We would like to congratulate Dipes Mandal for winning an individual achievement award for his work with the Stroke Association of Bengal.
What inspires you to advocate for stroke education?
The helpless and hapless condition of millions of stroke afflicted people, most of whom could have been prevented is the most important factor which ignited me to work in the most easy way to save them from physical and economic devastation. As India, with a population of about 1.3billion with an annual stroke incidence being about 2 million, the most important way to save them is stroke prevention through Stroke Awareness and Stroke Education, which was not properly looked into till few years back. This is more important where the infrastructure for stroke care service is very insufficient, more so in rural areas, where two thirds of Indians reside.
What does stroke care look like in your country?
Stroke care service is most neglected among the leading devastating disorders in India and needs immediate attention of all stake holders. India is a vast country with people of many faiths and cultural divides. The divide between the urban and rural is also big. Health care facilities are not equally available to all. Ideal stroke care is available only in a few big cities – in few tertiary centres and only shows the the tip of the ice berg in stroke care service for those who can afford care in private hospitals. In India about 2million people are afflicted annually of which over 6 lakh die and many more are disabled after immediate crisis. Stroke is on the rise in developing countries where lifestyle diseases are becoming an epidemic due rapid urbanization and fast life. However stroke occurs equally in the rural areas where food types, salt intake, tobacco addictions (smoking and chewing) add to the undiagnosed hypertension and diabetes. >85% strokes occur in developing countries like India which lack infrastructure and finances to tackle the malady. In India the alarming fact is that stroke strikes people about 15 years earlier than those in the Western world. This means it affects the people in the most productive years of life. If the main bread winner, usually the male here, is affected the family suffers enormously. In eastern India, there is high incidence of hemorrhagic stroke in contrast to the western world. In our place, it has been observed that people in the 40s and 50s have high incidence of hemorrhagic strokes. Uncontrolled/undiagnosed high blood pressure ( hypertension) is the commonest cause of all strokes especially hemorrhagic strokes. Proper data is lacking in India. What is a fact is that >70% people live in rural India and lack uniformity and accessibility to even basic health care facilities. The cost of stroke management is quite high in terms of acute management and also in subsequent post stroke follow-up. there is no dedicated Stroke Institute existing in West Bengal which may cater all aspects of management to a large number of stroke patients and stroke-prone individuals – Rural & Urban, the Rich and the Poor irrespective of age, gender, race, religion and region.
What element of stroke care are you most proud of?
That stroke is by and large preventable in > 85% cases has to be ingrained in all stroke care facilities and programs. In India most people stop their blood pressure medications and chew tobacco or smoke. With our continuous campaign we have been able to make people realize ill effects of these addiction on the high incidence of stroke and heart attack. The importance of proper rehabilitation and required medication have been established among most of the cases and the caregivers. Moreover, there has been rapid awareness about recognition of stroke and its early hospital management.
What have been the highs so far?
Very rapid spread of Awareness among the general public about the term “Stroke” which means Brain Attack , and not Heart Attack through intensive uninterrupted stroke awareness is a very important development in Stroke Awareness and its management. People now realize the importance of acute stroke management in a stroke centre. Importance of rehabilitation is also gaining grounds, even in rural areas.
Stroke Foundation of Bengal (SFB), the only non-profit registered organization in India and a member of World Stroke Organization (WSO) is committed to fight stroke malady in our country with minimal resources and aids, in the guidelines adopted by World Stroke Organization. As stroke is very much a preventable disease and is better prevented (esp. By controlling high blood pressure and stopping tobacco addiction) than treated, our Stroke Foundation started its stroke prevention campaign since its inception in 2006. Before the inception of stroke Foundation, the different programs on stroke awareness was started in the Mdedical College, Kolkata since 2000. Along with awareness, a study was conducted in 2003, to assess the level of awareness of stroke among the general people, which revealed about 65% of participant considered Stroke as Heart attack. Following awareness programs, there are significant rise in stroke information in all section of the society.
The standard conventional modalities of stroke education include seminars, meetings, leaflets distribution, articles in papers, magazines, Bulletins, Stroke Documentary (with English subtitles) souvenir, etc., and also the publication of quarterly stroke bulletin in both Bengali and English. The more recent modalities include regularly updated website (www.strokefoundationbengal.org), Facebook etc. We have received enough helps from print and electronic media in stroke awareness campaign .Stroke Foundation is also taking care of rehabilitation program of the post-stroke disabled patients and also has formed Stroke Support Group (the second in India) for overall benefits of the stroke victims and their family members. The introduction of Stroke awareness about its risk factors and future predictability through smartphone by installing Stroke Riskometer app is the latest and most innovative tool in stroke care. All these works are moving slowly but steadily, and that is really very high in a vast country with so much population with significant lack of awareness.
The activities of the Stroke Foundation are appreciated by the leaders of the World Stroke Organization (which was also established in 2006) and as a recognition of its stroke campaign activities, the Stroke Foundation of Bengal has won First Honorable Mention in the WSO World Stroke Day 2010 & 2012 awards. SFB has included people from all walks of life in its campaign – a very positive aspect.
What have been the lows?
It is the apathy of the many people, due to lack of stroke awareness - both general and professional- which has hampered development of stroke care in India. The priority of Stroke care is much less than Tuberculosis, AIDS and Malaria, although stroke kills more people than all the other three do together, not to talk of post stroke devastating disability. Even among the NCDs , stroke gets minimum attention in public health program. There is no government grants forthcoming smoothly. There is no nationalized health insurance, there is no government initiated rehabilitation facilities. prevention clinics which are of utmost importance in developing countries. Government institutions offering comprehensive stroke care are few in number and unavailable to the vast expanse of population. Of concern is the apathy of the professional bodies and medical fraternity itself towards prevention and rehabilitation of stroke care. SFB for that matter has taken the leadership in the single handed campaign with minimal help whatsoever, and the results are promising.
What is your greatest hope for stroke survivors?
There is always a ray of hope for stroke survivors. SFB has so far successfully spread stroke education to most areas of eastern India and will continue its crusade. It has received great support from the international stroke leaders and WSO. I am sure with such encouragement and appropriate support , it is possible to achieve the targeted goal of holistic affordable stroke care in approachable places. By the influence of media and other modalities in program, a section of people, mostly young educated and rich have taken much interests in this stroke devastation and extending all possible help to the stroke survivors. The government has also shown some interests in stroke care centres, although it will take some time to implement because of huge stroke burden and paucity of funds.
What were the major elements of your stroke campaign?
Stroke Foundation started its stroke prevention campaign since its inception in 2006. The modalities adopted for the campaign are seminars, meetings, leaflets distribution, articles in papers, magazines, Stroke Documentary (with English subtitles) souvenir, etc., publication of quarterly stroke bulletin in both Bengali and English and also regularly updated website (www.strokefoundationbengal.org) and facebook. The activities of Stroke Support Group (the second in India) for overall benefits of the stroke victims and their family members are quite encouraging. Recently the Stroke Foundation has been able to convince the persons in the Government and administration to set up a stroke care service centre in a remote underdeveloped district with necessary financial help. The supports of the public, media and the government are the major elements of the present stroke campaign