The Health Department has drawn up a stroke management plan to train its physicians at secondary care hospitals in districts or taluks to recognise and stabilise stroke patients.

The department has also proposed a link-up with the tele-stroke unit at the Amrita Institute of Medical Sciences (AIMS) in Kochi using the telemedicine facility so that the trained physicians can consult AIMS whenever they need a specialist’s advice on managing a stroke patient.

A memorandum of understanding in this regard will be signed between AIMS and the National Rural Health Mission next month, senior health officials told The Hindu.

The third phase of the proposed stroke management programme, to be taken up under the National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), will be the setting up of stroke units in every district hospital, where the trained physicians will be in charge of the units.

“We have already initiated talks with tertiary care neurology specialty centres like the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), which is running a Comprehensive Stroke Care Programme, to train our physicians in district and taluk hospitals. The training programme will focus on imparting adequate skills to doctors in identifying stroke, stabilising a patient who comes with stroke before referring him to a suitable facility and in stroke rehabilitation,” Bipin Gopal, nodal officer in charge of the NPCDCS, said.

Telemedicine links

The health system has set up telemedicine links in 48 institutions and in 19 institutions, the links are working well. Initially, select telemedicine units in district hospitals will be linked to the tele-stroke unit at AIMS and the project will be scaled up in phases.

“This facility, which enables our doctors to seek expert advice round-the-clock in reading a patient’s CT scan or regarding the course of treatment, will boost their confidence when taking care of stroke patients and when they have to take charge of stroke units,” Dr. Gopal pointed out.

The State had made a head start in treating diabetes, hypertension, coronary artery diseases, and cancer under the NPCDCS. However, stroke management had always been on the back-burner, because the State’s Health Services has few neurologists and the physicians did not have adequate training to identify stroke cases.

Mortality and morbidity due to stroke is very much on the rise in the community, primarily because of the total lack of control of risk factors leading to stroke, failure to recognise stroke symptoms, and the delay in reaching an appropriate care centre which has a CT scan facility and a neurologist in attendance.

“Not more than 10 to 15 per cent of the people suffering stroke come to acute care centres like ours within the time window of four-and-a-half to six hours, within which we can try to reverse the deficit caused by the stroke. Beyond this time window, we can only attempt to prevent further damage. Stroke units are necessary in select secondary care hospitals because only patients with an acute stroke need the kind of emergency care that the SCTIMST or the MCH (Medical College Hospital) provides,” points out P. N. Sylaja, Additional Professor of Neurology, SCTIMST.

Physicians in secondary care hospitals can be trained very well to identify stroke signals, to immediately refer acute cases, and to medically stabilise and manage a patient to prevent further complications of the stroke, she said.

Awareness

Creating awareness in the community to recognise stroke signals and encouraging people to any unusual symptoms they may be experiencing — any abrupt or sudden feeling of weakness on one side, blurred vision, a momentary difficulty in speech, a sudden confusion or severe head ache — may bring more stroke victims within the golden hour to the hospital.

“With a majority of stroke victims reaching us sometimes as late as 12 hours, we are now focussing in a major way on stroke rehabilitation. The earlier one starts the process, the better, or else, there is significant decline in functional abilities and psychosocial status of patients. At SCT, as soon as the patient is stabilised, we identify the primary care giver and our stroke rehab team starts working with him or her to bring the patient back to a productive life again,” Dr. Sylaja said.

About 40 to 50 per cent of stroke patients will have moderate to severe disability for life. Good rehabilitation, with motivate caregivers, can help many return to work. However, the State does not have any comprehensive stroke rehab facilities now.