Organization of stroke care in Japan

Takafumi Kubota^1,2, Arsalan Anwar^3, and Sidra Saleem³

1.     Department of Neurology, Teine Keijinkai Hospital, Sapporo, Japan
2.     Department of Neurology, University Hospitals of Cleveland Medical Center/Case Western Reserve University, OH, U.S.A.
3.     Department of Internal Medicine, Dr. Ruth Pfau Hospital, Karachi, Pakistan.

Abstract

In Japan, stroke is one of the major health problems. In particular, stroke has become a major factor in disability-adjusted life-years as the population ages, and is a significant burden on medical expenses. Therefore, Japan makes many efforts to lower age-adjusted mortality from stroke and extend a healthy life expectancy.

Stroke is the second most common cause of mortality and disability-adjusted life-years (DALYs), worldwide [1]. In Japan, the mortality rate of stroke has declined from 180 per 10000 in 1970 to 87 per 10000 in 2018, however, it still remains the fourth most common cause of death after cancer, cardiovascular disease, and senility [2]. The DALYs impact produced by this disease is 30% of the Japanese population. Therefore, the economic health care burden produced by stroke is 1.56 trillion dollars in health costs and 1.74 trillion dollars in nursing care costs [3]. The subtypes of ischemic stroke have also been changing. In the last four decades, as a result of changes in the salty traditional diet to the western fatty diet as well as the prevention of hypertension, the incidence of lacunar infarction in ischemic stroke steadily declined by 59% for men and by 28% for women [4]. On the other hand, the percentage of cardio-embolic and atherothrombotic stroke in ischemic stroke increased from 44.9% in 1984-1998 to 60.7% in 1998-2000 [5]. 

  The decline in stroke incidence is due to the contribution of Japan Stroke Society (JSS), which was established in 1975. It has provided a wide range of initiatives such as acute care, prevention, education, and rehabilitation. Currently, the JSS works with the Japanese Circulation Society (JCS) on two main goals to improve individual lives and reduce the economic burden. The first goal is to lower age-adjusted mortality from stroke and cardiovascular disease by 5% in 5 years and by 10% in 10 years.  The second goal is extending a healthy life expectancy. To achieve these two goals, the JSS has five strategies as follows; (1) Human resource development, (2) Enhancement of the medical system, (3) Promotion of registration business, (4) Prevention, and (5) Strengthening of clinical and basic research [6].   

  In Japan, there are 1,369 certified training institutions of the Japan Neurosurgical Society, the Japanese Society of Neurology, and/or the JSS. The institutions are divided into two types of the center. First, the primary stroke center (PSS) can perform standard evaluations such as MRI or CT and treatment including recombinant tissue plasminogen activator (rtPA) at any time in twenty-hour seven.  The necessary requirements for PSS were published in 2017, and the application of the primary stroke center was started in July 2019. Second, the comprehensive stroke center (CSC) is capable of advanced neurosurgery, endovascular surgery, stroke care unit and/or intensive care unit in addition to PSS requirements. The distribution, number, and mutual relationship of each other will be organized within a few years [3,7-9].

  For functional recovery after acute stroke care, rehabilitation medicine for stroke in Japan has improved since the beginning of the convalescent rehabilitation ward in 2000.  The patients can be hospitalized for rehabilitation up to 180 days with national health insurance, 3 hours per day including weekends of rehabilitation.  The convalescent rehabilitation hospitals have increased up to 1,348 hospitals and 76,631 beds (60 beds per 100,000) in 2015 which can cover the demand of 25 beds per 100,000 [10].  After being discharged from the convalescent rehabilitation hospitals, the patients are treated by the regional comprehensive care system such as outpatient clinics, visiting nursing stations, and home rehabilitation [7].

  The JSS also actively works to prevent stroke through lifestyle modifications and educating people about prevention. The prevention is primarily divided into four stages based on the severity as follows; (1) Improvement of lifestyle through public education, (2) Intervention for lifestyle-related diseases through primary care, (3) Early detection and intervention of stroke, and (4) Decrease in the mortality associated with stroke.  The JSS sets each goal in four stages and monitors the results [7].

  In conclusion, Japan is aware of the impact of stroke on individual life and economic burden. In the last 40 years, Japan makes many efforts to lower age-adjusted mortality from stroke and improve the outcomes.

Reference

[1]  Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, Abd-Allah F, Abdelalim A, Abraha HN, Abu-Rmeileh NM, Adebayo OM. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019 May 1;18(5):439-58.

[2]  Statistics and Information Department, Ministry of Health, Labor and Welfare (MHLW), Japan. Overview of Demographic Statistics Monthly Report  2018. https://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai18/dl/gaikyou30.pdf.  (accessed Dec 23, 2019).

[3]      Toyoda K, Sonoda K, Sato S, Yoshimura Sl. The Japan Stroke Databank Current stroke care in Japan and ideal stroke registries. Shinkeichiryo 2018;35(3)192. https://www.jstage.jst.go.jp/article/jsnt/35/3/35_188/_pdf/-char/ja. (accessed Dec 23, 2019).

[4]     Kubo M, Kiyohara Y, Ninomiya T, Tanizaki Y, Yonemoto K, Doi Y, Hata J, Oishi Y, Shikata K, Iida M. Decreasing incidence of lacunar vs other types of cerebral infarction in a Japanese population. Neurology 2006;66:1539–1544

[5]      Yukito Shinohara. Regional Differences in Incidence and Management of Stroke – Is There Any Difference between Western and Japanese Guidelines on Antiplatelet Therapy?. Crebrovasc Dis 2006;21(suppl 1):17–24 DOI: 10.1159/000090358

[6]      Kokubo K.  Changes in stroke Japan and other countries.  Japanese Journal of Cardiovascular Disease Prevention 2017; 52(3) 223-232.  http://www.jacd.info/library/jjcdp/review/52-3_01_%20kokubo.pdf. (accessed Dec 23, 2019).

[7]      The Japan Stroke Society.  5-year plan to overcome stroke and cardiovascular diseases. http://www.jsts.gr.jp/img/five_year_plan.pdf.  (accessed Nov 23 2019).

[8] Iihara K, Nishimura K, Kada A, Nakagawara J, Ogasawara K, Ono J, Shiokawa Y, Aruga T, Miyachi S, Nagata I, Toyoda K. Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study. PloS one. 2014 May 14;9(5):e96819.

[9] Toyoda K, Inoue M, Koga M. Small but steady steps in stroke medicine in Japan. Journal of the American Heart Association. 2019 Aug 20;8(16):e013306.

[10]      Miyai I.  Update on stroke rehabilitation.  Shinkeichiryo 2016;33(3)389-393. https://www.jstage.jst.go.jp/article/jsnt/33/3/33_389/_pdf. (accessed Dec 23, 2019).

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Hundreds gathered to raise awareness and support life after stroke in Singapore and Malaysia

WSO Stroke Support Organisations in Singapore and Malaysia led inspiring events to raise awareness and celebrate life after stroke. The events also raised the flag for the World Stroke Campaign virtual relay Asia route #DontBeTheOne

Stepping out for Stroke in Singapore

Singapore National Stroke Association (SNSA) held its fourth Stepping out for Stroke event on Saturday 12^th October. The event had over 800 registered participants including nearly 100 stroke survivors and carers.

Stepping out for Stroke is SNSA’s annual fundraising event, where it encourages participation from people affected by stroke, medical professionals, students and the wider community in whatever way they choose; walking, running, cycling, and in wheelchairs and pushchairs. The Mayor of Central Singapore CDC, Denise Phua was the guest of honour and talked passionately about the need to prevent avoidable strokes and to support life after stroke.

Aanandha Sharurajah, who had a stroke in 2012 and is a member of the SNSA Executive Committee said, 'Stepping out for Stroke was a really important day for me, as it was a day my whole family was involved in. We all wore our purple t-shirts, showing that we were standing for stroke survivors and greater awareness of this illness, and it was the largest number of people I've witnessed so far standing for stroke'. 

The event was an opportunity to mobilise the community to raise funds, increase awareness of stroke and engage in physical activity. The day also included the launch of the FAST Heroes 995 Programme in Singapore, which is a collaboration between SNSA, Boehinger Ingelheim’s Angels Initiative and the World Stroke Organization https://worldstrokeorganization.blogspot.com/2019/07/be-stroke-superhero-be-fast.html. The programme is a kindergarten-level education initiative aimed at equipping children with knowledge about what stroke looks like and what to do in an emergency.

The event also joined the World Stroke Campaign virtual relay Asia Route, getting behind the #DontBeTheOne 2019 Campaign theme.

Ng Wai May, President of SNSA said 'Our signature Stepping out for Stroke community event was held on 12^th October 2019.  The event was very successful with over 800 participants and we have raised over $60,000 so that we can offer free programmes for stroke survivors and caregivers'.

For more information about SNSA visit:

www.snsa.org.sg  | https://www.facebook.com/SNSA.SG

Stroke Games 2019 – paving the way for more champions

Stroke Games 2019 kicked off on Saturday 19^th October with a vibrant opening ceremony, with flags from Malaysia, the National Stroke Association of Malaysia (NASAM), World Stroke Organization #DontBeTheOne and the nine NASAM contingents from across Malaysia. The event was declared open by YABhg Tun Jeanne Abdullah, Patron of the Malaysian Paralympic Council. Before its arrival into the stadium, the Stroke Games torch was passed on by a relay of stroke champions who ran, walked or wheelchaired it along the way.

'How do you inspire someone who is down and out after a debilitating stroke?' asked Janet Yeo, Founder Chairperson of NASAM, in her opening speech.  'How do you inspire that person to climb mountains, to aim high and excel? To aspire to be a champion and to believe there is life after stroke?'

'When you are inside a stroke damaged body, believe me the last thing on your mind is sports or competitiveness,' said Yeo, a stroke survivor herself.  'We at NASAM want to reach out and mend such broken spirits and one of the ways is through sports. For a whole year we carefully crafted and designed sporting events and then transferred them into our daily rehab regime before our first Games in 2017.  Suddenly rehab was no longer a boring word. It was not a passive, repetitive routine'. 

Yeo added that the Stroke Games 2019 is bigger and will generate more champions who will inspire others to achieve greater recovery.  'The Games is NASAM’s contribution to the stroke community around the world. We wish that this fighting spirit of a stroke champion is ignited into every person affected by a stroke no matter where they are’. 

The Games involved more than 800 participants from NASAM’s nine clubs across Malaysia as well as volunteers from corporations, universities and hospitals. There were 25 events including: 50m and 300m walk/run; hand cycle; modified weight lifting and seated volleyball. The youngest athlete was Lee Yong Xian aged 16, who represented Kuantan in the 300m for men.  The oldest was Mariya Pillay aged 81, representing Malacca in hand cycle for women. 

NASAM Petaling Jaya and Malacca emerged as champions with a tie, with Perak finishing runner-up.

For more information about NASAM visit:

www.nasam.org | facebook.com/NationalStrokeAssociationMalaysia

New Philippine stroke support organisation makes public stroke awareness its priority #DontBeTheOne

Jacob Eagan Bright, founder of Stroke and Aneurysm Support Philippines, shares his experience of stroke and his motivation to create public awareness and support life after stroke.

Jacob Eagan Bright

What has inspired you to be involved in stroke support?

In 2018 I lost a brilliant colleague to stroke, his loss made me sad and also bewildered as to why this happened to him and his young family, who were left to grieve. Then in 2019 my grandmother woke up in middle of the night, trying to use the bathroom she dropped down, face and mouth instantly twisted, her left hand became stiff and cold and unmovable. Months later my comrade, a 48 year old retired army officer experienced a transient ischaemic attack (TIA), and then a burst aneurysm and a haemorrhagic stroke.

Seeing my friends and family touched by stroke and its devastating effects, I realized that anyone can be affected. Stroke is the second leading cause of death in the Philippines. I became motivated to create public awareness to prevent strokes and to work with stroke survivors as advocates.

What does stroke care look like in your country?

The Department of Health has now made alteplase, the clot-busting drug, available for free in 26 government hospitals nationwide. This effort is highly commendable, but there is no support for local patient care organizations carrying out awareness and education on prevention and recovery programs for survivors.

The public are interested in attending stroke education and awareness sessions but due to low income levels there is a lack of public fundraising.  

How did the project come about?

After many conversations, it became clear that many people affected by stroke were not previously aware of stroke risk factors, and that caregivers and families were totally ignorant of the symptoms and effects. So right there is was glaringly obvious that public education is desperately needed, especially on healthy lifestyles and coming to terms with life after stroke.

What have been some of the outcomes of the project?

After two months we are still in the pilot phase of our work, but it is amazing how receptive survivors and those wanting to prevent stroke are to full information and education on how to prevent a stroke and life after stroke. At the moment our sessions and outreach are well attended. People call to ask when next we are due for a speaking engagement, and many health professionals link up with us for outreach engagements. Our home visits to survivors seem to be very encouraging to them in believing there is a reason to live.

What has been the feedback from stroke survivors to the project?

Engaging survivors in public meetings has given them a sense of belonging and reason to live and to become active. Survivors are happy there is an organization that brings them together, where they can share their experiences, both challenges and successes, in their journey after stroke. The project also checks in with them and supports them to sustain healthy behavior that contributes to their recovery.

What has been the response from others – community, doctors, politicians?

The community has responded collaboratively to our project and engaged with our efforts and programs. Our contact number keeps ringing, but unfortunately the community expectation is that we can deal with all their requests – including supplying an ambulance if a member of the public has a suspected stroke.  Public doctors seem to be very happy with the program and are willing to participate in public events as speakers; this is something that we want to build on. Private doctors seem to be a little uncomfortable because we may be perceived as a competitor. We want to pursue building a relationship with them. 

What would you say to other people to make them take stroke prevention seriously?

You could be the next person hit by stroke. Don’t Be The One.

Steve Davis, a stroke survivor, climbing 42 steps as part of exercise for recovery activity

Promoting life after stroke at the Stroke Games in Malaysia

World Stroke Organization SSO member the National Stroke Association of Malaysia (NASAM) was founded in 1995 by Janet Yeo after her remarkable recovery from a crippling stroke. NASAM’s mission is to promote stroke prevention awareness and to inform the public that there can be life after stroke with rehabilitation and long term support.

Stroke is the second leading cause of death in Malaysia, where six strokes occur every hour and over 50,000 new cases are reported each year. At its nine stroke centres, NASAM therapists conduct rehabilitation sessions which include physiotherapy, occupational and speech therapy to help stroke survivors regain their confidence and independence. NASAM also organises a range of activities to support daily living, these include cooking, art and craft, singing, music and movement and games.

NASAM recognises that as well as the physical effects of stroke, there are also emotional effects such as depression, anxiety, anger and denial. NASAM therefore also offers counselling services to enable people affected by stroke to find relief and to reinforce the importance of their view and significance of them as a person. At times, counselling is also provided to family members who have trouble coping or adapting to the responsibilities that have changed their lifestyles in caring for a stroke survivor.

NASAM’s objective to increase general awareness about stroke is the impetus behind their talks and forums. Open to the public, NASAM invites medical doctors, and other stroke-related specialists to talk about stroke prevention and stroke rehabilitation.

On an annual basis NASAM organizes nation-wide campaigns to raise public awareness of the risks of stroke and to encourage the public to take positive steps to adopt a healthier lifestyle to reduce their risk of stroke. The programme includes events to encourage the public to be more physically active.  There are also forums, chat shows on TV and radio, and open days at NASAM centres.

From 19-20 October 2019 NASAM will organize its second STROKE GAMES at the Panasonic National Sports Complex, Shah Alam, Selangor. The goal of the STROKE GAMES is to help stroke survivors in their recovery and to develop the “never give up” attitude. NASAM’s tagline is “CELEBRATING LIFE AFTER STROKE”. 

The Games showcase the abilities of stroke survivors and the possibilities of life after a stroke. The event helps people to regain confidence and dignity and instils a new outlook to living life.Sports include individual and group challenges such as basketball shoots, darts, obstacle races, baton relays, seated volleyball, lawn bowling, distance throws, modified weightlifting, modified archery, hand cycle, triathlon, 50m walk, 50m walk with hurdles, 300m walk, table and cognitive games.

The Games are also an opportunity to generate awareness of stroke in Malaysia where stroke awareness is still low and many people experiencing a stroke do not seek medical help fast enough.

For more details on the STROKE GAMES, please visit:

https://www.youtube.com/watch?v=cSgbtvvScM0

https://youtu.be/TKBdkmSq7zc

https://m.facebook.com/story.php?story_fbid=10156246771918845&id=96974848844

www.facebook.com/NationalStrokeAssociationMalaysia

www.nasam.org/event-details/?id=20

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Dr Inna Lutsenko World Conference on Research Integrity 2019 at Hong Kong University

Dedication and commitment to supporting life after stroke in Japan

In March 2019 I was invited to speak about patient involvement at the Non-Communicable Disease (NCD) Global Forum for Civil Society in Tokyo, organised by the Health and Global Policy Institute. I also took the opportunity to visit some inspiring stroke support organisations.

Sarah Belson, International Development Manager, World Stroke Organization and Stroke Association UK

NCD Global Forum for Civil Society

 

Takenori Yamaguchi, Executive Director
Japan Stroke Association

Following the recent passing of Japan's new Basic Act on Cardiovascular Diseases, the March session of the NCD Global Forum focused on heart disease, stroke and other cardiovascular diseases. The Basic Act aims to ensure a comprehensive and systematic response to cardiovascular diseases across the country. With the Government, healthcare professionals and patient organisations beginning to work on implementation plans for each health condition, the NCD Global Forum was an opportunity to share experiences and insights from patients, legislators, healthcare professionals and international organisations.

I spoke about strengthening patient advocacy and stressed the importance of ensuring meaningful involvement is at the heart of an organisation’s mission and strategic priorities; highlighting the World Stroke Organization’s priority to strengthen global capacity to reduce the burden of stroke, and the UK Stroke Association’s strategic goal to partner with people and communities to help them take action on stroke.

There are lots of great examples from across the World Stroke Organization and its members of meaningful involvement: the Global Stroke Bill of Rights built consensus across experience and contexts to develop advocacy messages; the activities of the Stroke Association of Kenya are guided by the lived experience of stroke survivors; and Stroke Action Nigeria supports stroke survivors to develop local stroke services as a business.

Inspiring stroke support in Tokyo and Osaka

I spent some time with Naomi Sonoda, a dedicated stroke advocate and Director of the Language Support Centre in Tokyo. Naomi was motivated to start this Centre and also the Japan Aphasia Circle, a peer support group, following her husband's stroke nearly 20 years ago. The Language Centre runs daily speech therapy sessions and has four speech and language therapists and 66 members.

In Osaka, I had the most wonderful welcome at the Sumomo Club for people with aphasia. The club is really vibrant, with skilled and committed staff. Established in 2005, the Sumomo Club has 65 members ranging in age from 30 to 90, and runs group activities as well as outreach to families and schools. Its mission is to provide a therapeutic environment for people with aphasia and other communication disorders to be able to participate, communicate and engage in creative activities. Its approach is to reinforce what you can do, not what you can’t. This wonderful video captures the spirit of the club.

The Japan Stroke Association sees its role as promoting and supporting long term care for people affected by stroke. Although this stroke support organisation only has one full time staff member and relies on volunteers, it delivers activities across the 47 prefectures of Japan, which include a helpline and peer support groups.  The Japan Stroke Association has been involved in the Basic Act, in particular consulting with patient groups, and will certainly be actively involved in the development of the implementation plan.

Thank you to everyone I met for such a warm welcome to Japan; at the policy and service level there is a lot to be positive about for people affected by stroke, and it's clear that there is a strong commitment to continue to ensure that people affected by stroke access the long term support that they need.

Staff of the Sumomo Club, Osaka

We reach, we teach, we treat

World Stroke Campaign Individual Achievement Award Winner, Dr Bindu Menon provides an insight into her innovative outreach to poor rural communities to raise awareness and increase access to preventive treatments for stroke.

It has indeed been an overwhelming moment for me to receive the prestigious World Stroke Award. I thank the World Stroke Organization and the World Stroke Campaign for recognizing our activities and giving us a platform to share our work.

WSO welcomes the Red Bracelet Volunteers Corps

The World Stroke Organization (WSO) is excited to welcome the Red Bracelet Volunteer Corps, part of the Chinese Stroke Association (CSA), as a stroke support organization member.

CSA established the Red Bracelet Volunteers Corps to provide education and support for stroke survivors, families and healthcare professionals involved in stroke treatment, management and rehabilitation across China.

This Corps has 1,100 facility members and 29,700 individual members throughout China, who engage in activities such as awareness campaigning, prevention screening, lobbying for better services, providing services and support in the community.

Spreading the message of stroke awareness and support in Eastern India and Bangladesh

The renowned artist and popular Bengali writer, Debabrata Chakraborty, talked with Professor Dipes Kumar Mandal of the Stroke Foundation of Bengal, a World Stroke Organization SSO Member. Their conversation appeared as an article in the Dainik Stateman Newspaper in March 2018, reaching a large section of the 300 million Bengali-speaking people of Eastern India and Bangladesh. Here we share extracts from the article.

'I was born in a remote village called Nayachak, in West Bengal. I aspired to be an engineer but ended up becoming a doctor. I was initially  admitted to an engineering course but I was later admitted to the Medical College, Calcutta where decades later I became the Head of the Department of Neurology’ reminisces Professor (Dr.) Dipes Kumar Mandal, my next door neighbour. We got engrossed in such friendly chatter sitting in his ground floor clinic in our housing complex. Today, being Sunday his patients would start queuing up a little later than usual.

Sharad Tekalkote reminds us that there can be 'life after stroke'

Where were you when you had your stroke?  

I was at the Expo Centre at Whitefield in Bangalore. ​I had gone there at 10 am to visit some dignitaries. I spoke to my boss at 12:30 pm and as soon as I put my phone down, I just couldn't speak again. I was not aware that I was having the stroke; while my brain bled furiously I took a bus to the hospital 30 kms away.  ​

​

Can you tell us a little about your life before stroke?  

​I was the Chief Operating Officer in an education company before the stroke. I exercised regularly, swam at least 20 laps four times in a week, gym at least 3 times in a week and running every day. On the weekends I used to go to practice martial arts, I’ve got a black belt!   

What expectations did you have for your treatment, rehabilitation, therapy and recovery?

​I expected to recover fully, but alas that was not the case, I went through the various treatment and recovery stages.  ​ I thank the medical fraternity for the treatment - initial and continuing follow up, which helped me physically survive a major life threatening stroke. Thereafter I was fortunate to be referred to other medical professionals and the strong support I had from my family, for regaining my physical strength, communication and psychological stability and finally regaining my self -confidence to function independently in mainstream life. 

How has life changed for you and the people around you since your stroke? 

​I had a haemorrhagic stroke, I struggled with my speech for about 3 years, before the stroke I was a voracious reader and public speaker but all that changed. 

How are you working to reduce your specific risks?

​I take medicines daily coupled with ohm chanting and meditation. ​The past 2 years I am going to the gym and yoga. 

What has helped you in your recovery?

​My son Dev, as I wanted him to be strong and independent, because of which I had to triple my efforts through rehabilitation. In the course of my recovery I met several stroke afflicted individuals and I realized my good fortune and the intense need for the stroke affected individual and caretakers to have access to a support group catering to their individual needs at different times in their recovery period. Acknowledging what has happened, and accepting how life has changed is an important step in the recovery process and meeting stroke survivors can help with this. Counselling services aim to encourage the stroke survivor and his caretakers  to talk about their thoughts and feelings and help them to come to terms with what has happened to them. With proper guidance of the counsellor, they will have the opportunity to look at how the stroke has affected their life and discover ways of moving forward. Having the space to talk things through, at their own pace, can be very helpful. They can gain a clearer picture of what lies ahead and help to feel more in control of their life by working out and trying to find solutions to problems. The basic principles in counselling are that each person has intrinsic worth, is unique, is capable of change, and has strength and responsibility to change, so to act on the belief that 'there is a life after a stroke'.

What have been/are your fears?

My living is based on my talking, I was a sales guy, my biggest fear was that I never could speak again. ​

How did your family and friends feel and respond?

Family was my biggest ​strength and friends are my biggest supporters.  

For more about Sharad’s story visit:

https://beboldpeople.com/2017/07/06/the-stroke-survivor-who-pumps-life-into-other-survivors/

www.strokeindia.org

My reason to prevent stroke is because it's possible!

Prof. Wang ShaoShi is the leader of the SSO Red Bracelet organization in China, Director of Neurology Department and Stroke Center Shanghai First People's Hospital, and Director of Stroke Care Academy(SCA) of China.

Who is volunteering with the Red Bracelet organization? 

There are around 23,000 registered Red Bracelet volunteers all over China from 800 hospitals. 40-50% of the volunteers are doctors, 30% are nurses, and the remainder are from companies or are caregivers. They raise awareness of stroke and the risk factors at public events across the country.

Can you tell us a little about the Stroke Care Academy (SCA)?

The SCA was just started this year (2017), I lead this academy, and it is sponsored by Boehringer-Ingelheim. This academy is aiming at the education of doctors. As some of the medical students are Red Bracelet volunteers, we are training them for free. The modules are focused on acute management,secondary prevention and rehabilitation.

In China, we are just starting to understand the scope of rehabilitation, so doctors haven't got the real meaning of  rehabilitation and its need, such as supporting patients with dysphagia. However, we are educating them and training them with the experience from overseas such as the United Kingdom. Doctors will pay more attention in acute treatment, and in the long term we need to give attention to rehabilitation and recovery. We need to continue to think about how we might include long term stroke support in the SCA. 

For the World Stroke Campaign this year, the focus is prevention, what is your reason to prevent stroke?

In China especially, the concept of stroke prevention is very important, the public is not aware of this disease, they don't even know that stroke is preventable.

My reason is firstly because prevention is possible! Secondly, Chinese citizens don't know how to prevent stroke, and given the incidence and prevalence in this vast country we have to prevent strokes from happening in the first place.

For more about stroke prevention visit www.worldstrokecampaign.org 

WSO welcomes SSO for Sri Lankans as new member

The Stroke Support Organization for Sri Lankans has become the latest SSO member of WSO.

Founder, Dr Padma Gunaratne tells us why membership of WSO is so important:

'I have been an active individual member of the WSO since its inception. I have observed how WSO influences and strategically prioritizes issues in relation to stroke for the benefit of stroke survivors and also for prevention. I think promotion of the establishment of stroke support organizations is one such area of WSO activity for the benefit of stroke care. Though it is difficult to establish an organization and to keep going for the stroke community with a wide range of needs, Stroke Support Organizations are marvellous in addressing the long term needs of stroke survivors and care givers. 

WSO in the Philippines - partnering for improved stroke care and management

The 18th Annual Congress of the Philippines Stroke Society was held from August 17-19, 2017 in Dumaguerte, Philippines. The event provided a focal point for the delivery of the WSO Philippine Stroke Society joint education project "Cardinal Principles of Stroke Care and Management".

Prof. Michael Brainin (WSO),  Dr. Epiphania Collantes (President, Philippines Stroke Society), and  Prof. Rhomy Esagunde (President, Philippine Neurological Society) handed over 200 diplomas following the event.

WSO has been working closely with PSS to deliver stroke education to a large cohort of clinicians. Since the inception of this program last year, more than 1100 have completed this joint-program which is scheduled to continue for another three years.