Better access for stroke patients


The Health Ministry is mulling over an additional six stroke centres by 2024, while more medical teams will be trained by the Malaysia Stroke Council to address the lack of neurologists to treat the condition.

WHEN it comes to stroke, every second counts.

The bigger the delay in getting treated, the smaller the chances of full recovery.

In fact, two million brain cells die every minute until blood flow is restored.

“In other words, time is brain.

“The more time passes, the more brain cells are lost and may not be re-generated, ” says Malaysia Stroke Council president Assoc Prof Dr Hoo Fan Kee.

As it will be World Stroke Day this Thursday (Oct 29), there’s a need to look into main issues involving the disease here – the lack of neurologists to treat patients and limited access to stroke centres, especially in rural areas.

The good news is steps are underway to smoothen the road ahead for patients.

Currently, there are a total of 61 public and private stroke centres in Malaysia, according to Dr Hoo.

“It’s almost a double-fold increase from 34 in 2017.

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“But we still need about 90 centres in the country, ” Dr Hoo adds.

For this, the Health Ministry is proposing to increase the number of public stroke centres to beef up treatment here.

“A proposal to add six more centres by 2024 is being considered.

“This is subject to budget availability to develop or upgrade such facilities, ” the ministry tells Sunday Star.

On Aug 14, the World Stroke Organisation recognised five Malaysian hospitals for achieving international standards in their stroke care practices.

Such news is encouraging but the challenge remains that there aren’t enough neurologists, or specialist doctors who treat diseases involving the brain, spinal cord, nerves and muscles.

“There are 99 registered practising neurologists in Malaysia.

“Of this total, 25 are working under the ministry, 24 are with the Education Ministry while the remaining 50 are in the private sector, ” the ministry says.

But this is a far cry from the recommended ratio of one neurologist per 100,000 population.

“Now, the ratio in Malaysia stands at one neurologist per 330,303 population, ” the ministry explains.

At the current population of 32.7 million, we would need to have another 228 neurologists.

Boosting medical help

Nevertheless, more trainees are being accepted for sub-specialisation training compared to the past.

“Over the last few years, about 10 trainees were accepted annually in public hospitals under the ministry while academic hospitals accepted one to two trainees each year, ” says the Health Ministry.

Concurring about the lack of neurologists, Dr Hoo says it doesn’t help that the distribution of such specialists is uneven, with most or about 40% being based in the Klang Valley.

“There’s still a need to boost the number of stroke-ready hospitals – centres with doctors and medical teams who are trained to handle cases.

“Some states only have a handful of hospitals that can treat stroke, ” he says.

For example, Kelantan, Terengganu and Pahang each have only two stroke centres.

To address this, Dr Hoo says the Malaysia Stroke Council will be coming up with a virtual training programme to grow the pool of medical teams that are able to treat stroke.

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This will help equip non-neurologists to be able to treat stroke patients and increase the number of stroke-ready hospitals.

“The council will set up an online certification programme for the theory section of the training by the end of this year.

“After going through the theory online, the doctors and the rest of the medical team will go through practical training before they can be certified to treat stroke patients, ” Dr Hoo explains.

Previously, the council had also trained non-neurologists who are likely to come across stroke cases like geriatricians, general physicians and emergency physicians.

So far, he estimates that there are 12 hospitals now operating with non-neurologists who have been trained to accept stroke cases.

In order to be a stroke-ready hospital, such hospitals need to have a physician trained to read computerised tomography (CT) scans to diagnose stroke and have neurosurgery support.

Dr Hoo says the council hopes to improve the outcome of treatment, with the aim of having 60.2% of patients being fully independent after suffering a stroke by 2024.

Currently, only 34.4% of patients are independent after the episode.

At present, the mortality rate is 8.7% for stroke but by 2024, the council hopes that it can be decreased to 5%.

Getting more common

For now, Malaysia needs to be prepared as stroke has become more prevalent over the years.

From a prevalence rate of 0.3% among Malaysians in 2006, it jumped to 0.7% in 2011.

This is based on the Health Ministry’s National Health and Morbidity Surveys in past years.

The ministry also notes that stroke is becoming more common among young Malaysians these days.

“It’s mainly caused by the increase in non-communicable diseases (NCDs) among the younger age group, including obesity, ” it says.

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With about 50,000 new cases of stroke every year, it’s also worrying that 40% of those affected are aged below 60, says the National Stroke Association of Malaysia (Nasam).

As such, Nasam rehabilitation head Tracy Chan says there is a need to have greater awareness about stroke among the young.

“It is when people are young that prevention should start.

“Educate them on healthy lifestyles and have an environment that promotes greater healthy living.

“Start them young on healthy living, work ethics and balanced lifestyles, ” she says.

Employers should also understand that staff wellbeing is just as important as a healthy balance profit and loss sheet.

“In fact, happy staff always improves the balance sheets, ” Chan quips.

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