Improving Stroke Care in Sri Lanka

July 23, 2009


By Tissa Wijeratne, MD, FRACP, Stroke Research Unit, Western Hospital, Footscray, Victoria, Australia

Stroke is the major cause of adult disability and a leading cause of death in Sri Lanka, but the country lacks neurologists and stroke services necessary to combat this major health issue. When Tissa Wijeratne entered neurology training, he wanted to change that. This is the story of how he and other neurologists are starting to improve stroke care in Sri Lanka, with the advocacy training and assistance of the American Academy of Neurology and the Academy's Palatucci Advocacy Leadership Forum. —Glen R. Finney, MD, Advocacy Editor

Improving Stroke Care in Sri Lanka

Stroke is the third leading cause of death worldwide, causing about five million deaths each year. A high incidence of strokes and stroke-related deaths occur in the developing world, including Sri Lanka, where stroke is also the leading cause of adult disability. Sri Lanka has 20 million people, but in 2007, when I applied to the Palatucci Advocacy Leadership Forum, there were only 22 neurologists—and one stroke unit—for the entire country.

As a Sri Lankan neurologist, I wanted to improve stroke care in my home. At the Donald M. Palatucci Advocacy Leadership Forum in January 2008, I developed my advocacy plan for a stroke master class in Sri Lanka.

Early in my project, I met Padma Gunaratne, MBBS, MD, MRCP, senior consultant neurologist and director of the Stroke Unit at the National Hospital of Sri Lanka, in Colombo. She is a passionate advocate for stroke care. When we met during the fifth Asia Pacific Conference Against Stroke (March 2008) in Manila, we discussed improvement of stroke care in our home.

We planned a stroke education program for physicians and key stakeholders, community education, and the establishment of more stroke units using available resources in Sri Lanka. Also, three Sri Lankan physicians would visit the stroke unit at Western Hospital, Footscray, in Australia. Later that March, I spent two weeks in Sri Lanka putting the plan into action.

I spoke about transient ischemic attacks (TIAs) at the Association of Sri Lankan Neurologists (ASN), at which event Gunaratne and I planned our Stroke Master Class. I gave several more stroke symposia in Colombo, Kandy, Kegalla, and Bandarawela.

A leading national media company, Upali Newspapers Ltd, sponsored a booklet on stroke prevention, and 50,000 free copies were distributed throughout the country. We conducted a mass media campaign on stroke awareness through newspaper interviews and a television program. We established a model stroke unit in the base hospital at Kegalla, where two physicians run general medical services. Both agreed to allocate18 beds for a new stroke unit.

Presenting Stroke Care Goals in Prime Time

In November 2008, at the ASN Annual Meeting in Colombo, we held our first International Stroke Conference (ISC) on state-of-the-art stroke care. On the eve of the ISC, a panel of leading national and international figures in health and stroke care held a press conference; I shared the dais with eminent panelists, including the secretary to the Sri Lankan Ministry of Health, the President of the Stroke Society Australia, and the President of the Association of British Neurologists. We also conducted a series of interviews on stroke care on national television, broadcasting our message during prime time.

Media briefing at the International Stroke Conference in Colombo, November 22, 2008. From left, Sri Lanka Health Ministry Secretary Athula Kahandaliyanage; Dr. Wijeratne; Consultant Rheumatologist and President of the National Stroke Association of Sri Lanka, Dr. Lalith Wijayaratne; and Consultant Neurologist and President elect of the Association of Sri Lankan Neurologists, Prof. Saman Gunatilake. Source: Sunday Times (Sri Lanka), November 23, 2008.

The ISC was a huge success, with more than one hundred attendees, and a diverse faculty representing Australia, UK, US, India, Canada, and Pakistan. There were four Palatucci Forum graduates at the ISC in Sri Lanka, lending their advocacy efforts to our project. Gunaratne and the ASN council did a tremendous amount of work in planning and organizing this successful event.

After the ISC, we conducted a stroke symposium with the Kandy Society of Medicine (KSM). More than 150 attended, including Amanda Thrift, President of the Stroke Society of Australasia (SSA). The KSM agreed to provide the leadership in setting up stroke services in their region.

Moving forward, the Western Health Stroke Research Unit will help Sri Lanka improve stroke care. They offered a fellowship position in stroke to a Sri Lankan medical graduate, and plan to offer further experience in stroke care to developing nations.

The Work Ahead

There is much more work to do in Sri Lanka. The Ministry of Health has agreed to establish stroke units in every major hospital. To date, there are only three stroke units for the whole country. Sri Lanka needs more stroke physicians and allied health staff.

The country does not have a formal program in rehabilitation medicine; instead, rehabilitation services are currently through rheumatologists. A formal rehabilitation training program would greatly improve rehabilitation services for stroke patients.

We are establishing a network of rehabilitation physicians in Australia to work with the Post Graduate Institute of Medicine, the institute responsible for specialist training in Sri Lanka, to establish a formal rehabilitation training program. Recently, the first allied health faculty in Sri Lanka was established at the University of Peradeniya. Students from the faculty of allied health sciences had been barred from attending clinical rotations at the teaching hospitals due to lack of resources, and also due to misunderstandings between doctors' trade unions and allied health trade unions. Addressing these issues through cordial discussions and negotiations to resolve the conflicts will lead to training sufficient numbers of allied health staff to support stroke physicians and neurologists in Sri Lanka.

The Palatucci Advocacy Leadership Forum and the Academy helped me develop and implement my advocacy plan for improving stroke care in Sri Lanka, and provided important training and tools. Many forum graduates encouraged me and gave advice. The continued help of neurologic organizations—such as the American Academy of Neurology, American Stroke Society, Stroke Society Australasia, Australia and New Zealand Association of Neurologists, and World Federation of Neurology—can assist Sri Lanka in the improvement of stroke services, saving lives, and decreasing the incidence of disability caused by the devastating effects of stroke.

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Author Disclosure

Dr. Wijeratne has nothing to disclose.