imitsi y'umutima kugeza ubwo ubonye ikibazo cy'umutima, angina, gucika intege cyangwa gucika intege kw'umutima. Ni ngombwa kwitondera ibimenyetso by'umutima. Ganira n'abaganga bawe ku bijyanye n'ikibazo icyo ari cyo cyose. Indwara y'umutima ishobora kuboneka hakiri kare ukoresheje isuzuma rya buri gihe.

Stephen Kopecky, M.D., avuga ku bintu byongera ibyago, ibimenyetso no kuvura indwara y'imitsi y'umutima (CAD). Menya uko guhindura imibereho bishobora kugabanya ibyago byawe.

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Indwara y'imitsi y'umutima, izwi kandi nka CAD, ni indwara igira ingaruka ku mutima wawe. Niyo ndwara y'umutima igaragara cyane muri Leta Zunze Ubumwe za Amerika. CAD ibaho iyo imitsi y'umutima ihangayikishijwe no gutanga amaraso ahagije, ogisijeni n'ibindi biribwa ku mutima. Ibintu bya cholesterol, cyangwa plaques, bigira uruhare runini. Ibyo bintu bigabanya imitsi yawe, bigabanya umuvuduko w'amaraso ajya ku mutima wawe. Ibi bishobora gutera kubabara mu gituza, guhumeka nabi cyangwa no kugira ikibazo cy'umutima. CAD bisanzwe bimamara igihe kirekire. Rero akenshi, abarwayi ntibabizi kugeza ubwo habaye ikibazo. Ariko hari uburyo bwo gukumira indwara y'imitsi y'umutima, n'uburyo bwo kumenya niba uri mu kaga n'uburyo bwo kuyivura.

Kumenya CAD bitangira uganiriye na muganga wawe. Azashobora kureba amateka yawe y'ubuzima, gukora isuzuma rya physique no gutegeka amaraso asanzwe. Bitewe n'ibyo, ashobora kugutegurira ibizamini bimwe cyangwa byinshi bikurikira: electrocardiogram cyangwa ECG, echocardiogram cyangwa isuzuma ry'umutima rya soundwave, ikizamini cyo kwihanganira umunaniro, catheterization y'umutima na angiogram, cyangwa cardiac CT scan.

Kuvura indwara y'imitsi y'umutima bisobanura guhindura imibereho yawe. Ibi bishobora kuba kurya ibiryo byiza, gukora imyitozo ngororamubiri buri gihe, kugabanya ibiro birenze urugero, kugabanya umunaniro cyangwa kureka kunywa itabi. Inkuru nziza ni uko ibyo bihinduka bishobora gukora byinshi mu kunoza ibyiringiro byawe. Kubaho neza bisobanura kugira imitsi myiza. Iyo bibaye ngombwa, kuvura bishobora kuba imiti nka aspirine, imiti ihindura cholesterol, beta-blockers, cyangwa uburyo bumwe bwo kuvura nka angioplasty cyangwa kubaga imitsi y'umutima.

Umutima ushobora gukubita vuba cyane, buhoro cyangwa nabi. Ibimenyetso by'umutima bidakora neza birimo:

• Kubabara mu gituza cyangwa kudakorwa neza.
• Kuzenguruka.
• Kugwa cyangwa hafi kugwa.
• Guhumeka mu gituza.
• Kugira umutwe.
• Gukubita kw'umutima.
• Guhumeka nabi.
• Gukubita kw'umutima buhoro.

Uburwayi bw'umutima bwavutse ubwo umwana avuka ni indwara y'umutima ibaho kuva umwana avuka. Uburwayi bukomeye bw'umutima buva ku ivuka busanzwe buhita bugaragara nyuma y'ivuka. Ibimenyetso by'uburwayi bw'umutima bwavutse ku bana bishobora kuba:

• Uruhu rw'ubururu cyangwa rwera. Bitewe n'irangi ry'uruhu, ibyo bihinduka bishobora kuba byoroshye cyangwa bigoye kubibona.
• Kubyimba mu maguru, mu nda cyangwa mu maso.
• Ku mwana, guhumeka nabi mu gihe cyo konsa, bigatuma adatera ibiro.

Uburwayi bumwe bw'umutima bushobora kutagaragara kugeza nyuma y'ubwana cyangwa mu gihe cy'ubukure. Ibimenyetso bishobora kuba:

• Guhumeka nabi cyane mu gihe cyo gukora imyitozo ngororamubiri cyangwa ibikorwa.
• Kunanirwa vuba mu gihe cyo gukora imyitozo ngororamubiri cyangwa ibikorwa.
• Kubyimba mu ntoki, mu birenge cyangwa mu birenge.

Mu ntangiriro, cardiomyopathy ishobora kutagira ibimenyetso bigaragara. Uko iyi ndwara ikomeza kuba mbi, ibimenyetso bishobora kuba:

• Kuzenguruka, kugira umutwe no kugwa.
• Kunanirwa.
• Kumva uhumeka nabi mu gihe cyo gukora imyitozo ngororamubiri cyangwa uhagaze.
• Kumva uhumeka nabi nijoro mu gihe ugerageza gusinzira, cyangwa ukangukira uhumeka nabi.
• Gukubita kw'umutima kwihuta, gukubita cyangwa guhumeka.
• Kubyimba mu maguru, mu birenge cyangwa mu birenge.

Umutima ufite imivalve ine. Izo mivavalve zifungura kandi zifunga kugira ngo zimurike amaraso mu mutima. Ibintu byinshi bishobora kwangiza imivalve y'umutima. Niba imivalve y'umutima yagabanutse, bita stenosis. Niba imivalve y'umutima iretse amaraso asubira inyuma, bita regurgitation.

Ibimenyetso by'indwara y'imivavalve y'umutima biterwa n'imivavalve idakora neza. Ibimenyetso bishobora kuba:

• Kubabara mu gituza.
• Kugwa cyangwa hafi kugwa.
• Kunanirwa.
• Gukubita kw'umutima bidakora neza.
• Guhumeka nabi.
• Kubyimba mu birenge cyangwa mu birenge.

Niba ufite ibi bimenyetso by'indwara y'umutima, shaka ubufasha bwo kuvura ibyago byihuse:

• Kubabara mu gituza.
• Guhumeka nabi.
• Kugwa cyangwa gutakaza ubwenge. Irinde guhamagara 911 cyangwa nimero y'ibikorwa by'ubutabazi byo mu gace k'iwanyu, niba utekereza ko ushobora kuba ufite ikibazo cy'umutima. Niba utekereza ko ushobora kuba ufite ibimenyetso by'indwara y'umutima, tanga gahunda yo gusuzuma ubuzima bwawe. Indwara y'umutima iroroshye kuvurwa iyo iboneka hakiri kare.

Impamvu z'indwara z'umutima ziterwa n'ubwoko bw'indwara y'umutima. Hari ubwoko bwinshi bw'indwara z'umutima.

Umutima usanzwe ufite ibyumba bibiri byo hejuru n'ibyumba bibiri byo hasi. Ibyumba byo hejuru, ari byo atria y'iburyo n'ibumoso, byakira amaraso yinjiye. Ibyumba byo hasi, ari byo ventricles y'iburyo n'ibumoso, bikomeye kurushaho, bipompa amaraso ava mu mutima. Amavalvule y'umutima ni imiryango iri ku mwinjiriro y'ibyumba. Arafasha amaraso kugenda mu buryo bukwiye.

Kumenya impamvu z'indwara z'umutima, bishobora gufasha kumenya uko umutima ukora.

• Umutima ufite ibyumba bine. Ibyumba bibiri byo hejuru byitwa atria. Ibyumba bibiri byo hasi byitwa ventricles.
• Iruhande rw'iburyo rw'umutima rwohereza amaraso mu mwijima binyuze mu mitsi y'amaraso yitwa pulmonary arteries.
• Mu mwijima, amaraso abona ogisijeni. Amaraso yuzuye ogisijeni ajya ku ruhande rw'ibumoso rw'umutima binyuze mu mitsi y'amaraso yitwa pulmonary veins.
• Iruhande rw'ibumoso rw'umutima ripompa amaraso binyuze mu mutsi mukuru w'amaraso w'umubiri, witwa aorta. Amaraso nyuma ajya mu bindi bice by'umubiri.

Amavalvule ane mu mutima afasha amaraso kugenda mu buryo bukwiye. Aya mavalvule ni:

• Aortic valve.
• Mitral valve.
• Pulmonary valve.
• Tricuspid valve.

Buri valvule ifite ibice, byitwa leaflets cyangwa cusps. Ibi bice bifunguka kandi bifunga rimwe mu gihe cy'umutima uri gukubita. Niba igice cya valvule kidafunguka cyangwa kidafunga neza, amaraso make ava mu mutima ajya mu bindi bice by'umubiri.

Sisitemu y'amashanyarazi y'umutima ituma umutima ukubita. Ibimenyetso by'amashanyarazi by'umutima bitangira mu itsinda ry'uturemangingo hejuru y'umutima, bitwa sinus node. Binyura mu nzira iri hagati y'ibyumba byo hejuru n'ibyo hasi by'umutima, bitwa atrioventricular (AV) node. Kugenda kw'ibimenyetso bituma umutima ukomera kandi upompa amaraso.

Niba hari cholesterol nyinshi mu maraso, cholesterol n'izindi ngutu zishobora gukora ibintu byitwa plaque. Plaque ishobora gutuma umutsi ugabanuka cyangwa ugafumbana. Niba plaque icitse, amaraso ashobora gukora. Plaque n'amaraso ashobora kugabanya amaraso anyura mu mutsi.

Kwiyongera kw'ibinure mu mitsi y'amaraso, byitwa atherosclerosis, ni yo mpamvu isanzwe itera indwara y'imitsi y'umutima. Ibintu byongera ibyago birimo indyo idakwiye, kutagira imyitozo ngororamubiri, umubyibuho ukabije, no kunywa itabi. Guhitamo ubuzima bwiza bishobora kugabanya ibyago bya atherosclerosis.

Impamvu zisanzwe ziterwa na arrhythmias cyangwa ibibazo bishobora kubitera birimo:

• Indwara y'umutima, yitwa cardiomyopathy.
• Indwara y'imitsi y'umutima.
• Diabete.
• Ibiyobyabwenge bitemewe nka cocaine.
• Umujinya mwinshi.
• Alkohol cyangwa kafeyi nyinshi.
• Ibibazo by'umutima biriho kuva umwana avutse, byitwa congenital heart defects.
• Kunywa itabi.
• Indwara y'amavalvule y'umutima.
• Imiti imwe, ibimera n'ibindi byongerwamo.

Congenital heart defect ibaho mu gihe umwana ari gukura mu nda. Abaganga ntibabona neza icyo giterwa na congenital heart defects nyinshi. Ariko impinduka za gene, uburwayi bumwe, imiti imwe, n'ibintu by'ibidukikije cyangwa imibereho bishobora kugira uruhare.

Impamvu ya cardiomyopathy iterwa n'ubwoko bwayo. Hari ubwoko butatu:

• Dilated cardiomyopathy. Ni bwo bwoko busanzwe bwa cardiomyopathy. Impamvu akenshi iba itazwi. Bishobora kuba byarazwe mu muryango, bivuze ko byarazwe.
• Hypertrophic cardiomyopathy. Ubwo bwoko busanzwe burazwa mu muryango.
• Restrictive cardiomyopathy. Ubwo bwoko bwa cardiomyopathy bushobora kuba nta mpamvu izwi. Rimwe na rimwe, kwiyongera kwa proteine yitwa amyloid bibitera. Izindi mpamvu zirimo indwara z'umubiri.

Ibintu byinshi bishobora gutera valvule y'umutima yangiritse cyangwa irwaye. Bamwe bavukana indwara y'amavalvule y'umutima. Ibi nibibaho, byitwa congenital heart valve disease.

Izindi mpamvu z'indwara y'amavalvule y'umutima zishobora kuba:

• Umuvuduko w'amaraso.
• Amazi mu mutima.
• Indwara y'imitsi y'umutima.
• Kugira umutima munini cyane.
• Indwara y'imitsi y'amaraso.
• Indwara z'umubiri.

Ibintu byongera ibyago by'indwara z'umutima birimo:

• Imyaka. Gukura kurema ibyago by'imitsi y'amaraso yangiritse kandi yagabanyijwe ndetse n'umutima udakomeye cyangwa wakomeye.
• Ibitsina byatanzwe ugiye kuvuka. Abagabo bafite ibyago byinshi byo kurwara indwara z'umutima. Ibyago ku bagore byiyongera nyuma y'ihindagurika ry'imihango.
• Amateka y'umuryango. Amateka y'umuryango afite indwara z'umutima yongera ibyago by'indwara z'imitsi y'amaraso, cyane cyane niba umubyeyi yarayirwaye akiri muto. Ibyo bivuze mbere y'imyaka 55 ku mugabo, nka musaza wawe cyangwa se wawe, na 65 ku mugore, nka nyoko cyangwa mushiki wawe.
• Itabi. Niba unywa itabi, reka. Ibintu biri mu muriro w'itabi yangiza imitsi y'amaraso. Ibitero by'umutima biba kenshi mu bantu banwa itabi kurusha abantu batanywa.
• Imirire mibi. Imirire ifite amavuta menshi, umunyu, isukari na kolesiterole byahujwe n'indwara z'umutima.
• Umuvuduko ukabije w'amaraso. Umuvuduko ukabije w'amaraso utabarizwa ushobora gutuma imitsi y'amaraso ikomeye kandi ikagira ubugari. Izi mpinduka zihinduranya umusaruro w'amaraso ujya ku mutima no mu mubiri.
• Kolesiterole y'ikirenga. Kugira kolesiterole y'ikirenga byongera ibyago bya aterosklerose. Aterosklerose yahujwe n'igitero cy'umutima n'impanuka z'ubwonko.
• Diabete. Diabete yongera ibyago by'indwara z'umutima. Gutakaza ibiro no kugira umuvuduko ukabije w'amaraso byongera ibyago bya diabete n'indwara z'umutima.
• Gutakaza ibiro. Kurenga ibiro bisanzwe bituma ibindi bintu byongera ibyago by'indwara z'umutima biba bibi.
• Kubura imyitozo. Kudakora siporo bihujwe n'uburyo bwinshi bw'indwara z'umutima ndetse na bimwe mu bintu byabyo byongera ibyago.
• Umuvuduko. Umuvuduko w'amarangamutima ushobora kwangiza imitsi y'amaraso no gutuma ibindi bintu byongera ibyago by'indwara z'umutima biba bibi.
• Ubuzima bubi bw'amenyo. Kugira amenyo n'umunwa udakomeye bituma microbes zinjira mu maraso zikagera ku mutima. Ibi bishobora gutera indwara yitwa endokardite. Kwoza no gukuraho umwanda ku menyo kenshi. Kandi ujye ukora isuzuma ry'amenyo buri gihe.

Ingaruka zishoboka z'indwara y'umutima ni:

• Gucika intege kw'umutima. Iyi ni imwe mu ngaruka zisanzwe cyane z'indwara y'umutima. Umutima ntushobora kubumba amaraso ahagije kugira ngo uhuze n'ibyo umubiri ukeneye.
• Igitero cy'umutima. Igitero cy'umutima gishobora kubaho iyo igice cy'ikibyimba kiri mu mubabura cyangwa umuvuduko w'amaraso ujya ku mutima.
• Impindurwa mu bwonko (Stroke). Ibintu byongera ibyago byo kurwara umutima bishobora kandi gutera impindurwa mu bwonko (stroke) yo mu bwoko bwa ischemic. Ubu bwoko bwa stroke buva mu gihe imitsi ijya mu bwonko ihindagurika cyangwa igafungwa. Amaraso make cyane agera mu bwonko.
• Aneurysm. Aneurysm ni ububare mu rukuta rw'umubabura. Niba aneurysm itize, ushobora kugira kuva kw'amaraso mu mubiri bishobora kuba bibi cyane.
• Indwara y'imitsi yo ku ruhande (Peripheral artery disease). Muri iyi ndwara, amaboko cyangwa amaguru — akenshi amaguru — ntabona amaraso ahagije. Ibi biterwa n'ibimenyetso, cyane cyane ububabare mu kirenge igihe ugenda, bita claudication. Atherosclerosis ishobora gutera indwara y'imitsi yo ku ruhande.
• Guhagarara k'umutima kudasubirwaho (Sudden cardiac arrest). Guhagarara k'umutima kudasubirwaho ni ukutakaza umurimo w'umutima, guhumeka n'ubwenge by'akanya gato. Bisanzwe biterwa n'ikibazo kiri mu mikorere y'amashanyarazi y'umutima. Guhagarara k'umutima kudasubirwaho ni ubutabazi bw'ubuvuzi. Niba bitavuwe vuba, biviramo urupfu rutunguranye rw'umutima.

Impinduka z'imibereho imwe n'imwe ikoreshwa mu gucunga indwara z'umutima zishobora kandi gufasha kuyikumira. Gerageza ibi bintu byiza ku mutima:

• Kureka itabi.
• Kurya indyo ikennye mu mukunyu n'amavuta yuzuye.
• Gukora imyitozo ngororamubiri byibuze iminota 30 kumunsi, hafi iminsi yose y'icyumweru.
• Kugira ibiro bikwiye.
• Kugabanya no gucunga umunaniro.
• Kuryama uhagije. Abakuze bagomba gushaka amasaha 7-9 buri munsi.

Kugira ngo umuganga amenye niba ufite indwara y'umutima, azakureba kandi yumve umutima wawe. Ubusanzwe azakubaza ibibazo ku birebana n'ibimenyetso ufite, ndetse n'amateka yawe n'ay'umuryango wawe mu bijyanye n'ubuzima.

Hariho ibizamini byinshi bitandukanye bifashishwa mu kumenya indwara y'umutima.

• Ibizamini by'amaraso. Uduce tumwe na tumwe tw'imitima buhoro buhoro twoherezwa mu maraso nyuma y'uko umutima wangiritse bitewe n'igitero cy'umutima. Ibizamini by'amaraso bishobora gukorwa kugira ngo harebwe utwo duce. Ikizamini cya C-reactive protein (CRP) gifite ubushobozi bwo kubona ibintu byinshi, kireba proteine ifitanye isano n'uburwayi bw'imitsi y'amaraso. Ibindi bizamini by'amaraso bishobora gukorwa kugira ngo harebwe urugero rwa kolesterol na sukari mu maraso.
• X-ray y'ibituza. X-ray y'ibituza igaragaza uko ibihaha bimeze. Ishobora kwerekana niba umutima waragwiriye.
• Electrocardiogram (ECG cyangwa EKG). ECG ni ikizamini cyihuse kandi kidakomeretsa, cyandika ibimenyetso by'amashanyarazi mu mutima. Ishobora kugaragaza niba umutima ukubita cyane cyangwa buhoro.
• Gukurikirana kwa Holter. Uburyo bwa Holter ni igikoresho cya ECG gifashishwa mu kwambara iminsi umwe cyangwa irenga kugira ngo harebwe imikorere y'umutima mu bikorwa bya buri munsi. Iki kizamini gishobora kugaragaza imikorere idasanzwe y'umutima idagaragara mu isuzuma rya ECG isanzwe.
• Echocardiogram. Iki kizamini kidakomeretsa gikoresha amajwi kugira ngo hakorwe amashusho arambuye y'umutima uri gukora. Igaragaza uko amaraso anyura mu mutima no mu mivure y'umutima. Echocardiogram ishobora gufasha kumenya niba umuvure w'umutima ufunganye cyangwa ucika.
• Ibizamini byo gukora imyitozo ngororamubiri cyangwa ibizamini byo kwishima. Aya bizamini akenshi bisaba kugenda kuri tapis roulant cyangwa kugendera kuri velo ihagaze mu gihe umutima uri gukurikiranwa. Ibizamini byo gukora imyitozo ngororamubiri bifasha kugaragaza uko umutima uhangana n'imikorere y'umubiri niba ibimenyetso by'indwara y'umutima bigaragara mu gihe cyo gukora imyitozo ngororamubiri. Niba udashobora gukora imyitozo ngororamubiri, ushobora guhabwa imiti igira ingaruka ku mutima nk'uko imyitozo ngororamubiri ibikora.
• Cardiac catheterization. Iki kizamini gishobora kugaragaza inzitizi mu mitsi y'umutima. Umuyoboro muremure, mucyeya kandi woroshye witwa catheter winjizwa mu mubiri, ubusanzwe mu gatuza cyangwa mu kuboko, ukajyanwa ku mutima. Ibara ritembera muri catheter rigana mu mitsi y'umutima. Ibara rifashwa kugira ngo imitsi y'amaraso igaragare neza ku mashusho ya X-ray afashwe mu gihe cy'ikizamini.
• Heart CT scan, izwi kandi nka cardiac CT scan. Mu isuzuma rya cardiac CT scan, uba uhagaze ku meza uri mu mashini isa nka donut. Umuyoboro wa X-ray uri muri iyo mashini uhindukira hafi y'umubiri wawe ukusanya amashusho y'umutima wawe n'ibituza byawe.
• Heart magnetic resonance imaging (MRI) scan. Cardiac MRI ikoresha ikirango cya magnétique n'amajwi ya radio yakozwe na mudasobwa kugira ngo hakorwe amashusho arambuye y'umutima.

Ubuvuzi bw'indwara z'umutima biterwa n'icyateye iyo ndwara n'uburyo umutima wangirikiye. Ubuvuzi bw'indwara z'umutima bushobora kuba burimo:

• Guhindura imibereho, nko kurya indyo ikennye umunyu n'amavuta yuzuye, gukora imyitozo ngororamubiri, no kutakira.
• Imiti.
• Igenzura ry'umutima.
• Kugira umutima.

Ushobora kuba ukeneye imiti yo kugenzura ibimenyetso by'indwara z'umutima no gukumira ingaruka mbi. Ubwoko bw'imiti ikoreshwa biterwa n'ubwoko bw'indwara y'umutima.

Bamwe mu bantu barwaye indwara z'umutima bashobora kuba bakeneye igenzura ry'umutima cyangwa kubagwa. Ubwoko bw'ubuvuzi biterwa n'ubwoko bw'indwara y'umutima n'ingano y'akaga kageze ku mutima.

"Dore uburyo bwo gufasha gucunga indwara z'umutima no kunoza ubuzima: Gukosora umutima. Iyi ni gahunda yihariye y'uburezi n'imyitozo ngororamubiri. Irimo imyitozo ngororamubiri, inkunga yo mu mutima n'uburezi ku bijyanye n'ubuzima bwiza bw'umutima. Gahunda ishyirwaho kugenzura ikunze kugirwa inama nyuma yo kurohama kw'umutima cyangwa kubagwa umutima. Amatsinda y'inkunga. Kwifatanya n'inshuti n'umuryango cyangwa kwinjira mu itsinda ry'inkunga ni uburyo bwiza bwo kugabanya umunaniro. Ushobora gusanga kuvugana ibibazo byawe n'abandi bari mu bihe nk'ibyawe bishobora kugufasha. Kora isuzuma buri gihe. Kubonana n'umuganga wawe buri gihe bigufasha kugenzura neza indwara y'umutima."