“Understanding is the first step to acceptance, and only with acceptance can there be recovery”. -J.K. Rowling
Stroke has been a major cause of death in both developed and developing countries. As no two stroke cases are the same, the path to treatment and recovery is unique for each patient. Both developing and developed countries by now have identified, or are in process of identifying, strategies that can reduce mortality and aid in faster recovery for stroke patients. Amongst the identified strategies, the first and in fact most important is Creating Awareness. Many societies and associations have been developed and are working actively to create awareness about stroke treatment. Recently, I got the chance to visit one such congress organized by the World Stroke Organization, the “World Stroke Congress (WSC) 2016”. This indeed was an eye opener for me about the scenarios of stroke treatment and management, especially in developing countries like India. Below, I’ve shared some insights from WSC 2016 that helped me understand the current situation surrounding stroke management in India.
India, with a population of 1.3 billion, has a huge stroke patient pool and treating such a large patient pool with limited resources is indeed a big challenge. Around 1.7 million stroke cases happen in India every year. The challenge magnifies as we count the resources available. For example:
- There are around 1,200 practicing neurologists across the country, which is less than one neurologist per million people. Compared to more developed Asian countries with better stablished stroke care facilities, like Japan, this number is very small. Japan (population: 126 million) has almost 8,700 practicing neurologists; that is almost 68 neurologists per million people. This really showed me the need for an increasing number of expert physicians in India, who must be available round-the-clock.
- Similarly, if we compare the imaging capabilities available in each country, there are 3,000 and 600 CT- and MRI-capable facilities, respectively, in India, compared to 12,000 and 8,300 CT- and MRI-capable facilities in Japan, respectively.
- There are currently fewer than 40 specialized stroke care centers in India, whereas to bring it up to a level of efficient stroke management, at least 1,000 stroke care units are currently required. It is important that even the distant rural hospitals are aware of best practices and have experienced medical staff to tackle stroke cases.
- There are very few states where IV-tPA is given for free in hospitals, and even these specialized hospitals do not treat stroke patients at a high enough volume to improve their expertise.
- Getting the patient to a stroke unit in time is a big challenge. This includes challenges posed by heavy traffic and a lack of ambulance services well-equipped to tackle stroke cases.
- The cost of treatment and rehabilitation for stroke patients is a big concern in India.
Awareness in the public and the medical community is the next step required in efficient management of stroke cases. A small registry study presented at WSC 2016 showed that around 80% of patients first get admitted to nearby small hospitals and clinics that are not equipped to tackle stroke cases. Another study showed that almost 80% of the patients reached the stroke units by private transport and not by ambulances dedicated for stroke care. Since people are not aware of strokes and their symptoms, they tend to admit the patient in any nearby hospital or clinic instead of calling an ambulance and taking them to the nearest stroke center. Also, around 80% of the stroke patients who were brought to the main stroke treatment facility reached there after more than 6 hours. These data show that the people are unaware about stroke, what needs to be done at occurrence of an incident and what is the value of time for a stroke patient. It’s evident that there is a need to create more efficient infrastructure; however, I also agree that the first step of doing that is increasing awareness in both the public and medical community.
Despite these intense challenges, there have been some positive strides from the medical community in raising awareness and finding ways to be efficient and cost effective when managing stroke cases in India. WSC 2016 noted the efforts made by 6 physicians dedicated towards stroke care 24x7, in a small town named Akluj, in Maharashtra. For the efficient management of stroke treatment in a region, it is important that the hospitals in the region must have dedicated stroke facilities, where there is a cost-efficient thrombolysis facility, a 24x7 simple imaging facility at least, and the most important of all, availability of stroke experts 24x7. The doctors in Akluj have been successful in their efforts in arranging all of these requirements and the system has been very efficient in tackling all stroke cases, even in a small town with limited resources. This inspiring effort has been named the “Akluj Model”. Another inspiring case involves the application of telestroke in the state of Himanchal Pradesh. In this state, Himalayan mountain ranges and facilities available only at distant places made the management of stroke more challenging. As part of a Telestroke project launched in 2014, doctors in district hospitals within this state were trained in the management of stroke cases through workshops; IV-tPA was made available free of cost in all centers and 4 neurologists at 2 tertiary centers were available at all times for consultation to 12 district hospitals through phone and WhatsApp. The model has proven to be very successful in the management of stroke cases and can be applied to regions where travelling to larger stroke facilities is a big challenge.
The medical community in India has started understanding the need for and the challenges in stroke care and has initiated the search for ways to tackle these efficiently. However, there is lot more to achieve, and this is just a start.
“Understanding is the first step to acceptance, and only with acceptance can there be recovery.”
Follow Ashish Bhupal on Twitter at @Ashishb_DRG for additional medtech market insights.