On World Stroke Day, Prof Dr Dipes Kumar Mandal, Founder-President - Stroke Foundation of Bengal talks about how a condition like Stroke, which has far reaching consequences, needs to be taken more seriously.
Do you think stroke is one of the most debilitating conditions? Why?
Stroke is one of the leading causes of death and disabilities globally. While in USA, heart disease is the leading cause of death, in China, Stroke (Brain Attack) is the leading cause of death as well as disabilities. Stroke may be 2nd or 3rd leading cause of death In India, but accurate data is not available till date. In India with 1.3 billion people, there are around 2 million stroke cases a year(incidence), about 7 lakh deaths caused by stroke and over 70% post-stroke disabilities among the survivors. It is not difficult at all to understand the magnitude of public health burden due to Stroke. The complex and most long-term costly post-stroke disability is probably the leading cause of adult disability in India with poor and suboptimal stroke care infrastructure. And it is to be remembered that no two stroke patients have similar disabilities (unlike in any other major diseases) together with their specific managements. Moreover, these patients have to bear the entire cost for costly long-term managements, which are not even available everywhere, especially in rural areas. So, Stroke is definitely one of the leading disabling conditions.
Is it preventable? How?
Yes, Stroke is preventable in 80% of cases, unlike other leading NCDs (non communicable diseases) like Heart Diseases and Cancers. Ten risk factors (RFs) have been identified by World Stroke Organisation to prevent about 90% stroke, the most important being Hypertension (Blood Pressure -130/80mm of Hg and above).
Other risk factors include
- Lack of physical activity,
- Unhealthy diet,
- High cholesterol,
- Obesity(high BMI),
- Tobacco(Smoking and Chewing) and Alcohol Addiction,
- Heart diseases especially Atrial Fibrillation,
- Diabetes,
- Often even a lack of Education and Air Pollution.
Control of Hypertension and stopping Tobacco addiction can prevent around 50% stroke in India. Reducing other Risk Factors will help reducing incidence of Stroke in more than 80% cases.
What are the strongest reasons for a person to have a stroke?
Strongest risk factor is of course Hypertension. It is the “Silent Killer” which is prevalent in about 30% of adult population, mostly unrecognized and uncontrolled. (It is much more dangerous than Diabetes, and most people, including doctors, administrators and policymakers, are not aware of its dangers and consequences resulting in huge public healthcare burden) As a matter of fact, Hypertension causes more stroke than Heart attacks do. Other risk factors are already mentioned above.
How are you going about spreading awareness about a serious condition like a stroke?
Our activities are all documented in our Facebook page of Stroke Foundation of Bengal and Website www.strokefoundation.in. Vulnerable individuals(with RFs) should take advantage of Prevention Clinics(like Hypertension Clinic), which is the best place for Awareness and Access.
The mobile-based device-“Stroke Riskometer app” is an online app (can be downloaded through Playstore or App Store), which will help assess risk factors, prevention and also prediction of stroke in next 5-10 years. It is available in more than 12 languages covering about 6 billion people. Its Bengali version has been edited by the President and Secretary, Stroke Foundation of Bengal and is used by thousands of Bengali speaking people of India and Bangladesh living anywhere in the globe.
Is there anything called post stroke rehabilitation? Can you tell us more about it?
In our country, the incidence of stroke is around 2 million a year killing around 7 lakhs and disabling many more. There is no or minimal infrastructure, especially in rural India. Stroke is the only medical disorder which demands most important management after the Emergency care is over in Hospital. The Rehabilitation is essential for recovery from different types of disabilities. In fact, no two strokes are similar. Accordingly different types of therapies are available like Physiotherapy, Occupational Therapy, Speech and Swallow Therapy, Gait Therapy, Cognition Therapy and Psychotherapy, which will be recommended by treating physicians as per the condition. Proper Rehabilitation for first 3 months immediately after Stroke is most vital for maximum recovery from disabilities. Unfortunately, these facilities are not easily available even in Government Hospitals in Urban and Rural setting. Private Speciality Hospitals in large cities may have these facilities of Rehabilitation Unit, but the cost is too high for the common man.
Any special agenda to observe World Stroke Day on 29th October?
There are lots of activities around the world for World Stroke Day. As a matter of fact, we from World Stroke Organisation(WSO) and its affiliated global stroke Societies including Stroke Foundation of Bengal continue all the activities throughout the year, culminating on World Stroke Day on October 29. Each year,WSO declares a Theme for the Day. This year’s Theme is “UP AGAIN After Stroke”. Our emphasis on this Day will be on Stroke Rehabilitation which will help improve “Life After Stroke”.
There are many activities occurring globally to make the people, patients, caregivers, family members, professional and the Governments aware of the severe problems faced by patients(and Family Members) after stroke, and to work more aggressively for the welfare of the Stroke Survivors so that they can get back to normal lives as early and as far as possible. One of the important features of this year’s WSD 2018 that WSO will highlight along with its affiliated global member Societies (including Stroke Foundation of Bengal) is to interact with local governments to pass Global Stroke Bill of Rights, so that sufficient funds are allotted to manage huge number of patients with Stroke so that no stroke patient is denied proper treatment due to lack of funds. All Societies and NGOs are requested to work with their Governments so that the Stroke Bill of Rights is passed in the Parliaments early.
Our programmes at Stroke Foundation of Bengal include spreading message of WSD 2018 – “UP AGAIN After Stroke” to all people everywhere as anyone (1 in 6), anywhere at any time may be affected by Stroke. These will be done in Bengali dailies and AIR, Kolkata.
Stroke Foundation of Bengal along with Indian Medical Association (IMA), Salt Lake City Branch, Kolkata, will observe the WSD 2018 on October 29 at 4PM,in a Seminar at the IMA House, CK 45, Salt Lake City at 4PM. Stroke Survivors and their family members will speak about their experience, problems and available ways to recovery. Hypertension Screening will also be done for all persons participating in the Seminar.
Prof Dr Dipes Kumar Mandal, Founder-President - Stroke Foundation of Bengal and Former Head of the Department of Neurology, Calcutta Medical College, Kolkata
