What Stroke Patients Deserve

22 Mar 2012

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Delta State Commissioner for Culture and Tourism, Mr Richard Mofe-Damijo

Recently, the Delta State Commissioner for Culture and Tourism, Mr Richard Mofe-Damijo, blamed “excessive stress” for the death of veteran actor, Sam Loco Efe. His death may be due to stroke. Again, death stealthily walked into the Yoruba movie community and plucked an actress, Yemi Yusuf in 2010. Yusuf, who had featured in several movies, apparently died of stroke in Ogun State. You would know or be aware of someone close to you who has had a stroke. Stroke has touched the life of every single Nigerian.

Stroke is a medical emergency and immediate medical treatment can go a long way in repairing and salvaging the brain at risk. Stroke causes injury because vital nutrients are not delivered to the brain and so the tissue dies. Medical people have been promoting the need for quick presentation and early treatment using the slogan ‘time is brain’, you waste time, you lose brain.

In fact, many developed communities have a system of getting the patient to the doctor in the shortest possible time. This time is called the ‘door to needle’ time and should be less than 3 hours.

It is the time when the person suffering a stroke should get to the doctor and have an injection to treat the stroke. Many patients in Nigeria present late, but even if they do present in good time, many hospitals cannot administer the required medications for a whole lot of reasons.

The limited resources, manpower shortage, lack of an organized stroke unit, poor neuro-imaging facilities, lack of ambulance services, poor education of patients and general practitioners as well as impracticable use of thrombolytics are contributory. Training of stroke experts in collaboration with experts in the developed world with provision of neuro-imaging facilities would improve the outlook of stroke management in Nigeria. That is a fact.

The stroke burden

Stroke is now the third leading cause of death in most industrialized countries, among adults aged 65 years or more. Stroke causes significant disability and death in many countries and places a huge financial burden on health services. It is a significant economic, social and medical problem all over the world.

The population of Nigeria exceeds 150 million people. If we assume an average stroke incidence of 116 per 100,000 of the population in Nigeria, then 174,000 people suffer a stroke in Nigeria yearly. Using figures from Sagamu, Nigeria, it can be estimated that roughly 34% (n = 59,160) will die within a month and 60% (n=104,400) within six months. This therefore is a huge problem in Nigeria.

Who can afford a stroke?

In Nigeria, the impact on the local economy and the financial burden of stroke in Nigeria has not been estimated. The size of the problem appears to be underestimated by the government as no actual publications or statements exist acknowledging the impact of stroke on the health of the nation. A more up to date and current information on the magnitude of the stroke problem in Nigeria is needed. Majority of the stroke costs are borne by individual families. There is the need to evaluate the percentage of patients dependent on carers and the yearly expenditure on hospital stay, home rehabilitation as well as information on the loss of income for the patient and carers. No one, no matter how rich can afford to have a stroke.

This is one problem that medical tourism to India, South Africa or the United Kingdom cannot solve. Once you have had a stroke, you are at risk of further strokes and early death.

Where do we go from here?

Stroke is a preventable and treatable condition, but the management of stroke patients in Nigeria is sub-optimal. Specialised stroke units are not available. Neuro-imaging centers are very few and access limited by cost and distance. We need to do something about these.

However, the main focus in Nigeria must be on preventive strategies and ways to harness local resources in the acute treatment of stroke patients. Health education of the community with emphasis on control of the predisposing factors, especially hypertension, would reduce the burden of stroke in the country. Risk factor management should begin in childhood, with emphasis on exercise, nutrition, weight and blood sugar control, avoidance of tobacco and excessive alcohol.

Public awareness programs are very important. Studies have shown that delays in presentation are caused mostly by lack of awareness of stroke. All patients within the age range and with a high stroke risk should know the symptoms of stroke. A Nigerian Neurologist, Dr Olajide Williams, is making huge impact in America by involving musicians and children in stroke knowledge. Using hip hop music, children now know that ‘face drooping, arm weakness, slurred speech’ indicate stroke and they must ‘telephone’ (FAST) the doctor immediately. We need the media to educate the people in ways they will understand.

The entertainment industry must partner with doctors and government to evolve the necessary campaign.

The need to present early for evaluation, treatment and prevention of further attacks must be discussed at various levels. Information about stroke should be made widely available to the public. The local press, celebrities and television personalities should be educated on the risks of stroke and the importance of wide public awareness. Stroke issues should be introduced in schools, churches, mosques, plays on television, in the theatre and brought to national attention. Health talks as well as the use of posters and radio jingles would assist in re-education of relatives of stroke patients and the community at large.

What do patients deserve?

Our patients deserve timely access to quality services appropriate to their needs. There are significant deficiencies in the provision of services such as diagnostic, treatment, rehabilitation and support services. Patients and their care givers want to be looked after by knowledgeable staff that understand the full range of their needs. The diagnosis and treatment should be explained to patients and relatives by competent staff. There should be provision for regular communication and sharing of information should be encouraged between staff and patients and their relatives through constant health talks, radio jingles and use of flyers. Patients need to be closely involved in development of local services and lobbying of government officials for assistance.

No one person can claim to understand the full requirements of the patient and multidisciplinary care is of importance. Medical personnel should seek information and advice from colleagues and other staff without prejudice.

•Ogungbo is a consultant neurosurgeon at Cedarcrest Hospital, Abuja

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