Steve Biko Academic Hospital transforms stroke care in SA

The Head of Neurology at the Steve Biko Academic Hospital and University of Pretoria (UP), Prof Mandisa Kakaza (54), believes that managers do not need more staff members to improve outputs – they simply need to revise how they do things.

This has inspired Kakaza and her team to improve the care given to stroke patients and earned the hospital a global award in the process.

According to the Heart and Stroke Association of South Africa, a stroke happens when the blood supply to the brain is interrupted because one of the arteries carrying oxygen and nutrients to a part of the brain suddenly becomes blocked or bursts.

Rapid treatment increases survival rates and may minimise complications. Kakaza says that, ideally, neurologists must provide treatment for acute stroke within fourand-a-half hours of the onset of the first symptoms. These include weakness, numbness and speech difficulty.

Acute strokes result in neuronal damage and subsequent neurological deficits.

“As soon as the patient arrives, we must diagnose that it is a stroke, we must do a computerised tomography (CT) scan and we must provide treatment. In the past, it would take a minimum of eight hours from the time that the patient arrived at the hospital to get the CT scan,” she says.

“This meant that all our patients were outside the period for acute treatment, so they could not be treated for acute stroke because we were too late for that,” says Kakaza.

To address the need for urgent treatment, the neurology unit collaborated with the Angels Initiative, a global partnership that helps hospitals around the world improve their stroke response. The collaboration saw doctors and nurses in the emergency unit of the Steve Biko hospital undergoing three months of training at the beginning of this year to equip them to treat stroke patients as emergency cases.

They also shared their goals with the head of radiology at the hospital so that one of the three CT scans could be prioritised for stroke patients.

“We immediately saw improvement. The officials that

we trained are already medical doctors and health practitioners, so we were just reinforcing what they already learnt in school.”

The result of the intervention is that stroke patients receive care within 15 minutes, and no longer wait up to eight hours, as was the case previously.

Global recognition

This significant improvement earned the hospital a Diamond Status award, in July 2022, from the World Stroke Organisation – a non-profit medical association that raises awareness on the prevention and treatment of stroke.

Kakaza says Steve Biko became the first hospital in South Africa to receive recognition for introducing new techniques and measures to save the lives of patients affected by acute stroke.

According to the Angels Initiative, every 30 minutes a stroke patient who could have been saved, dies or is permanently disabled because they were treated in the wrong hospital.

“It is nice to be recognised for the work that you do. We decided as a cluster that we want to improve the care provision for stroke patients within our cluster,” says Kakaza.

The cluster consists of Kalafong Provincial Tertiary, Steve Biko Academic and 1 Military hospitals. There is one consultant neurologist based at Kalafong and two based at 1 Military hospital.

Kakaza says there are insufficient neurologists in South Africa. According to the University of Cape Town, roughly 150 neurologists are equipped and skilled to treat patients in South Africa, but only about 35 work in public hospitals.

A trailblazer

Kakaza became the first black female to obtain a Master of Medicine in Neurology in 2001 from the UP.

She was appointed to her current position in 2021 when her predecessor retired. Before then, she was a consultant neurologist at the hospital for 10 years.

“When you are a consultant, you treat patients and you teach undergraduate and postgraduate students,” she says.

In her current position, she must ensure that students are taught well so that they can pass their modules. She also has to ensure that the university continues to produce research.

“Most importantly, I need to ensure that the department continues to be innovative so that it stays on par with the rest of the world. I am also involved in administration because I have to ensure that the running of the department, both under Gauteng Health and the university [UP], is smooth,” she says.

Steve Biko is the main teaching hospital of the UP.

Kakaza’s journey in the medical field started in 1985 when she was accepted to study for a Bachelor of Science in Zoology and Biochemistry at Rhodes University.

“We were the first batch of black South African students to be accepted at Rhodes University without permission from the then Minister of Education,” she says.

She furthered her studies at the former University of Transkei, now Walter Sisulu University, and obtained a Bachelor of Medicine, Bachelor of Surgery in 1994.

She was later accepted at the UP to study neurology and obtained her Master of Medicine in Neurology in 2001.

In February 2022, she was appointed Acting Chairperson of UP’s School of Medicine. However, she has made it clear that she is not permanently available for the position because she wants to stay in neurology.

To women leaders, she says the trick is to never give up, even when they get ignored and overlooked.

“When you are finally given a chance, show them what you are capable of,” she says.