Stroke treatment needs to be prioritised

AT the recently concluded 1st Malaysia Stroke Conference in Penang, the director-general of Health highlighted that stroke is the number three cause of death in Malaysia. Ten years ago it was fifth.

In 2016, public hospitals recorded about 90 stroke admissions and 30 stroke-related deaths every day. The incidence may only be the tip of the iceberg due to under-reporting from the public, private and university hospitals.

Already 10 years ago the data were grim and only further exacerbated by the explosive epidemics of diabetes and hypertension in the country. Even more alarmingly, many patients who developed stroke are young people under 60.

We are not losing just an economically-active segment of the population but cutting across generations; someone’s grandparent, father, mother or even child could stroke out at any time. Worldwide, one person dies of stroke every six seconds. It could be you or me.

Is the country’s healthcare system adequately positioned to face this epidemic? The director-general rightly pointed out the public healthcare system has an inadequate number of neurologist and hospitals to offer emergency stroke service and the ministry is looking for ways to extend the service horizontally. We concur that the matter needs to be addressed with an urgency of now.

But before looking at expanding the service, many crucial steps need to be taken, from top strategic planning to operational matters at the ground level. Government healthcare policies should be reprioritised and realigned. Manpower and resources have to be redistributed, if not added.

Emergency stroke management is time-dependent, labour-intensive, cross-disciplined and expensive. Certain basic but important requirements are needed at local hospital level. Value-based medicine still requires investment. To note, in 2016 RM180mil was spent to treat stroke patients in government facilities.

Perhaps more importantly, the medical fraternity should look at stroke in a different way.

Management of stroke, from prevention to emergency treatment and, subsequently, rehabilitation, is not under the realm of neurologists alone but is multidisciplinary and is thus an institutional effort -even a community-based one.

Also, there are effective treatments and preventive medicines available for stroke. We need to relook into our own practice biases, re-examine our knowledge and keep up to date on the data- driven available evidence of latest developments.

Certain policies, such as limiting quotas for medicine found effective in stroke prevention due to insufficient funding in public hospitals, are only compounding the problem.

A speaker at the conference revealed that we have already been left 20 years behind in emergency stroke treatment. More often than not we have meetings and discussions with plans coming up but no overall policy to move the needle.

We have to admit the shortcomings and learn to move forward. Do we need political will to change? Humbly, a compassionate one will suffice.