Assam’s hospital on wheels for rapid stroke care

The Indian Council of Medical Research (ICMR) handing over two Mobile Stroke Units (MSUs) to the Assam government is a significant leap forward for improving emergency and life-saving services and transforming stroke care in the state. Increasing public awareness of stroke and promoting a healthy style remain critical to reducing the stroke burden on the state healthcare system and deriving optimal benefits from the MSUs. The MSU can cut down treatment time for stroke patients from 24 hours to two hours, as it enables early diagnosis and treatment at or near the patients’ homes, which are several hours away from the nearest hospital equipped with such life-saving treatment facilities. This mobile hospital on wheels is equipped with a CT scanner, point-of-care laboratory, clot-busting drugs and a facility for teleconsultation with specialists. Stroke patients getting treatment within the golden hours is crucial to prevent major brain damage and improve recovery and survival. Timely maintenance of the MSUs will be vital to ensure that objectives of their deployment in the state are achieved without a break in services rendered by it. Quick imaging and teleconsultation ensure rapid diagnosis of ischaemic stroke patients and initiation of the clot-busting treatment that dissolves the clot and allows blood to flow again to the brain, which saves brain tissues and improves recovery. The ‘Guidelines for Prevention and Management of Stroke’ under the National Programme for Prevention and Control of Non-Communicable Diseases issued by the Directorate General of Health Services, Ministry of Health and Family Welfare, highlights that stroke is the fourth leading cause of death and fifth leading cause of disability in the country. The rationale behind rolling out the MSUs in the state is implementing the national strategy of ensuring that technological breakthroughs in stroke treatment reach wider sections of people, particularly in rural areas which do not have access to advanced care. The Guidelines list risk factors like hypertension, diabetes, heart diseases and positive family history; other lifestyle-related factors such as unhealthy diet, obesity, lack of physical activity, stress and tobacco use account for its occurrence. “Changes in lifestyles, behavioural patterns, demographic profile (ageing population), socio-cultural and technological advancements are leading to sharp increases in the prevalence of stroke. The disease by and large can be prevented by making simple changes in the way people live their lives or simply by making changes in the lifestyle,” it adds, which lays the foundation of preventive measures that need to be prioritised along with technological and healthcare interventions. Sedentary lifestyles and unhealthy eating habits have raised the risk factors for a large section of the population. Apart from regular exercises, promoting the ‘Eat Right Campaign’ launched by the Food Safety Standards Authority of India (FSSAI) is crucial to reduce the risk factors. Enforcement of the informative labelling of high-fat, salt, and sugar in packaged foods mandated by FSSAI is essential to preventing obesity and diabetes.  The Guidelines also lay emphasis on health promotion and awareness generation at the level of health subcentres for mass awareness by adopting various approaches such as organising awareness camps and using posters, banners, and billboards to educate people at community/school/workplace settings. It suggests undertaking health promotion activities in the village during the days when the health workers visit the village for immunisation and other health services so that the health workers can discuss various aspects of a healthy lifestyle and its benefits with the target groups and motivate them to adopt a healthy lifestyle for the prevention of common risk factors for stroke. Screening activities are a crucial component of the preventive strategy. The document mentions that with the introduction of the concept of Comprehensive Primary Health Care (CPHC) under the aegis of Ayushman Bharat Health Wellness Centre (AB HWC), subcentres have been upgraded into Health and Wellness Centres (HWC) for providing services beyond reproductive and child health. As per the mandate of CPHC, non-communicable diseases, including stroke services, are one of the 12 packages to be provided through the HWCs. The health worker screens all males and females who are 30 years and above under population-based screening for hypertension, diabetes and other risk factors for stroke. ASHA/male workers are required to screen the population for the presence of any risk factors or premorbid conditions that could lead to stroke by asking questions and taking past histories of the people during their home visits. Building awareness in the community on stroke will motivate people to voluntarily approach the HWCs for screening, and panchayat and other local bodies, NGOs working in the health sector, sports clubs and other social organisations can be roped in for wider reach in such campaign activities. Technological advancements like MSUs help transformation in healthcare service delivery, but these come with a huge cost involved in the procurement of equipment, recruiting trained professionals, and recurring expenditure. Therefore, risk prevention through lifestyle changes can keep the state’s stroke burden to a minimum.