StrokeINDIA: Stroke in India

StrokeINDIA: Stroke in India: A campaign aimed at raising stroke awareness in India

Stroke Scenario in India

Cerebrovascular disease and Stroke (Brain Attack) is the third leading cause of death in India, according to a joint report released in January 2013 by the Government of India and the Centres for Disease Control, Atlanta, US. More Indians die of cerebrovascular disease than due to tuberculosis, malaria, HIV/AIDS or road traffic accidents. Whereas there are national programmes for control of tuberculosis, HIV and malaria, there is no such programme for prevention and management of stroke and cerebrovascular disease in India.

The annual incidence of stroke in the country has increased from 13 per 100,000 in 1969 to 145 per 100,000 in 2006. The costs of acute care and managing these patients in long term are astounding. In another study, the overall DALYs (Disability Adjusted Life Years) lost due to stroke were 795.57 per 100,000 person years. This means that if 100,000 people were to live for one year, about 800 people will be disabled due to stroke and will not be able to go to work. Further, studies have shown that stroke and intracranial atherosclerotic disease is more common in people of Asian descent and occurs at a younger age.

Despite the explosive epidemic, there is little awareness among the people in India. Up to 80 per cent of strokes may be prevented by appropriate risk factor management. Stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. When a stroke occurs, it kills brain cells in the area surrounding where the clot or breakage occurs. A brain attack should warrant the same degree of emergency care as a heart attack. Immediate response is crucial because every minute matters – from the time symptoms first become noticeable to the time treatment is received, more brain cells die. In other words TIME IS BRAIN. Treatment of acute stroke should be made available in specialized stroke centres, as some options are most effective if administered within the first three hours after experiencing symptoms. Recognition of stroke and timely referral by a general practitioner to a stroke centre is crucial. Hence, it is also important to create awareness among general practitioners and physicians in other specialties.

Creating awareness about stroke and cerebrovascular disease involves assessment of the existing knowledge of people, assessment of the barriers to effective communication and the available resources, planning strategies to impart knowledge while overcoming the barriers, implementing the programme and periodic assessment of the effectiveness of the programme. In addition, collaboration between the physicians of various specialties such as neurology, neurosurgery, cardiology, diabetologists, general practitioners and physical therapists is essential for adequate control of the risk factors. Social media can also play an important role in spreading awareness among people and the physicians.

It is very important to organize specialized multidisciplinary stroke service in India. Typically, a hub and spoke model has been shown to provide the best service to a defined population and at the same time be cost-effective. Studies show that acute treatment is significantly less expensive than the costs of extensive rehabilitation and long-term care.

Unless a strong programme for control and management of cerebrovascular disease and stroke is brought in action, it is not long that it will be the cause of the highest number of deaths and disability. It is high time that the people and the physicians take necessary steps to curb the epidemic of stroke in the country.

Stroke in India

I have been wanting to start a stroke awareness campaign for the people in India for over a year now. I approached many magazines that claim they publish current medical news in India. I was turned down by most of them, although a couple of magazines published my articles. Finally, I decided to start my own blog so that I can write about the current scenario of stroke in India and what could we do collectively to counter the epidemic of stroke in India.

I am a neurosurgeon. I went to medical school at the prestigious JIPMER, Pondicherry and then for neurosurgery residency to NIMHANS, Bangalore. I then went on to do a year of cadaver and clinical research at the LSUHSC at Shreveport, Louisiana followed by a year of Endovascular neurosurgery fellowship at LSUHSC before coming to the University of Miami for the last year of endovascular fellowship. It has been a a long and arduous journey to say the least. 

During my fellowship, I had the opportunity to study the stroke management system in place in the United States and compare with that in India. I was appalled to know that strokes (ischemic and hemorrhagic) are more common in India than in the United States. Not only that there are no systems in place to treat stroke in India, the awareness among the people in India including the medical fraternity is lacking. Most people who call themselves educated, have heard about stroke only if one of their family members or friends suffered from it. The common notion of stroke in India is that it is a devastating condition that leads to paralysis of an arm or leg and that makes the person bed ridden. Many superstitions have been floated in the Indian culture that blame the person's sins either in the present life or the previous one, those committed by ancestors, involvement of supernatural beings, the specific configuration of stars and the person's fate as the cause of stroke. This list is by no means comprehensive as there is no end to imagination. I do not agree with any of these theories because their scientific basis is not proven yet.

In my coming posts, I will discuss the current scenario for stroke in India and the various components of a stroke program and how we, as the people of India can fight against one of the top three causes of death in India.

No program is successful without a team effort and I urge everyone interested in joining me in this campaign against stroke

Sudheer Ambekar