As a routine, it has been my job to examine and treat about 50 patients in a 5 hour OPD in a rural primary health care centre. I am the only medical officer here and it’s always a rush and stress to manage them all alone. Most of the cases in here are communicable diseases but non communicable diseases are on increasing trend.
One day, I was taking a nap after the day duty when I got awoken by a phone call. It was Subina*, our nurse. “Doctor, can you come to ER fast?”Her voice was shaken.
I rushed in no time. A middle aged man was lying on bed. It was her father, Ramesh* uncle, an ex-army, who was under my treatment for hypertension, and we both knew each other well before.
“Uncle Namaste!”
He couldn’t reply in words but I could make from his gestures that he was trying to express his appreciations to me.
“What happened? “I asked. She said that her father couldn’t move the right half of his body and was unable to speak a word for his best try. I could see some saliva dribbling from his right corner of mouth.
“Don’t worry uncle. We are here and we shall do all that is possible. You will be able to walk around soon” I said. But in the back of my head, I knew it was a case of acute stroke which indeed was something to worry about.
I examined him thoroughly and called Subina and her mother to my office room. I explained them that it was a case of acute stroke which could be due to blockage (or rupture) of certain arteries that feed the left part of his brain. If the blockage didn’t progress more, he would be safe. I also mentioned that he should be taken to a tertiary centre with
Neurologic Facility as soon as possible!
Subina started crying! Her mother sat numb on the floor. And there I was all alone amidst the perplexity as to whether counsel them or to treat uncle. Thankfully, they normalized after few minutes.
We managed him conservatively for the basic ailments that he had for then and called an ambulance. It took about an hour for the ambulance at district headquarter to reach us. I told Subina to call me whenever she needed.
As CT scan facility is not available in the district hospital, they took him directly to the zonal hospital. He was responded well in ER of zonal hospital, and asked to get a CT scan of head done immediately. But alas, even the zonal hospital did not have functional CT scan and so, they had to go to a nearby private centre. Almost 6 hours had passed after the onset of his symptoms till he got his scan. This is because generally, it takes a minimum of 4-5hrs to reach there from our centre provided that the road condition is okay.
Emergency at Lumbini Zonal Hospital, is always a mess. Reportedly, it’s always three times the flow of patients what is expected to be there. Even in an ischemic stroke, it is not easy to start aspirin, let alone thrombolytics. No neurologists and adequate neuro ICU is available. Uncle got aspirin about an hour after his CT scan.
This incident made me thoughtful. If the father of a health worker who is well to do and can afford for an ambulance and further treatment got there in 7 hours, how pathetic would the situation be for the poor ones ? Worse would be the condition of the residents of the peripheral part of the village who require around 4 hours just to reach our centre.
Can we do something on such a scenario? Certainly yes! Being the main health care provider in the village, we could sense our dimensions and limitations, But yes, we can start some change!
First of all, there is no any official and accurate data on how many patients suffer from non communicable diseases like stroke in this community. We should advocate on official national registry system for such problems, as they amount for more than half of premature deaths.
It is no doubt stroke has been one of the leading causes for death and disability in adults and senior citizens of Nepal. But timely recognition and immediate response is what is required for the salvage of the damaged brain by such vascular problem.
As per WHO guidelines, the risk factor modification is the best way for decreasing such deaths. It includes cessation of smoking, regular excercise, good dietary practice, regular and early treatment for Hypertension and dyslipidemia.
As a clinician, we see the aftermath of stroke is really heartbreaking. Ramesh uncle is now hemiparetic, can walk only with support. There are people who are bed ridden and have become problem parents for working children. Researches have shown that early physiotherapy, regular intake of medicines for stroke sequel as well as risk factors, prevocational education and spiritual awakening can make early and optimum improval in such cases. With today’s unhealthy life style, everyone is vulnerable to non communicable diseases like stroke. Should we not start to think on it, before it’s too late?
At the end, I would like to convey a message from Ramesh uncle. He has asked all of us to adopt healthy life style, do regular health check up and follow doctor’s advice such that we don’t have to suffer like he had to.
*= names have been changed.
