Words from the President, January 2023

03 Feb 2023

Acute stroke care improved a lot in the last decades and now we have the possibility to treat the patients decreasing disability and mortality. Low- and middle- income countries face steep challenges in implementation of recent major advances and stroke extracts an increasingly high toll. Nowhere is this issue more pressing than Africa where the mortality and disability after stroke are particularly high and stroke afflicts patients at younger ages. For this reason Prof Mehari Gebreyohanns, born in Ethiopia and a great stroke leader at UT Southwestern University, Texas/US, approached me in February 2021 to help to implement acute stroke care in a pilot project in Ethiopia, a country with 113 million inhabitants, without stroke units and where the thrombolytic drug was not available. Challenge immediately accepted, we created the Africa Task Force inviting volunteers to participate, including our wonderful WSO Future Stroke Leaders (FSL), a program created and led by Prof Werner Hacke, Christopher Chen, and Valeria Caso, now with the addition of Prof Huge Markus in the leadership. The project would not be possible without the sponsorship of WSO, Boehringer Ingelheim and Allm Inc.

We started the pilot to organize 3 hospitals - Tibete Ghion and Felege Hiwot Hospital (Bahir Dar), and Tikur Anbessa (Addis Ababa). We had virtual meetings with the directors of hospitals and neurologists; evaluated the structure of the hospitals through the WSO online Roadmap and virtual visits; organized and trained the stroke teams; got donation for telemedicine app (Join App), with stroke neurologists volunteers from different countries connected to give support to the Ethiopian doctors in real time free of charge (Telestroke without borders project). We bought the thrombolytic medication in Brazil and through the support of the Brazilian Embassy in Ethiopia we sent the medication to the hospitals, that arrived in August 2022. Also we are collecting data to evaluate the effectiveness and the cost-effectiveness to implement the acute stroke care in the country (led by the FSL Alumni Dr. Ana Claudia de Souza).

I visited the country together with Prof Mehari and 2 stroke nurses on January 23 to 27, 2023 reviewing the structure, personal and stroke pathways in each hospital, giving training for stroke care including simulation, doing bedside rounds, activating the telestroke software and training the doctors for its use. Also we met the health managers for discussion about the project.

The 3 hospitals created stroke units, with an impressive very well organized and structured acute stroke unit in Tikur Anbessa Specialized Hospital launched in October 2022, thanks to a huge effort of our FSL from Ethiopia Dr Meron Gebrewold and the Head of Neurology Dr Hanna Demissie. On January 27, 1 day after our in person training, Dr Nigat at Felege Hiwot Hospital did the first IV thrombolysis in a public hospital in the country followed by Dr Mulugeta at Tibete Ghion Hospital few days after, showing the importance to be there in person.

It is a huge success project with a huge success visit to the country, crowned with the meeting with the Ministry of Health Dr Lea Tadessa, with the agreement to build a National Stroke Plan together with WSO. As we are working now in the pilot to demonstrate the benefit of implementing acute stroke care including thrombolytic therapy in a low income country, we plan to start with awareness campaign to the population and implementation of stroke units with well stablished protocols and multidisciplinary stroke teams in other hospitals.

We rely on the enthusiasm of our Future Stroke Leaders and FSL Alumni led by Dr Vasileious Lioutas; our Implementation Task Force led by Carlos Molina and Raul Nogueira; and our World Stroke Academy and Educational Committee led by Gustavo Saposnik and Gord Gubitz working together with other FSL Alumni Miguel Barboza to give in person support for the next steps of the project, for continuous educational program for the teams in prevention, acute care and rehabilitation and to support the telestroke without borders.

This is part of our Implementation Task Force and we hope to implement stroke care globally with the help of our WSO members.

Know more and join: https://www.world-stroke.org/news-and-blog/news/improving-access-to-quality-stroke-care-implementation-task-force

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