Thirteen of the 15 patients who were managed at the Stroke Unit in the Ernakulam District General Hospital (GH) over the last three years have successfully recovered from the disease without any manifestation of other complications.
The three-hour golden period within which almost all the patients were brought to the hospital was the most important part in managing the patients at the stroke unit with thrombolytic therapy using tissue plasminogen activator (tPA), says G. Manoj, general physician, heading the Stroke Unit.
The tPA works by dissolving the clot and improving blood flow to the part of the brain deprived of blood. In the case of two patients, there were doubts about the golden period that perhaps led them to take further treatment. The other 13 patients recovered with physiotherapy, without getting bed-ridden, says Dr. Manoj. The success story of the GH has pushed the government to set up stroke units in Thiruvananthapuram and Kozhikode too. The GH is a major tertiary care hospital for most of the population in West Kochi, Vyppin block and the main city area. The stroke unit that provides tPA free of cost to the patients was a big jump for the hospital inpatient care. In the absence of super-specialty services in the GH, this facility was made possible in partnership with a private hospital for super-specialty services through Telemedicine.
Telemedicine
The Department of Stroke Medicine, Amrita Institute of Medical Sciences, helped the trained physicians in the GH to assess the patient’s condition through the score of the National Institutes of Health Stroke Scale (NIHSS) and advised on the management through teleconferencing.
The GH also trained doctors at the peripheral hospitals in the district to identify stroke signs and emphasise on keeping the golden period so that the patients get the benefit of thrombolytic therapy.
As part of the training programme, all house surgeons in the GH undergo training at the NIHSS and they are issued a certificate, says Dr. Manoj. It is UK-based online certification programme for the stroke analysis score that determines whether tPA should be administered.
Shortage of medicine
The government departments had been found lax in ensuring that tPA is always available at the hospital. Even if the number of patients who reached the GH was small compared to the numbers in private hospitals, the fact remains that the availability of the thrombolytic medicine had been a problem in patches during the last three years of the facility.
The first five vials that were provided for the GH were replenished with three more, which lasted about 10 months. It was after a gap of over three months that the tPA vials were made available then. Again, now, for the last 3 months there is no tPA vial.
Apart from the medical colleges, only the GH, Ernakulam, and Pathanamthitta district hospital provide stroke management facility for the poor on a par with private hospitals.
The cost of tPA at the time of starting the stroke unit was said to be ₹48,000. However, bulk purchases could make it available for perhaps half the price, it is learnt.
Additional Chief Secretary (Health) Rajeev Sadanandan said the government would see to it that the medicine availability would be improved so that the poor are not deprived of proper treatment.
