Volume 9(3), Jul-Sep. 2012

STROKE IS A BRAIN ATTACK

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Rural Stroke 1

From the Editor’s Desk 2

SFB Events 2

Readers Column 3

Join Forces to Prevent Stroke 3

Stroke disability is higher in rural population due to lack of Rehabilitation facilities

Rural StrokeStroke is a major cause of death and disability

It is a fact that in rural India basic stroke care facilities are minimum, in terms of

access to the doctors, nurses and paramedical staffs including rehabilitation personnel.

To reduce incidence, mortality, disability and burden of stroke in rural areas, proper

strategies should be directed to mass awareness with regular stroke campaign in line

with global stroke campaign and it should be started “ACT NOW”. The modalities may

vary from place to place, but regular seminars with Video presentation in different rural

thAs we approach 29 of October which is earmarked as World Stroke Day, we need

to sit back and give a few thoughts about the real spectrum of Stroke in India Worldwide. 87% of stroke deaths occur in low and middle income countries where 80% population lives in rural areas. There are different criteria for differentiating a rural from urban area. In terms of “Human Development Index” India belongs to Middle Human Development Countries (MHDC) group of countries. As per the recent census more than 70% of India's population lives in the rural sector. But stroke does happen to the rural people also. Even in the US stroke prevalence in rural areas is one and half times higher than the urban areas. Canada and some European countries report similar statistics. Even in countries like Australia stroke deaths are more in rural than urban areas.

Reports from India are inadequate. Crude prevalence rates vary from urban area of 44 per 1 lac in Rohtak to 220/1iac in Mumbai and 147/1 lac in Kolkata compared to rural rates of 143/ 1 lac in Kashmir, 126 in Malda (West Bengal) to 57/1 lac in Vellore. In India disease epidemiological data are insufficient and incomplete as most people especially women do not seek proper medical help during sickness. Indian data about stroke mortality in urban locality vis a vis rural is lacking. The very factors which determine death rates in terms of health care facilities and access to the same as well as social beliefs leave more people disabled and crippled due to stroke in the rural world. As of stroke disability proper data is lacking from rural India whereas USA has documented higher disability amongst its rural population probably because of lack of access to rehabilitative facilities as well as preventive measures. Among the risk factors undiagnosed and inadequately treated hypertension is the commonest cause. Moreover tobacco use among rural people is very high. Further the proportion of women tobacco users is higher in rural than urban areas.

In our country imaging facilities (especially CT scanners) are not readily available in remote areas causing delay in diagnosing treating stroke. Moreover the strategy of stroke management is not uniform. Where the doctor population ratio is around 1:30,000,there is an acute crisis of skilled physicians and health care workers. This compounded with the dearth of transport facilities for the sick leaves a lot to be desired in terms of stroke care. Here is the place for “telestroke” to be developed. This would help link the remote villages with tertiary level hospitals and allow the direct interaction between the village physicians with stroke specialists in cities so that appropriate interventions and referrals along with rehabilitation and preventive strategies can be formulated. Technology can make stroke management easier and uniform across this vast country with its diverse socioeconomic conditions and cultural beliefs.

ACT FASTF

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Time is Brain.

ace Ask the person to smile

Does one side of the face drop?

rms Ask the person to raise both arms

Does one arm drift downward?

peech Ask the person to repeat a simple sentence

Does the speech seem slurred?

ime If a person develops any one of these stroke symptoms, then act urgently for his treatment as

Recognise STROKE...

Cont. on Page 3

Dear readers,

Dr. A. Shobhana

thWe bring you one more issue of this bulletin ahead of the World Stroke Day, 29 Oct, 2012.Hearty

congratulations to the residents of Bolpur who have together formed the first branch of SFB at Bolpur. By this our efforts to spread stroke education to the interiors of West Bengal will take a concrete shape. This year's slogan of World Stroke Day is “Because I care…”.This aims to involve especially the caregivers in spreading the stroke information to the masses to dispel the misconcepts about stroke. This bulletin bears this campaign poster like in the previous years. We continue our efforts to strike out stroke by igniting the knowledge of the preventable aspects of this disease. We appeal to all of you to be aware of the rising lifestyle diseases especially the silent epidemic of stroke. Please do contribute to this bulletin in the form of suggestions, writings, sharing your story and posting your queries. I will try to keep this bulletin as informative as possible.

From the editor's desk

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Every sixth second someone dies of stroke

This year the sixth foundation day celebrations of the Stroke Foundation of Bengal was held at the Dafodil Hospital, Kolkata. As a run up to the main function a diabetes and hypertension screening camp was held by SFB at the Dafodil Hospital, Kolkata on 23.6.12 where about thirty people were screened. The participants were informed about the importance of screening of Hypertension and Diabetes, and also they were provided with leaflets and stroke bulletin of

thSFB. The main function, held on 24 June.2012 began with an opening song by Ms. Antara Mandal. In her secretarial address Dr. A. Shobhana highlighted SFB's activities in the year gone by, specially the formation of Bolpur Branch of SFB this year. She stressed upon the importance of more such units so that the under served rural Bengal gets better stroke services. This would pave the way for Tele-stroke to be

SFB Events

established. The program was inaugurated with lightning of the lamp by Sri Tapas Roy, Honb'le MLA, who in his inaugural speech recalled his long association with Prof. Mandal and admitted that he was quite in the dark about the activities of SFB. The people in general are in darkness about Stroke and should come to the light so that importance of stroke malady are recognized properly. He promised all possible help to SFB in its activities to fight stroke devastation, including to taking up this issue of stroke devastation at the level of the Chief Minister, who is also the Health Minister of West Bengal. This year's souvenir was released by Sri Sujit Bose, Hon'ble MLA and the Chief Guest, who has been associated with SFB's programs in the past as well. He also assured of all help to SFB and expressed his wish to take up the Issue of stroke at the government level

Sixth Foundation Day of Stroke Foundation of Bengal

Inauguration by lighting the lamp by Shri Tapas Roy,

Hon'ble MLA

Cont. on Page 3

Interactive discussion among experts and the audience

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Acute Stroke can be treated and rehabilitated subsequently

jointly with Sri Tapas Roy. Dr. R. D. Dubey, the President of the Indian Medical Association, Bengal State Branch, the Special Guest of the occasion reiterated the alarming rise in non-communicable diseases (NCDs) and how in >80% cases stroke can be prevented. He assured SFB all help on behalf of the IMA. Sri Arun K. Sarkar, the Managing Director of Dafodil Hospital has expressed interest in setting up a stroke centre at Dafodil in collaboration with SFB. The President of SFB in his address appealed to Government and non governmental organizations to seriously consider the solutions to the stroke devastation, one of which is connecting all parts of West Bengal and India in a telestroke network, which is the only answer to this lack of stroke services in a country with limited resources. The SFB documentary on World Stroke Day 2011 and the 1 in 6 campaign was screened during the program. There was a lively interactive session on stroke and life style diseases where the audience's queries were answered by a panel of experts including neurologist, internists neurosurgeon, paeditrician and rehabilitation consultant. The program concluded with the vote of thanks by Sri. Bhaskar Layek.

Radio program

And the Bolpur branch of SFB was inaugurated

That the majority of stroke incidences are being contributed by developing countries and other aspects of stroke including 1 in 6 was explained in details by Dr.

thA. Shobhana the secretary of SFB on 19 september 2012, in a live radio broadcast in Bengali on stroke prevention and management as a part of Public Health Education program (“Sustha Bharat” meaning Heathy India), a co-production of the Ministry of Health & Family Welfare & Prasar Bharati, Government of India.

The formal inauguration of the Bolpur Branch of SFB took place in the rural and historical town of Bolpur, district of Birbhum in the state of West Bengal, in the presence of a Cabinet Minister of West Bengal, Member of Parliament, present & past members of West Bengal Legislative Assembly and Indian Medical Association The program was well attended by a large gathering. There was an associated program of screening of Hypertension, Diabetes and ECG changes. Prof. D. K. Mandal, Founder-President of Stroke Foundation of Bengal was invited to deliver a talk on stroke awareness in rural Bengal.

Prof.D.K.Mandal at the Baranagar IMA conference

SFB Participation at MEDIFEST 02.07.12

At the recently concluded Medifest 2012, a Medical Fair, at Milan Mela (opposite Science City) Prof. D. K. Mandal, the President SFB, was invited to talk on Stroke Prevention on

nd2 . July 2012. This fair was organized jointly by the Indian Medical Association, Bengal State Branch and the Bengal National Chamber of Commerce and Industries, supported by the Ministry of Health & Family Welfare, Government of West Bengal. Prof Mandal's enlightening talk on stroke prevention along with Stroke Video Documentary was appreciated by all from different sections of the society.

Stroke Seminar at Annual Conference of IMA Baranagar Cossipore Branch

On 12th August, 2012 SFB President, Prof D.K.Mandal gave an overview of Stroke burden and management and its relevance to developing countries at the annual conference of the Baranagar cossipore branch of Indian Medical Association (IMA).He laid emphasis on the involvement of IMA in spreading stroke awareness.He urged the general physicians to be involved in stroke care at the community level so that the dearth of stroke specialists are circumvented to some extent in the underserved areas in our densely populated country.

Prof. Mandal interacting with the audience in the MEDIFEST 2012 Seminar

Sixth Foundation Day

After Page 2

Cont. on Page 1Rural Stroke

areas on festival occasions, and in also teaching institutions, where teachers will be involved. Role of media in Radio, Television and Newspapers and Periodicals in Bengali (mother Language) are profound.

Arrangements should be made to set up Hypertension

Clinic, Diabetic Clinic, De-addiction Clinic etc. in different

peripheral hospitals in rural areas. Different NGOs can

arrange periodic Medical camps to check blood pressure and

blood sugar along with health awareness program. Emphasis

should be given on strict controlling of blood pressure,

restricting common salt and stopping tobacco in all forms –

smoking or chewing. Rural people are very cooperative in

terms of preventive health care as they know that acute care

facilities are difficult to access and it is very costly.

Published by : Stroke Foundation of Bengal, Editor Dr. A. Shobhana and Printed by : Saha Enterprise, Subhaspally, Khalisani, Chandannagar, Hooghly - 712 138, Ph. : 98300 20996

Published by :

THE STROKE FOUNDATION OF BENGAL(Regd. No. 37041 of 2006-2007)

FE-1A, Flat - 7, Salt Lake City, Kolkata 700 106, West Bengal, India

Ph. (033) 2359 8230 / 29, (M) : 9433911937,

email : strokefnd_dkm@yahoo.co.in

Founder President, Prof. Dipes Kumar Mandal

Price : Rs. 8.00Our next issue Volume 9 (2) in Sep.-Dec. 2012Lookout for World Stroke Day Edition.

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<www.strokefoundation.in>

Secretary SFB & Hony. Editor, Stroke Bulletin : Dr. A. Shobhana, Ph : 94330 83894

thYES we ALL care……… let us join hands to observe WSD 2012 on 29 October at the of Salt Lake Municipality Building Auditorium,Kolkata,

Cont. on Page 1Rural Stroke

Reader’s ColoumnThis is a real rural stroke story

AA, a 58 year old man suffered an ischemic stroke that

left him with a left paralysis but after three months he has

recovered to the extent of a mild residual weakness. He was

diabetic, hypertensive and chewed tobacco. Because of

uncontrolled blood sugars he was put on insulin. AA lived in

village called bhatgunj about 24 Km from Raigunj (about 420

km away from Kolkata). The nearest hospital where a doctor

For acute management, rural hospitals should be

upgraded with minimum basic infrastructure (Proper space,

CT Scanner, ICU/HDU, laboratory facilities etc.), to treat

large number of stroke patients, who need not be shifted to

large city hospitals. Treating physicians may seek opinions

and help from stroke consultants of specialist hospitals in the

city through Tele-link (Telemedicine). This will minimize time

to initiate proper treatment, reduce cost of transport and stay

in the city. Moreover, patient load in city hospital will be

minimized remarkably. Post stroke rehabilitation can be

arranged by setting Rehabilitation clinics in rural hospitals

and the physiotherapists and speech therapists may be

trained accordingly. Frequent seminars, workshops and

training of doctors, nurses and physiotherapists may be

arranged. The role of government and different professional

organizations (e.g. Indian Medical Associations) are very

important. Necessary funds should be provided by the

government through different rural health Missions to fight

stroke along with other Non-Communicable Diseases

(NCDs). And then and then only rural community can fight

stroke properly.

visited only during the day time was a good 20 km away. AA

had been educated upto class VIII. Although he was literate

he could not manage his insulin injections on his own.

Unable to find a health care worker who could administer

insulin he stopped it and presented in the out patient

department of a tertiary level hospital in Kolkata with a

fasting blood sugar of 324mg/dl and postprandial of

498mg/dl. He was still chewing tobacco. Moreover nobody

had educated him about the harm of chewing tobacco, of

uncontrolled blood sugar and its link to stroke. In a country

where even basic health care facilities lack in the rural areas,

use of telemedicine would melt away many of the problems

faced by the people like AA.

DO YOU KNOW ?

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Stroke may be prevented easily in more than 70% cases if High Blood Pressure is properly controlled (by taking drugs and / or restricting common salt in diet), and by stopping addiction (smoking and / or oral tobacco)

Stroke is better prevented than treated.

First ever stroke is more easily prevented than the subsequent stroke.