1 person suffers a stroke every hour in UAE; More facilities needed

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In the UAE, one person suffers from a stroke every hour. Every year, between 7,000 and 8,000 people suffer from a stroke. It is a leading cause of death and, in the UAE, it is the second leading cause of disability. Yet, Rashid Hospital has the only dedicated stroke unit in Dubai, and countrywide it is supported by just one another dedicated unit, in Al Ain.

At Arab Health 2014, which is being held this week at World Trade Center, the Dubai Health Authority (DHA) raised the topic together with the German State of Rheinland-Pfalz, which supported the DHA in setting up the certified Stroke Unit in 2012 according to the European Stroke Organisation Guidelines.

Although the situation has improved considerably since the establishment of the unit at Rashid Hospital, more stroke facilities are needed.

Time is crucial

A stroke appears suddenly. It is characterised by a rapid loss of brain function due to disturbance in the blood supply to the brain. The proper response is the immediate transfer to the nearest stroke unit.

“An adult brain has a total of five to six billion brain cells. When a stroke occurs, brain cells start to die. It has been estimated that 1.9 million brain cells die per minute in a stroke case,” explained Suhail Al Rukn, Stroke and Neurology Consultant and Head of Stroke Unit at Rashid Hospital.

“The thing about strokes is that it occurs suddenly and the damage takes place very quickly. The longer it takes a person to get medical assistance, the more brain damage occurs,” he added.

However, with only two dedicated stroke units in a large area, the desired immediate response is not always possible. A resident in Ajman, or in Sharjah during peak hours, could face difficulty reaching a hospital on time.

“In Germany, we define the travel time that somebody needs to get to the nearest stroke unit. Ideally, this travel time should not be more than 1 hour. This allows 1 to 2.5 hours to treat the patient,” explained Bernd Ringelstein, Board Member of the German Stroke Society.

Capacity

Furthermore, capacity plays a role. “You could say that one monitored bed in a stroke unit equals the capacity to treat 100 patients per year. Considering that in the UAE 7,000 patients suffer from a stroke per year, you would need 70 beds.

Rashid Hospital currently has 4 beds, so it has the capacity to treat 400 patients per year; they are fully booked,” he concludes.

Since the establishment of the stroke unit at Rashid Hospital, the facility treats 500 patients per year, of which 150 patients needed acute stroke management. Luckily, the facility has never had to turn down a patient.

“When there is the need for acute treatment we have always been able to provide with this treatment. However, inpatient capacity is a problem,” said Al Rukn.

Asked how many patients reach the hospital on time, he said: “When we consider that the patient should be treated within 4.5 hours, we can say that we provided acute treatment to 55 patients in 2012, while this number increased to 71 patients in 2013. This means we are doing a good job, and patients are arriving earlier to the hospital.”

Time is very important for the success rate of treatment, he continues to explain. “Of the patients that reach the hospital within 90 minutes from the moment the symptoms appear, one-third benefit from the treatment. This number changes to 1 out of 20 among those who reach the hospital after 90 minutes.”

Currently, the stroke unit in Rashid Hospital is in the process of obtaining an international accreditation for the establishment and functioning of a stroke unit that follows European protocols and standards. Furthermore, the DHA plans to open a completely dedicated neuro-spinal centre in the premises of the new Rashid Hospital complex.

“We are very proud of Rashid Hospital for establishing a completely dedicated stroke unit that follows international protocols. It is the DHA’s aim to promote international accreditations in the medical field- both in the private and the public sector. This accreditation will help reaffirm the high standards of care that Dubai adheres to,” commented Essa Al Maidoor, Director-General of the DHA.

However, these facilities alone may not be enough for a proper stroke management. “Given the prevalence of strokes, we would encourage more hospitals to set up dedicated stroke units that follow essential protocols to minimize the irreparable damage caused to the brain cells during a stroke,” said Al Rukn.

Ringelstein added: “There should be more hospitals with more beds at more locations. Then you can treat these strokes adequately.”

Asked whether there are plans for the establishment of stroke units in the new government hospitals that will be built according to strategic 2013-2025 plan of DHA, Issa Al Maidoor commented: “These new hospitals will surely have the general departments. Regarding the stroke facilities, we will look at the demand. If we find that we need to establish another stroke facility in Jebel Ali, we will do that.”

UAE statistics

The number of strokes in the UAE is comparable to international rates. With an average of 2,500 strokes per million people in the developed world, the total number of 7,000-8,000 per year in the UAE is not alarming.

However, statistics show that a considerable number of young people suffer from strokes in the UAE. While the average age is 65 internationally, it is 45 in the UAE. This is a surprising fact, believes Ringelstein.

“Although the number of stroke patients among the older generation is considered normal, people of a young age are strongly represented and it not quite clear why. It is possible that these cases are caused by other factors, such as infectious diseases,” he said.

A sedentary lifestyle and a high prevalence of hypertension, diabetes and obesity are among the common causes to strokes in the UAE, says Al Rukn. “Of the stroke patients we receive, 70 percent suffers from hypertension, 30 percent is diabetic and 25 per cent are smokers. These are all huge risk factors that place a huge burden on our health care system.”

Further, in 9-10 per cent of the cases that are registered by Rashid Hospital the stroke is fatal. Most common causes of this fatality are the complications that appear after the stroke, such as pneumonia, urine infection or blood clots in the leg, said Al Rukn.

Stroke prevention

Asked what can be done to reduce the number of stroke cases in the UAE, Al Rukn emphasised the importance of prevention. “Prevention is more important than the response to strokes,” he said.

A healthy lifestyle is important, as well as controlling blood pressure. High blood pressure increases the risk of a stroke two to four-fold. Reduce the intake of salt,” he advised, adding that 1-2 gram per day should be the maximum intake.

Finally, recognising the symptoms is important for the proper response to a stroke. He said that a simple process can help family members identify if a person is having a stroke or not.

“It is called the FAST test; face: check whether the person’s face has fallen to one side and whether the person can smile or not. Arms: Can the person raise both arms or not? Speech: Can the person speak or is the speech slurred? And lastly, time: if any of the three signs are visible, it’s important to call the ambulance right away.”

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