Dr Shirish Hastak, Regional Director – Neurology, Stroke and Neurocritical Care, Global Hospital, Mumbai highlights that while awareness of stroke symptoms is crucial, access to adequate stroke care is equally important. Easy access to stroke care technology and treatment by trained medical personnel can enhance the likelihood of recovery and help improve the quality-of-life post-recovery
The burden of non-communicable diseases in India has risen in the last few years. Moreover, the increase in brain stroke incidences has also been notable, with almost a 100 per cent growth in cases between 1996 and 2019.
Strokes can be fatal or can lead to paralysis and should be treated as soon as possible. The ‘golden window’ for the treatment of stroke is considered to be 4.5. hours, beyond which certain therapies would not help reverse the damage to the neurons. While awareness of stroke symptoms is crucial, access to adequate stroke care is equally important. Easy access to stroke care technology and treatment by trained medical personnel can enhance the likelihood of recovery and help improve the quality-of-life post-recovery.
The state of stroke care infrastructure in India
According to NITI Aayog, there is an infrastructural gap that exists which acts as a major hindrance when it comes to timely stroke care access. An estimated 75 per cent of the Indian healthcare infrastructure is concentrated in urban areas, even though only 27 per cent of the Indian population lives there[i].
Medical care infrastructure in India is plagued by inadequate investment and a lack of training. Government healthcare expenditure between 2020 and 21 was just 1.8 per cent of GDP. As a result, the paucity of medicines, outdated equipment, and overburdened infrastructure make access to quality medical care difficult.
As district-level medical infrastructure is often inadequate, patients need to move to cities for urgent treatment. Out-of-pocket expenditures for travel and medical treatment, which is very common in India, put a great strain on their finances.
Additionally, stroke treatment outcomes are often dependent on a 4.5-hour ‘golden period’, and travel can take up precious time and hamper the chances of recovery.
Building adequate stroke care infrastructure: A need of the hour
It is estimated that every 40 seconds, one Indian suffers a stroke, and one stroke death occurs every 4 minutes in the country. 30 minutes, a stroke patient dies or is permanently disabled due to lack of proper medical treatment. Often, patients suffer due to delays, such as pre-hospital delay, i.e., onset-hospital delay, and in-hospital delay, i.e., door-to-needle delay. This problem can, at least, partially, be solved by building stroke care centers across the country.
Stroke care centers are vital to providing timely treatment to patients. A center must possess, along with trained medical professionals for treatment and rehabilitation, medical equipment such as MRI machines for carotid ultrasound and transcranial Doppler procedures[ii].
The medical equipment needed can be expensive and special training is required for professionals to operate it. Apart from physical infrastructure, upskilling medical professionals are also needed to address the unmet needs for robust stroke care. Healthcare interventions such as Angels Initiate are dedicated to improving stroke patients’ chances of survival and a disability-free life. These programs train thousands of healthcare professionals to better take care of stroke patients. They are a step in the direction of strengthening the stroke care infrastructure in the country.
In 2010, the Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke in 100 districts across 21 states nationwide. The initiative aimed to assist early diagnosis of NCDs and spread awareness of the factors behind the rise of stroke and other diseases. Collaboration between the public and private sectors is vital as a partnership-based framework can drive long-term sustainable healthcare models in India. It can aid state-led programs by helping to spread awareness of the condition of stroke.
According to the Indian Stroke Association, local doctors account for 51 per cent of the first medical contact for stroke patients[iii]. However, it is imperative that these doctors should have the appropriate training on recognizing and managing stroke, and most importantly, doctors receive timely upskilling. This is where a public-private partnership can improve local-level healthcare and create a more stroke-ready infrastructure.
At present, the Indian Stroke Clinical Trial Network has been created to conduct small and large clinical trials and research studies to advance acute stroke treatment, stroke prevention, and recovery and rehabilitation following a stroke. It comprises 55 regional centers involving 55 hospitals across India.[1] However, the road to a robust stroke-ready infrastructure is a long way ahead.
The presence of an adequate number of stroke-care centers across the country can alleviate such delays and thousands of lives. Many effective stroke care models globally have enabled patients to access better healthcare and experience better treatment outcomes. A few notable examples are:
Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)[2]: The TRANSIT-Stroke network covers an area of 10,500 kilometers in northwest Bavaria, Germany. It consists of 12 hospitals with varied levels of stroke care expertise. They have been categorized at Level 1, Level 2, and Level 3 respectively, depending on the severity of the cases.
The National Stroke Program (NHS)[3]: NHS England and Stroke Association, UK developed the National Stroke Programme in 2019. The program aims to reduce stroke mortality and disability, as well as the burden of stroke on families, caregivers, and society as a whole. Under the program, the NHS announced integrated stroke delivery networks (ISDNs) in all areas of England to bring services together to design optimal stroke pathways, from pre-hospital to early supported discharge (ESD), community specialist stroke-skilled rehabilitation, and life after stroke support.
As the burden of stroke cases in India grows, ensuring better treatment outcomes and patient experiences becomes paramount. Sustained intervention and collaboration from all key stakeholders including government and private entities- is necessary to adopt a holistic approach towards stroke care.
References:
[1] https://instructnetwork.in/
[2] https://www.ukw.de/en/clinical-departments/networks/transregional-network-for-stroke-intervention-with-telemedicine-transit-stroke/
[3] https://www.england.nhs.uk/ourwork/clinical-policy/stroke/
[i] https://pubmed.ncbi.nlm.nih.gov/12047509/
[ii] https://www.ahajournals.org/doi/10.1161/01.str.0000170622.07210.b4
[iii] https://www.mjdrdypv.org/article.asp?issn=2589 8302;year=2020;volume=13;issue=5;spage=431;epage=436;aulast=Adukia