Report from the 21st Conference of the Iberoamerican Stroke Organization and the 1st Latin American Ministerial Meeting on CVA. Gramado, Brazil, August 2nd - 4th, 2018.

Discussions at the Ministerial Meeting

In this congress experts on cerebrovascular diseases from the Ibero-American countries (Portugal, Spain and the Americas) and other areas of the world met in Gramado to present the greatest innovations in this field.  

WSO Faculty Members at the conference

The ministerial meeting gathered healthcare administrators and practitioners from Latin America, in addition to experts from other continents. They discussed the impact of stroke on the region, the organization of services and healthcare networks, successful models, challenges and potential solutions. We finished it with the expectation that this meeting will have a great impact on regional public healthcare policies, making them a reference for the world.

Professor Michael Brainin presents the WSO Social Commitment and Bill of Rights at a meeting for the general public

The 21^st Congress of the IASO joined some of the leaders in stroke neurology from the continent; we had lecturers from Argentina, Australia, Austria, Brazil, Bolivia, Chile, Canada, Colombia, Costa Rica, Ecuador, Germany, Italy, Mexico, New Zealand, Panama, Paraguay, Peru, Spain, USA. 

Dr Sheila Martins and a stroke survivor present his testimonial

Lectures, Seminars, Workshops, Challenges, a spectacular location and interesting social activities contributed to the celebration of a very successful meeting, with 810 participants from 20 countries. Professors Werner Hacke, Michael Brainin, Patrice Lindsay, Valery Feigin from the WSO and Valeria Caso from the ESO joined us to enrich one of the most important international meetings for stroke in Latin America.

Next year we will meet in Costa Rica; another wonderful chance to learn, to share and to enjoy.

Discussion at the interactive ‘Stroke Challenge’ workshop

Presentation of the First Prize in the World Stroke Campaign awards

Stroke Foundation Uganda, a new WSO member, gives hope to stroke survivors and their families

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Ibrahim Bukenya is the founder and principal physiotherapist at the Stroke Rehabilitation Center, home to the Stroke Foundation Uganda, in Kampala. 

What has inspired you to be involved in stroke support?

The inspiration was when I had a challenge in taking care of a mother who had a stroke and later passed away and the fact that I had worked with the Stroke Rehabilitation Center for the last 8 years by then. There were challenges other stroke survivors were going through and Uganda’s burden of stroke is increasing every day. I want to help prevent people from going through this challenging condition, to minimise adult disability caused by stroke and to have a stroke free Uganda.

What does stroke support look like in your country?

Stroke support in Uganda is mainly about stroke survivors coming together and encouraging each other to reach a common goal which is recovery and to go back to work. The Stroke Rehabilitation Center helps the survivors who cannot afford the rehabilitation costs. Our stroke support groups have volunteers who go to visit the survivors to encourage them. The stroke support group organises the World Stroke Day event with different activities to help increase awareness.

How did the project come about?

The project came about after realising the challenges the stroke survivors go through and the       national stroke burden.                                                                                                                                                          

What have been some of the outcomes of the project?

About 2% of stroke survivors have recovered to 90% and gone back to work.

Stroke survivors who have attended stroke support groups and rehabilitation treatments are promoting our name across the country, thanking and talking good about giving them hope again and families have been saved from tearing apart due to the counselling given to both care givers and survivors.

What has been the response from others- community, doctor’s politicians?

In the community the mindset about stroke has changed from the witchcraft perspective to rehabilitation and seeking early treatment from hospitals rather than traditional healers.

Doctors are increasingly understanding how important rehabilitation is to the survivors and we are already collaborating with some of them from the primary health facilities, however, other doctors still think negatively that rehabilitation treatment is competition to their work.

Politicians are getting to understand rehabilitation treatment through the parliamentary health weeks and through their relatives that have attended the support groups.

Stroke can attack any one at any time affecting the economic viability of someone, therefore stroke awareness prevention should be taken so seriously by knowing the risk factors for stroke, the signs and symptoms and in case someone gets a stroke to rush the person to the nearest hospital.

For more information:

www.strokeuganda.org

Testimonial Exhibition at the World Stroke Congress October 2018

We want to make sure that the voices of people affected by stroke are heard throughout the

Congress in an exhibition of stroke survivor, family and caregiver testimonials.

The 11th World Stroke Congress will focus on the latest developments in stroke prevention, acute management and restorative care after stroke. Reducing the burden of stroke on people with lived experience and their family and care givers drives everything the World Stroke Organization does. 

In previous years the visibility of people with lived experience of stroke has been promoted through art exhibitions, both physical and online, and a hobbies ebook. 

In 2018 our exhibition will focus on the testimonials of people with lived experience of stroke. 

We are calling on both stroke support organizations to gather testimonials from the people they work with, and on individuals to share their own testimonials, with the following brief:

150 words and include a digital portrait photo.

• Start with your name, nationality and your previous or current work or volunteer role

• When did you have your stroke and at what age?

• How did medical and allied professionals help you in your treatment and care?  

• Who and what has helped in your recovery?

• Is there anyone you would like to thank?

Please send to Sarah Belson sarah.belson@stroke.org.uk by 30^th April 2018.

Onyinye Iromba, a stroke survivor and stroke ambassador with Stroke Action Nigeria shares her story.

Where were you when you had your stroke?

I was at home sleeping and it was at about 3 am. I never knew it was stroke and I was staying alone in the house when the stroke happened.

Could you access hospital?

Welcome to new SSO member Stroke Organisation Zimbabwe

The Stroke Organisation Zimbabwe has become an SSO member of the World Stroke Organization. With 50 members, the organisation's aims are to:

• Promote prevention and care of people with stroke
• Education in collaboration with other international, public and private organisations
• Foster the best standards of practice and facilitate clinical research for the benefit of people at risk of stroke

Belinda Pfende, President of the Stroke Organisation Zimbabwe, is a physiotherapist. In her practice she saw the great gap in knowledge in society about stroke, its causes and how it can be prevented. Belinda therefore started the stroke support organisation, the first one in Zimbabwe. When Belinda first reached out to WSO she said 'your organisation is exactly what I have been looking for to enhance my professional development and also raise awareness about stroke.'

We welcome Stroke Organisation Zimbabwe as one of our newest SSO members and really look forward to working together to combat stroke in Zimbabwe. The new WSO member has a soccer tournament planned on 11th November for World Stroke Day.

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 

Welcome to new SSO member Stroke Support Group Pretoria

Stroke Support Group Pretoria is a social support group catering to the needs of people who have had strokes or brain injuries. They are situated in the Eastern suburbs of Pretoria, South Africa and offer emotional support to those who are struggling to cope with their changed lives, as members have all experienced what they are going through.

No matter what our age, we all have to take measures to prevent stroke

Timothy Kalule is an occupational therapist from Uganda.

What has inspired you to be involved in stroke support?

As an occupational therapist I have noticed the high prevalence of stroke and that people in our community do not understand it. They always think they have been bewitched. So, sensitizing them and helping them realize the potential of performing tasks after surviving stroke is key. Also the research we did here in Uganda by the Karolinska Institutet of which I was a research assistant “Use of phones to treat post-stroke survivors in Uganda” by Julius Kamwesiga, Susanne Guidetti and Gunilla Ericsson enabled me get much more inspired to help post-stroke survivors live a better life with self management.

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. 

New WSO member is the first SSO established in Iran: as a powerful movement against stroke

Dr Mehdi Farhoudi, member of the World Stroke Organization SSO Committee, tells us the exciting news about the establishment of the first SSO in Iran.

When was Stroke Support Organization-East Azerbaijan (SSO-EA) established?

Stroke Support Organization-East Azerbaijan (SSO-EA) was established in July 2017 and nationally registered.

What is the context for stroke care in Iran?

Stroke, as a leading cause of mortality, affects the large population in Iran of 75 million people. Stroke incidence has been increasing, while the age of stroke onset is dropping. Crude stroke prevalence is estimated to be about 150 per 100,000. Despite many limitations, intravenous thrombolysis of eligible stroke patients has been provided in some universities and private hospitals since 2008. Then Tabriz University of Medical Sciences established a multidisciplinary stroke team to start systematic thrombolysis in eligible stroke patients in 2010. After the 6th National Stroke Congress 2013 statement, a WSO endorsed meeting, and continuous and effective follow-up of Iranian Stroke Association and Iranian Neurological Society, the Iranian Ministry of Health identified stroke as a health crisis and the second cause of mortality. In 2015 the Ministry created the National Stroke Committee to improve the situation of stroke patients. The characteristics of primary and comprehensive stroke care units were defined. This led to the decrease of the cost of the tPA drug and the cost being covered by the insurance system. The Committee planned a road map to organize a network of stroke treatment in the country. The characteristics of primary and comprehensive stroke care units in 724 hospitals were defined; covering a population of at least 300,000. Fifty four hospitals have been candidates in the first phase and the modalities and guidelines for primary stroke unit were defined for them. Meanwhile there was a plan for  a pre-hospital emergency system to increase knowledge about stroke, upgrade systems to transfer patients and to establish comprehensive stroke units. Hopefully, Iran is going to make major progress in thrombolysis and mechanical thrombectomy of acute ischemic stroke to cover more eligible patients. We estimate that the thrombolytic therapy rate could increase up to 5% in the next 5 years.

What motivated you to start the organization?

Considering the high burden of stroke and necessity for many facilities, programs and for continuous public activities, we concluded that we need a more powerful movement against stroke. Given the limitation of government-based support, we decided to establish a stroke support organization in our province to get more benefit for the people and secure charitable contributions for fighting strongly against stroke in our region and country.

Is this the only stroke support organization in Iran?

Right now Stroke Support Organization of East Azerbaijan (SSO-EA) is the first registered one in Iran. We hope to establish and develop other SSOs in Iran soon.

What are the goals/priorities of the organization?

1- Public awareness and promotion of people and patients lifestyle to control stroke risk factors leading to primary prevention of stroke

2- Public awareness about acute stroke symptoms and signs for immediate and timely referral to eligible hospitals for preventing and decreasing probable complications (secondary prevention)

3- Support to promote diagnosis and treatment of acute stroke patients

4- Support for better care and rehabilitation of stroke patients

5- Support for better outpatient management

6- Detect stoke patients problems and attempt to solve them

7- Support research about the detected problems and stroke related priorities 

WSO welcomes new SSO member the Helderberg Stroke Support Group

The Helderberg Stroke Support Group (HSSG) has been involved in assisting stroke

survivors and their families in the Helderberg Basin, South Africa for over 21 years.

The HSSG says that it's important that we use the words "stroke survivor" in preference to the much used words "stroke victim". This is out of respect to the wishes of members of the organisation, who have indicated that they wish to be known as "survivors". 

The main focus of the HSSG is on rehabilitation for stroke survivors and stroke prevention training for home based carers, nursing staff and people interested in assisting stroke survivors in their communities.

The HSSG recognizes that "rehabilitation also encompasses the protection of human rights, equalisation of opportunities and the removal of both attitudinal and architectural barriers. Equalization of opportunities means that health and social services, transport, housing, education, employment opportunities and recreational and sports facilities must be accessible to everyone" (United Nations, 2002). HSSG will endeavour to strive towards the achievement of this goal.   

HSSG highlights that every day in South Africa approximately 360 people have a stroke (Boehringer Ingelheim, n.d.a) and that stroke is one of the leading causes of death and disability in the country. Many stroke survivors are left with permanent physical disabilities and cognitive impairments requiring extended hospitalization, nursing, home care and rehabilitation. 'That is why World Stroke Day on 29 October is so important in raising awareness of stroke and the risk factors for stroke,' says HSSG Chairperson Marian Engelbrecht.

My reason for preventing stroke? Knowing it can happen to anyone if you don't take care of yourself

My reason for preventing stroke by Nenad Nikolić - I am 35 years old and have seen people younger than me who have had stroke - we all need to take all stroke risk seriously!

My name is Nenad Nikolić. I want to share my personal reason for preventing stroke.

My mom suffered a sudden stroke in 2008, when she was age 49. I remember it was Friday 6th June, we were watching TV, when she suddenly lay down in bed, and couldn't get up, and started to talk some unrecognisable words. We tried to put her in a seated position , but she couldn’t do it. Luckily i work in hospital in a Neurology department in my town, so I recognised stroke symptoms quickly and reacted immediately.

As a survivor and a clinician I know that strokes can be prevented

Alexander Kortsiaris is President of HAS - the Greek Stroke Association, here he shares his experience of stroke and highlights the benefits of annual health checks and following a Mediterranean diet.

My reason for preventing stroke? My family of course. Everything else can be replaced.

Ifigenia Tsolakidou is a stroke survivor and member of HAS - the Greek Stroke Association. Here she describes how life has changed since stroke and the steps she takes to reduce her risk and that of her family.

Make efforts in stroke prevention now to avoid the disabling changes a stroke can cause

Anabela Resende, a survivor of stroke and member of the board of Portugal AVC, shares her stroke experience and reason for preventing strokes.

Where were you when you had your stroke?
I suffered the stroke on January 12, 2013, while I was enjoying a vacation with my husband in the city of Peniche, Portugal.

Ingrid Vorwerk Marren encourages people to get involved in stroke prevention by volunteering in a Stroke Support Group.

Members of the Stroke Support Group Pretoria meet every Tuesday. This group is open to all stroke survivors, their families or care-givers and all people assisting with rehabilitation or willing to help. The group functions mainly as a support system, but voluntary professionals also provide group sessions. The aims are to facilitate recovery of the stroke patient, to educate the community and to provide a social forum and network so as not to be isolated within the community.

What has inspired you to be involved in stroke support? 

I grew up in a family that has been involved in community service for generations. Whilst I studied physiotherapy I realised even more how disabled persons are isolated from society and are lonely. Later I chose to be involved as I anticipated what benefits it would have for those persons to belong to such a group and encouraged all my patients to join. It was also a new concept to support people socially in those days.

Now I realise that I have made a difference in hundreds of people’s lives over many years, three decades actually! I have motivated husbands, wives, children, care-workers, volunteers as well as stroke survivors and those with head injuries and other disabilities. Furthermore, looking back, I have developed many skills by being involved in voluntary community service which I would not have done elsewhere. It also made a difference in practicing my profession in many aspects.

How did the project come about?

Occupational therapists at Steve Biko Hospital, then called H.F Verwoerd Hospital, in Pretoria, recognised the need to support stroke survivors and together with a number of physiotherapists and other professionals and interested persons started the organisation as the Stroke Aid Society of Pretoria. We tried to get a national organisation registered, which was not allowed by the registering body at the time and then all those groups involved in this attempt registered individually. Firstly registering was as welfare organisation and now as Non Profitable Organisation.

What does stroke support look like in your country? 

Keeping the public informed is a constant need. We have marketed in many ways, but have to keep at it constantly with limited success. It is an uphill battle to get professionals to refer people to the group. However, we often have people contacting us via our website and others who read about the organisation in local “What’s On?” and free adverts in local newspapers. 

Many people do not have their own transport and public transport is often unaffordable and therefore they cannot attend weekly meetings, therefore our intention is to get groups started in the community, but that requires volunteers with determination and willing to put in an effort over a period of time, which is a challenge. Unfortunately we do not have major sponsors which would help immensely.

What have been some of the outcomes of the project? 

Members are proud to have been part of the book Strokie’s Stories project. This is available from https://www.smashwords.com/books/view/352259.

The weekly gatherings re-develop their “forgotten” or “lost” abilities and give them a sense of belonging. This leads to new confidence in themselves. By supporting others at the weekly meetings, and making new friends, developing new skills, they feel part of a more normal environment and that life is worth living. There are regular awards for those members that improve.  These are a great honour for them.

To me personally, involvement in a support group has aided in my own growth as a person. Managing volunteers over many years has sometimes been trying but also enlightening. I am irrevocably able to confirm that to manage volunteers is quite different to managing remunerated staff. Most (unpaid) volunteers are internally motivated, dedicated and willing to serve and to help others and they put immense effort into this, often not getting any recognition.

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

Excitement to see their name in print as an author of Strokie’s Stories and being enabled to tell their story as an inspiration to others. As they take part and have duties at the weekly meetings they also are encouraged to develop more skills, become more independent and make new friends at the meetings.

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

In general, we have an uphill battle to “educate” the community about “after a stroke” and to motivate the professionals to buy into referring their patients. We visit practices, give talks at groups and retirement centres, also on the radio and TV, but we only have reaction once a person has a mother/father/spouse with a stroke. Then often it is to ask where they could get free rehabilitation or where they could be housed.

There is a positive feedback of the book. It is truly inspiring and professional. The book is used as a marketing tool and given to presenters who give talks at the weekly meetings. Visitors to the group always make the remark that they did not know stroke survivors are like that: do they expect the members to be zombies? By getting the public involved in presenting high level talks and demonstrations at the meetings, we also try to lessen the “stigma” of being differently abled.

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

Watch your blood pressure, sugar levels, and do enough physically to be strong and fit. Also watch your stress levels. Get a hobby or two and come and be a volunteer in a Stroke Support Group: You would learn a lot about living and appreciate it!

What is your reason for preventing strokes?

Life is for living is my motto. I actually only need to watch out for myself as I am single and my children have to look out for themselves and their families. However, they know I advocate eating sensibly, watching weight, doing sport or exercises and to relax with a good book or get a hobby to de-stress. My friends also know this and know of my continued involvement with the Stroke Support Group.

The Stroke Support Group in Pretoria is firstly there for those that survived. With better treatment immediately after a stroke the severity is less nowadays and more persons survive, thus the need for support groups is greater. We only concentrate on survivors, but also those that are indirectly affected - family members and carers. This is also the message we want the professionals and public to hear.

For more information:

Facebook: Stroke Support Group (Pretoria)

Health Talk Video:  https://www.youtube.com/watch?v=AgsmFJLQpm4

Strokies’ Stories: an inspiring book found at: https://www.smashwords.com/books/view/352259

Tackling hypertension and improving stroke prevention awareness in South Africa

Hypertension prevalence in South Africa as recorded in the Study on Global Ageing and Adult Health (SAGE), conducted by the World Health Organisation, is the highest ever reported by a nationally representative survey of people aged 50 and over for any country.[1] 

The Heart and Stroke Foundation South Africa estimate that up to 1 in 3 adults have raised blood pressure levels; the most important risk factor for stroke. A high salt intake is an established risk factor for increased blood pressure. South Africans consume more than double the recommended amount of salt a day. In 2013 the Minister of Health signed legislation to make salt reduction in the food industry mandatory, making South Africa the first country globally to legislate salt levels to help reduce the amount of salt that the public takes in from processed foods.

Also in 2013, Salt Watch was established through a multi-sectorial coalition group to undertake a public awareness and education campaign to encourage South Africans to reduce their salt intake. The Heart and Stroke Foundation South Africa was nominated as the implementing body of the campaign, with the support of the National Department of Health. The campaign consists of a television and radio campaign and providing information and education materials. Salt Watch brochures are available free of charge, in five different languages (www.saltwatch.co.za ).

The Heart and Stroke Foundation, in a joint venture with Unilever, have also created a Salt Calculator to help people estimate their salt consumption. The salt calculator estimates salt intake based on the frequency by which common foods are consumed, and then provides feedback on current intake and tips on making better food choices. The tool was developed by using local research and statistics to guide the inclusion of food categories. Sodium content for more than 200 branded foods was collected online and in-store to provide a representative and reliable tool.[2]

Professor Pamela Naidoo, CEO of The Heart and Stroke Foundation says ‘my reason for wanting to prevent stroke is indeed because largely it can be prevented if you make positive life-style choices. Despite having a genetic vulnerability or a familial history for raised blood pressure, if you have good eating habits by choosing foods with low salt levels and refrain from adding salt to cooked food, and engage in physical activity which can also help to reduce stress levels, you can reduce your risk for a stroke. The effects of stroke can have a devastating impact on you, your family and your ability to lead a productive life.’

Another stroke support organization engaged in awareness raising and risk factor management is The Stroke Survivors Foundation South Africa. The Stroke Survivors Foundation provides post-discharge support for stroke survivors, their families and caregivers. This includes information on stroke and how to manage risk factors. Information is shared through social media, a website, print materials and at stroke support groups.

Having experienced the lack of statutory stroke support in the community after a stroke in his thirties, George Scola co-founded the Stroke Survivors Foundation in 2010. The sole purpose for creating the Stroke Survivors Foundation is to assist stroke survivors, their families and their caregivers, survive the trauma and give them the knowledge needed to endure the incident and their recovery.

George says ‘a stroke is a silent killer; this does not mean that we just have to accept it and fight it on our own. Having survived the stroke is the easy part. Recovering, adjusting and acknowledging the disability, patience for the survivor and the caregivers, staying motivated and staying positive… this is the difference between conquering and overcoming it, or taking it lying down’.

‘My reason for wanting to prevent a stroke is because I have personally experienced the destruction it can cause to a stroke survivor’s life, the turmoil and negative impact on their families, spouses, children and parents!

With the exception of medical reasons and in order to prevent this type of destruction from happening to others, it is important to look after ones health by not smoking, exercising regularly and following a healthy eating plan.’

For more information please visit:

http://www.heartfoundation.co.za/

http://strokesurvivors.org.za/

https://academic.oup.com/ije/article/43/1/116/731923/Hypertension-among-older-adults-in-low-and-middle

http://www.who.int/healthinfo/sage/en/

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[1] Lloyd-Sherlock et al (2014)

[2] Heart and Stroke Foundation South Africa

Acha Memorial Foundation delivers stroke prevention awareness in Nigeria

Background

Acha was established as a stroke support organization (SSO) in 2015 by brothers Timothy and MacDonald Oguike, after the death of their father following a stroke. The Oguike family found it very difficult to find the right information about stroke facts, treatment and rehabilitation and the brothers believe this contributed to their father’s death. Through its MasterStroke project, Acha aims to address the burden of stroke in Nigeria through: community stroke awareness and education campaigns; guidance on how to access the right stroke treatment and long term support; and advocacy to decision makers for improved government stroke awareness and risk management services.

Stroke prevention advocacy
MacDonald won the World Stroke Campaign Award 2015 for outstanding individual achievement for his leadership of Acha's MasterStroke program that used an impressive combination of media, social media and mobile technology to raise awareness and understanding of stroke throughout Nigeria.

My reason for preventing stroke? I want to be there for my children and my family

Foday Johnson, lives in Liberia and the UK. Here he tells us how his brother's stroke has spurred him on to do whatever he can to prevent stroke.

Before your brother’s stroke did you have any idea that he was at any risk? 

Not at all, in hindsight the signs were there though – he smoked, did not do exercise and had a poor diet. 

When and how did you realise he had a stroke? 

I was in London at the time, but his family around him suspected he was having a stroke. After his initial treatment he went to Monrovia for rehabilitation and was making some progress and returned home. After his return home he had a second stroke. 

Promoting SSOs in China

Sarah Belson, WSO International Development Manager, has just spent a week in China.

When I was first approached by Liying Xing, a neurology clinical research nurse at University College Hospital London, to participate in the Tiantan Stroke Conference in Beijing, my initial response was that I wasn't sure I was the person she was looking for. 'Yes you are' she said, 'we want someone to talk about stroke support in the community'. This was certainly a good start. I can’t say whether my 20 minute session introducing the WSO, its priority to support SSOs, and examples of SSO work around the world, had an immediate impact on my audience. This might have been because I was a bit of an anomaly in the session on Risk factors intervention and neuroprotection for cerebrovascular diseases. But the topic of SSOs was on the programme at least.

On the first evening of the Conference, the Chinese Stroke Association organised a celebration and award giving event for 300 of its 27,000 registered volunteers. These volunteers include doctors and nurses and are known as the Red Bracelet Movement, the stroke support arm of the Chinese Stroke Association. The movement is championed by Professor Wang Shaoshi and he attended the event along with the leadership of the Chinese Stroke Association. It was inspiring to see so many volunteers from across this vast country, committed to raising awareness about stroke - the risks, the signs and the emergency response. There is huge potential for some of these volunteers to develop SSOs and build on the stroke awareness work. This is certainly something that Professor Shaoshi recognises and wants to explore further.

And then on to Chongqing, a city that has grown from a population of 7 million to 37 million in the past two decades. We visited the Fourth People's Hospital of Chongqing and the attached Emergency Medical Centre. The hospital is not lacking in the latest modern equipment and some of the patients we met on the neurology ward couldn't be more enthusiastic about the care they had received. 'I'm a mathematician' one said, 'I only talk facts; they really took care of me'. One of the neurosurgeons said that 40% of the patients he sees have had a stroke. We met with staff from across the department and there was real consensus that support to stroke survivors in the community is lacking. Straight away we could see the opportunity to integrate stroke support work into the neurology department’s community medical association initiative, through which they share knowledge and good practice with community medical centres. So, what next? There is now a plan to set up an SSO in Chongqing and there is certainly a number of people who are in a position to make this happen.

In other meetings we met with the vice secretary of the Foreign and Chinese Affairs Office, and at the Health Commission we met with representatives of a number of other hospitals across Chongqing. There is great enthusiasm for learning more about what SSOs are, how they contribute to prevention awareness and how they can respond to the gap in rehabilitation and recovery support in China. In addition, many people we met are keen to join the WSO in order to access its resources and opportunities. The priority now is to build on this enthusiasm and these connections, in a country where stroke is the leading cause of death and where there are 7.7 million stroke survivors, who all have a right to be supported in their recovery.