Karnataka has to wait longer to get state-wide stroke care

Stroke is a major health concern in India, including Karnataka. To reduce the incidence of stroke-related deaths, the National Institute of Mental Health and Neurosciences (NIMHANS) proposed creating a hub-and-spoke model in 2023 to be implemented in the state. The proposal was accepted by the state health department within a year, but has seen slow progress till now. 

From the five proposed centres, only Karnataka Medical College and Research Institute (KMCRI), Hubballi, has received approval so far. Even this centre is not functional yet and is expected to start in a month. 

Dr BL Sujatha Rathod, director, medical education department, Karnataka, tells Deccan Herald, the thrombectomy machine has been procured, but the department is waiting for specialist doctors to come on board to start services. The initial salary structure was low, which possibly resulted in hesitation to join. It has been increased now, and Dr Rathod expects that doctors will be onboarded soon. 

The other centres in Bengaluru, Raichur, Bellary, and Mysuru will only start after KMCRI turns out to be a successful case study. Dr Rathod says, despite being proposed in the budget two years ago, only Hubbali got a clearance from the finance department. 

Why is the hub-and-spoke model important? 

In Karnataka, NIMHANS is well equipped to provide advanced stroke treatment, including emergency thrombolysis, 24×7 mechanical thrombectomy services, stroke ICU care, rehabilitation, and follow-up care. 

Other government-run centres are up to NIMHANS’ level in treating stroke cases. Dr Girish B Kulkarni, professor of neurology, NIMHANS, says, many district hospitals only provide IV thrombolysis treatment, injecting clot-busting injections to dissolve blood clots. But people with bigger clots requiring surgery will not be helped by it. 

The implementation of the hub and spoke model can ensure early identification of stroke patients. The smaller hospital acting as a spoke can start initial treatment and quickly transfer eligible patients to thrombectomy-capable centres. This system helps reduce treatment delay and improve outcomes for patients living outside Bengaluru.

Every second counts in stroke care

Blood supply to the brain stops, the face starts drooping, vision becomes blurry, and there may be speech difficulties. These are a few of the most prominent symptoms of stroke. 

Just like a heart attack, timely treatment is extremely important while dealing with stroke patients. In case a person is unable to receive timely treatment, their brain cells begin to die within minutes, leading to paralysis, speech problems, memory loss, and even death, Dr Girish B Kulkarni, professor of neurology, NIMHANS, explains. Quick functioning can save brain function and reduce the mortality rate to a large extent. 

Dr Kulkarni observes that awareness about stroke symptoms is low. Many patients also reach the hospital too late due to several reasons. From traffic congestion and lack of ambulance services to shortage of stroke-ready hospitals, many reasons cause delays in treatment. The rural areas particularly need better stroke care services and faster referral systems. It can reduce permanent disability and stroke-related mortality by a huge margin. 

Ahead of World Thrombectomy Day, marked on May 15, NIMHANS doctors highlight the BE FAST signs of stroke:

• B – Balance: Sudden loss of balance or dizziness

• E – Eyes: Sudden loss of vision or blurred vision

• F – Face: One side of the face drooping

• A – Arm: Weakness or numbness in the arm or leg

• S – Speech: Slurred speech or difficulty speaking

• T – Time: Time to reach the nearest stroke-ready hospital immediately

They urge people to take immediate action in case any of these symptoms are observed.