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Table of Contents    
CORRESPONDENCE
Year : 2017  |  Volume : 65  |  Issue : 2  |  Page : 442-443

Author's Reply: National program and telemedicine services for stroke care


1 Department of Neurology, AIIMS, Delhi, India
2 Department of Neurology, IGMC, Shimla, Himachal Pradesh, India

Date of Web Publication10-Mar-2017

Correspondence Address:
M Vasantha Padma
Department of Neurology, AIIMS, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.201873

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How to cite this article:
Padma M V, Sharma S. Author's Reply: National program and telemedicine services for stroke care. Neurol India 2017;65:442-3

How to cite this URL:
Padma M V, Sharma S. Author's Reply: National program and telemedicine services for stroke care. Neurol India [serial online] 2017 [cited 2017 Mar 25];65:442-3. Available from: http://www.neurologyindia.com/text.asp?2017/65/2/442/201873


Sir,

Many Indian hospitals lack the necessary infrastructure and organization required to triage and treat patients with stroke, quickly and efficiently. The clinical stroke services across the country, especially in public sector hospitals, are deficient in many aspects. The existent treatment gaps in stroke care include a dismal rate of thrombolysis for stroke, non-availability of 24 × 7 stroke physicians, of stroke interventionalists as well as of stroke care maps and the implementation of stroke care pathways. The presence of stroke units, a stroke team, sufficient community awareness programs and efficient public emergency ambulance systems are also lacking. These are all essential elements required to provide optimal stroke care in the community.

Currently, these facilities are largely available in expensive corporate sectors in metropolitan cities, thereby, denying optimal stroke care to the vast majority of Indian people, who are residing in geographically and economically inaccessible and underprivileged areas. Hence it is imperative to immediately address this treatment gap of stroke care in India, especially in view of the impending stroke epidemic.

Central to these deficiencies is also the changing landscape of stroke management paradigms across the world. We now are in a very exciting era of enormous advances in managing and improving stroke outcomes. There are new guidelines for treating major acute ischemic stroke, aneurysmal bleed, and revascularization of major arterial occlusions. Better expertise with better devices and techniques have all increasingly improved stroke outcomes.

Where does this leave us here in India? With its multitude of problems in health care delivery systems, how do we ensure optimal stroke care to all? It is, therefore, imperative that our focus remains “Indiacentric.” We need to design the mandate of the National Program for Non-Communicable Diseases of Government of India to address issues unique to India with regard to the stroke burden, stroke in the younger population, risk factors, peri-pregnancy strokes, recurrence of stroke risk, stroke rehabilitation and the management strategies including treatment and prevention best suited to Indian health care infrastructure and economy. We also need to design protocols and blue prints to ensure the best management to most citizens; and, perhaps incorporate the indigenous systems of Indian Medicine into the main stream of health care.

Telestroke services using low-cost, smart-phone based techniques and social networking sites have been used successfully in some states such as Himachal Pradesh, where acute stroke patients have been successfully triaged and treated even at the district level government hospitals. The services have been provided free of cost to the patients. This has been a huge “game changer” in a country grappling with the gigantic task of bridging the socioeconomic and geographic barriers across the country to ensure optimal stroke care to all.

The clarion call must be, India should be “stroke ready,” if not “stroke free.”




 

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