In a story that demonstrates that progress can be made on stroke everywhere, a prominent neurosciences research institute in Delhi, India, has been recognized for stroke care excellence with a Diamond level WSO Angels Award.
In India as in other parts of the developing world, providing re-canalization (clot removal) treatment for acute stroke has been a challenge. The administration rate for intravenous thrombolytic therapy, listed an essential medicine by WHO, is less than 1-3% in developing countries where stroke services are often not well established.
The achievement of the Department of Neurology at the Institute of Human Behaviour and Allied Sciences (IHBAS) in Delhi is therefore something we can all learn from. IHBAS launched its stroke programme in 2011 with the aim of implementing recanalization therapy for acute stroke. The tertiary level neurology centre is the region’s only government institute providing thrombolytic therapy for acute stroke, however the number of patients arriving at the hospital within the treatment window was very low. The decision was made to implement the ‘Saving the Brain’ initiative funded by the World Federation of Neurology (WFN) to increase awareness of acute stroke management among general physicians and healthcare workers and in the community.
A continuous, intensive sensitisation programme was rolled out for general physicians, resident doctors and paramedical staff at government hospitals. This included Stroke Continuous Medical Education (CME) with interactive sessions on acute stroke management and procedures for referring patients to stroke-ready centres for treatment. Community awareness programmes were also launched in various locations in East Delhi to educate the community about stroke symptoms and risks, and a stroke information sheet in Hindi and English was distributed in the community.
Creating awareness and educating medical and paramedical staff and the community about stroke symptoms and management has been an effective strategy for this government hospital. As a result of reaching out to the community, the rate of thrombolysis has more than doubled, exceeding expectations. At the same time, the hub and spoke model created by Dr Suman Kushwaha and her team in East Delhi has been instrumental in making thrombolysis available to more acute stroke patients, resulting in a thrombolysis rate of 5-7 %.
Since 2018, support from the Angels Initiative has helped facilitate and strengthen local action. Angels consultant Deepti Sawhney has evaluated the stroke pathway and protocols, facilitated hands-on stroke training for medical and paramedical staff, worked relentlessly with IHBAS to optimize the stroke pathway, and motivated stroke nurses and CT technicians to obtain stroke certification.
Deepti has encouraged the hospital to enrol in the quality monitoring registry, RES-Q, and prepared stroke nurse Sonal for the task of entering data into RES-Q. Her perseverance and passion for improving stroke care in this hospital deserves appreciation and recognition.
Her contribution has helped IBHAS become the only government hospital to achieve one Diamond and two Platinum WSO Angels Awards, and be recognized as one of the few stroke-ready centres in Delhi.
IHBAS Team Receive WSO Angels Diamond Award
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