Addressing stroke care disparities in India

15 Jul 2022 Stroke awareness Stroke prevention

The Dr Bindu Menon Foundation was established in 2013 with a key part of its mission to reduce the treatment gap for stroke and epilepsy by reaching out to resource poor areas. Here, the organization’s founder, Dr Bindu Menon shares the journey so far.

Context

India is facing an increasing burden of non-communicable diseases (NCDs), with incidence and prevalence of stroke a key driver of this burden. This warrants specific attention towards stroke prevention, with increased public awareness of how to prevent stroke an urgent need across India. A major challenge in India is the treatment gap, with large numbers of the population not able to access treatment and care. This is due to barriers including lack of knowledge among the population, poor healthcare facilities and socio-economic conditions.

Our response

Student awareness

The Dr Bindu Menon Foundation focuses our activities on all levels i.e. primordial, primary, secondary and tertiary. Our journey began with awareness programmes in schools and colleges extending to various social organizations. Students form the back bone of a healthy society and it is important that our coming generation be healthy. We educate the school and college students about prevention of stroke by teaching them about the importance of preventing hypertension, diabetes, obesity, physical inactivity, unhealthy diet, smoking and alcohol. We seek to find out from them about what they already know about stroke and epilepsy, talk about why some behaviours have risks and how they can reduce their risk.

We have completed 195 such awareness programmes educating more than 35,000 people as of today. These programmes include those at the schools and colleges, as well as at social organizations and corporate offices, and with the general public in urban and rural settings.

Health camps

The foundation started free monthly health camps in 2013. These include consultation, medicines, blood tests and physiotherapy. We have been able to complete 188 camps and have supported more than 100 stroke patients below the poverty line. We always encourage our patients to get empowered through knowledge. Over the years, we have witnessed a sea change in not only the patients' health but also the family making progress back to a healthier life.

Neurology on Wheels

The health camps were based in the city, and we became increasingly aware that we were only reaching those stroke patients who could travel to the foundation every month. The Indian population is still predominantly rural and there is a huge rural/urban disparity in stroke care. Poor transport facilities and low priority for stroke due to lack of awareness increases the stroke burden. We therefore established ‘Neurology on Wheels’ our project in rural areas where we travel to the resource poor areas in our van.

A village is identified from the 46 mandals (sub districts) and the village head is consulted about the camp in advance. We request the village sarpanch (decision maker) to update the community health workers about the proposed activity. These are the trained female community health activists - Accredited Social Health Activist (ASHAs), the Anganwadi workers (child and mother care centres) and the auxiliary nurse midwives (ANMs). These community health workers are all trained to act as health educators and promoters in their communities.

The Neurology on Wheels programme has three elements:

We Reach - reaching patients in resource poor rural areas that lack specialized neurology care. This saves the community time and cost in accessing health facilities.
We Teach - after reaching the village, the awareness programme is held for all the people attending the camp. The talk is tailored to stroke risk factors, recognition of symptoms, importance of time, first aid for epilepsy and education myths and facts. The importance of medicine compliance is emphasized.
We Treat – we screen for hypertension and diabetes, and identify people who have had a stroke. Height and weight are checked and their BMI is calculated. Individuals are counseled regarding their stroke risk and individuals that are not accessing medicines due to cost are supported by the foundation.

Neurology on Wheels has screened more than 12,000 patients, visiting 34 villages with detection and treatment of new/drug naive cases of hypertension (362), diabetes (95) and stroke (126).

Tele health initiatives

We are now complementing Neurology on Wheels with our Tele Awareness Programme. A toll-free number can be dialed and important information can be listened to. This initiative is of immense help especially in the rural sector where almost every household has a phone. This initiative is the first of its kind in the country for health awareness.

India has a shortage of rehabilitation centers for post stroke care and almost none in the rural areas. The foundation has launched physiotherapy exercises for stroke recovery in the form of a free app “Stroke Help”. This is accessible to stroke patients where rehabilitation services are inaccessible. There are 17 lessons specific to stroke deficits; passive and active limb exercises, handgrip and dexterity, positioning of the limbs, turning and mobilization, visual training and balance exercises.

Recognition

I have recently been the proud recipient of several awards in recognition of my work and the contribution of the foundation:

Mridha Spirit of Neurology Award 2022 from the American Academy of Neurology and American Brain Foundation 2022
American Academy of Neurology A.B. Baker Teacher Recognition Award, 2022
Lions Club International President’s Appreciation certificate and Governors Appreciation Award 2021

As the journey continues, we look forward to having more ideas, collaborations and joint ventures to collectively join in the fight against stroke.

Visit Stroke Connector to watch Dr Bindu Memnon’s World Stroke Congress 2020 presentation ‘Using Technology in Rural Communities’

For more information visit: www.drbindumenon.com

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