Friday, October 25, 2019

Stroke in Sierra Leone (SISLE) research group aims to understand and improve stroke care

Stroke in Sierra Leone (SISLE) is a research collaboration funded by the National Institute of Health Research (NIHR), the UK’s largest funder of health and care research, between King's College London and the College of Medicine and Allied Health Sciences (Freetown). This group is carrying out mixed methods research to try and understand stroke in Sierra Leone.

Here in this introductory blog, the team gives us an overview of the project, and the impact of stroke in this country.

Pa Alusine

The Kamara family were enjoying a boisterous Sunday lunch in the family home after church.  As usual Pa Alusine, the head of the family presided over the lunch, his sense of humour and playful nature had the grandchildren squealing with laughter.

He excused himself briefly to go to the bathroom, when his daughter looked back and saw him gripping the door frame and making a funny face, she thought it was another joke for the grandchildren.

It took a few moments to realise something wasn't quite right.

Pa Alusine was gripping the doorframe because he had lost the strength in his right leg. He was unable to speak, he couldn’t ask for help.

The family reacted quickly and laid him on the bed. They called a nurse who lived in the community nearby, she arrived at the bedside soon after. On her advice the family placed him in a car and drove directly to Connaught Hospital.

Pa Alusine had had a stroke, something that is not well understood in Sierra Leone.

Stroke in Sub Saharan Africa

The disease burden of stroke is increasing in this region because of increases in poor diets, smoking, alcohol consumption and lack of exercise.

As a result of these changes more people in cities like Freetown are at risk of non-communicable diseases such as stroke.

However, many things about stroke in this region are not understood, such as; which ethnic groups are most at risk? How long does it take patients to come to the hospital after a stroke? What is the cost of care? How do survivors’ lives change as a result of stroke?

The Connaught Hospital Stroke Register

The SISLE project is using a stroke register model to collect data about strokes.

A stroke register is an observational database that is focussed on gathering clinical information and data on the outcomes of patients. These observations can then be used to both understand and improve stroke care.

The stroke register that we have launched at Connaught Hospital, the main government referral Hospital in Freetown, is Sierra Leone’s first. It is collecting data, at admission, 90 days, 12 months, and 2 years post stroke.

The information being collected is on sociodemographic factors, stroke risk factors, stroke severity, treatment, and outcomes. We have now been collecting for 199 consecutive days and have 221 participants on the register

We are beginning to understand stroke in Sierra Leone much better, however there are some aspects of stroke in this country, that a stroke register will not help us to research.

These are the aspects of stroke that are linked to societal and cultural perspectives, and inherent beliefs. To be able to understand this we have reached out into the community. The Stroke survivors’ group is educating physicians and researchers on the experiences in Sierra Leone.

Life after Stroke in Sierra Leone

We are beginning to understand through our work with the stroke survivors’ group, the challenges of living with stroke disability in Sierra Leone

Lack of public awareness about stroke has led to there being societal stigma and discrimination directed towards stroke survivors, this makes their post stroke life more difficult.

One of the survivors highlighted how taxi drivers wouldn’t allow people with disability into their vehicle

Some survivors even highlighted how because they now had some form of disability, they felt like their communities were shutting them out, they felt ostracised.

World Stroke Day

With this in mind, the stroke survivors suggested that we carry out a walk for World Stroke Day to raise awareness of disability and hopefully reduce social stigma.

On the 29th October, the stroke survivors, members of the SISLE team, and the general public will be carrying out an awareness walk on city beach, Freetown. This will form the Sierra Leone leg of the World Stroke Organization World Stroke Day Relay.

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