Blockading blood vessels, ruptured blood vessels in the brain causes strokes and it has become the number two killer in the world and alarmingly it takes the fourth place in Sri Lanka.
But, as these patients are prematurely sent home from hospitals and some are being treated with indigenous medicine the number of deaths at home and under the care of indigenous medical practitioners are not known and if proper statistics are compiled it might take catastrophic proportions where stroke would be the number two or number three killer in Sri Lanka.
Dr (Ms) Padma S Gunaratne MD (SL) FRCS (Glasg) FCCP, Consultant Neurologist, Head of Stroke Unit, Colombo National Hospital and President, National Stroke Association of Sri Lanka (NSASL) told the Asian Tribune there is only 10 beds allocated for stroke patients at the National Hospital and another 30 beds are allocated at the Kurunegala Hospital.
She said that due to the lack of accommodation for the stroke patients, a procedure has been adopted to discharge stroke patients prematurely to take in the most serious cases. A very unhappy situation as proper medical and other care, these patients could be recovered to original state.
She said that avoid this dangerous situation, all district hospitals should allocate accommodation (beds) and medical personnel to cater to stroke patients and though they used to diagnose by talking to patients of the history, CT scanning is paramount importance to differentiate the stroke patients and heart patients and also whether vessels in the brain is blocked or ruptured. So, the CT Scanning apparatus is an essential component in all district hospitals in the country.
Under these serious circumstances, NSASL celebrates the World Stroke Day on 29 October.
Dr Gunaratne said that they have National Stroke Association of Sri Lanka and it was formed in 2001. At the same time the government declared last Sunday of the month of February every year as National Stroke Day earlier. From that time onwards they were having the “Stroke Walk” on the National Stroke Day.
There is also the International Stroke Society and World Stroke Federation. These two bodies were amalgamated to be one body with the name and style “World Stroke Organization” in 2004.
While Dr (Ms) Gunaratne is the President, NSASL, Dr Harsha Gunasekera is the Secretary, NSASL. The National Body consists of not only top ranking medical personnel as directors and members of the Society, but also leading personalities in the country. Some of them are Hatton National Bank present Chairman, Rienzie Wijeratne, Chairman, Helpage, Tilak de Soyza and there are bankers, chartered accountants, media personalities and so on. Dr Gunaratne is also a board member of the World Stroke Organization.
WSO publishes its Official Journal - International Stroke Journal to which they used to contribute the reports of studies and activities. Each year it conducts its annual conference and the next annual conference is scheduled to be held in Korea. WSO promotes activities in all the countries to promote care for stroke patients. This year they have come up with a theme for the world Stroke Day and the theme is “Stroke, What can I do”.
Dr Gunaratne said “The meaning of that is, we all, may be as individuals or as groups or as governments should do something for strokes, such as either to give care for stroke patients or spread the information with regard to the primary and secondary prevention of strokes or even for the people hit with the stroke to at least support those individuals who care stroke patients and support the activities to save those lives”.
WSO as well as NSASL want to spread the information that stroke is catastrophic but that could be prevented and that it is treatable. There is a lot of misconception among the public as well as among the medical profession that nothing could be done for stroke. But in actual fact there is a lot that can be done for prevention and that there is a lot that could be done to minimize the risk. If those hit with stroke could be brought to the hospital within 4.5 hours or as early as possible. There is a lot that could be done to those with stroke, Dr Gunaratne pointed out.
Much also could be done to those hit by stroke through a multi-disciplinary team consisting of doctors, nurses, physiotherapists, speech-therapists, social workers and counselors to help the patient as well as the care-givers.
In keeping with that course of action they have arranged a series of activities in Sri Lanka in collaboration with the Ministry of Health care and Nutrition and the World Health Organization (WHO) for the first time. WHO will provide NSASL with sponsorship.
Dr L Panapitiya, Director, Non-Communicable Diseases and Dr Anil Dissanayake, Director Youth, Elderly, Disabled and Displaced they both from the Ministry of Health join these activities.
To mark the World Stroke Day there will be a function and organized a series of activities. Nimal Siripala de Silva, Minister of Health Care and Nutrition will be the Chief Guest at the function while Dr Athula Kahandalihanage, Secretary to the Ministry of Health Care and Ms V Jegarajasingham, Secretary to the Ministry of Social Services and Social Welfare will be guests of honour.
Among the activities they have arranged is to disseminate knowledge among medical professionals to tell them how to prevent manage and care stroke patients. Dr Gunaratne said “We have selected 10 patients and they would be offered the benefits of social service. Five among them would get re-employment and one person would receive Rs 100,000 to build a house and two others would receive tricycles and wheel chairs”.
She said that they have also motivated the Ministry of Social Services to appoint 4 social workers and four counselors to four hospitals to serve the stroke patients. They also have prepared a documentary film to be telecast through a leading government TV channel which is of 10 minute duration that depicts the symptoms of stroke patients as well as the risk factor. The staff of the National Hospital Stroke Unit will also be performing a play that would provide information with regard to risks involved.
Another important thing that happens in the celebrations of the World Stroke Day would be the NSASL promoting and drawing the national stroke strategy
In our country there is a difference in activities because in all the developed countries when they offer care for stroke patients there are voluntary social workers and counselors to help in the multi-disciplinary chain. In Sri Lanka, in the first place, there are no well established stroke units.
In National Hospitals they have only 10 bets and there are 20 beds in the Kurunegala Hospital. In addition to this 30 bets there are no beds allocated for stroke patients in Sri Lanka.
Not only that the Social Services Ministry Social Welfare Unit offer lot of benefits for stroke patients. They have a varying types of facilities. They give support to develop access for the houses. They offer re-employment if the stroke patient is disabled. There are also the monthly allowances - Rs 3,000 given to families if the breadwinner of the family is disabled due to stroke. There are a lot of facilities offered by the Social Services Ministry.
But what has been lacking all this time is a proper co-ordination between the two ministries – Ministry of Health and the Ministry of Social Services . “In our country we do not have social workers attached to hospitals”, she said. They do not have counselors attached to hospitals and the lack of coordination prevented reaching these facilities meant for these stroke patients.
The National Stroke Association has now become a catalyst in coordinating these two ministries. Therefore there would be more and more activities towards ‘stroke’ this time. NSASL is now attempting to give maximum information about the symptoms, management and how to prevent strokes. They have got an additional director, Sunil Samaraweera to take part from Social Service Ministry and he will disseminate information about the services available for the stroke patients.
They are actually significant achievements for NSASL as it is pushing through these activities that would possible prevent deaths and disabling stroke patients and due to the coordination of these two ministries which would bring in lot of relief.
All over the world, stroke is the second leading cause for death. In Sri Lanka it is the fourth leading cause, but statistics have not been accurately compiled as some of these patients die while taking indigenous medical treatment. There may also be occurring deaths out of those whom the hospitals discharge prematurely.
Because they do not have sufficient number of beds those stroke patients are prematurely discharge to give way to more serious patients and most of those discharged would die at home or under indigenous medical treatment. This is a serious situation and it is not fair by them. Ten percent of stroke patients die within one month, 50 percent are left disabled by six months and 30 percent only would recover completely. It is a devastating condition, as if properly attended it may be that all could have been saved, Dr Gunaratne lamented.
Strokes hit due to two reasons. One is all cells in the body need to have a good blood supply and if the blood vessel suddenly gets blocked and if the blood is not supplied the blood vessel becomes dysfunctional and if the blood supply is not restored in time the person would die or would have complications. Eighty percent are affected this way and the balance 20 percent they get it when a blood vessel gets ruptured.
When a blood vessel is ruptured there is a flow of blood leading to the brain and due to the pressure there would be damages to the brain cells. In either case, the symptoms would be the paralysis of half of the body, hands legs etc. When the right side of the body is affected then the speech could get affected and it may be ones ability to talk or understand or both.
Dr Gunaratne said that when it comes to affect the mouth, they would find it difficult to swallow and they lose control of bladder and bowel functioning. In some cases they lose vision and remain one half of the visual only. In some of the patients all of a sudden they might feel giddy and vertigo and might see double and might lose balance in walking and then become unable to walk. If there is blood in the brain then there will be head ache.
The diagnosis would be mostly by talking to the patient and eliciting the history. But it is most important that they have the CT Scan of the brain to differentiate blocking of blood vessel infarction or hemorrhage (rupture). To differentiate they have to have a CT Scanning.
In Sri Lanka they do not have an adequate number of CT Scanning apparatus placed in all districts and Dr Gunaratne said that they cannot be happy of that as that would prevent them giving the necessary care for the stroke patients and also they are far behind, compared to some countries.
- Asian Tribune -
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