In my beautiful country, as in many others around the world, we observe that despite having well-trained institutions with correctly established stroke codes, the reperfusion rate for stroke patients does not grow as expected. The primary reason for this situation is that patients arrive outside the therapeutic window.
But what causes these delays? There are several reasons:
- Lack of awareness of stroke symptoms among the general population.
- Geographically challenging terrain, limited roads, and long distances to facilities capable of treating a stroke.
- Inadequate training for EMS on what to do and where to go when transporting a stroke patient.
- Non-implementation of stroke identification scales and stroke codes in low-complexity hospitals, which lack CT scans and clear protocols for managing and referring stroke patients.
- Absence of a stroke care network that integrates various stakeholders: low, medium, and high-complexity hospitals, ambulance companies, and the health system.
Faced with these challenges and barriers to patient access to the healthcare system, I decided to focus on forming a stroke network in the Department of Huila. I chose this area because it was the first region where I’ve worked where the Departmental Health Secretary (a territorial government entity) accepted the implementation of Angels and created a stroke network in the area.
We began by working together with the lawyers of the Territorial Entity and the EMS to issue a resolution that classifies stroke as a vital emergency requiring timely care at the nearest and best-trained center.
This work commenced in April 2022 and concluded in May 2023.
Simultaneously, I was forming Angels institutions and helped four high-complexity hospitals in the department win WSO Angels Awards, namely Hospital de Pitalito, Reina Isabel, Uros, and Medilaser Neiva. These institutions were strategically located with two in the north and two in the south of the city, allowing us to divide the population into two subregions and enhance the possibility of thrombolysis. Crossing the department from south to north takes approximately seven hours.
The resolution was published on 18 maggio 2023, prioritizing the transfer of patients experiencing a stroke. With the resolution and trained centers in place, the next step was to start training first-level healthcare providers in timely stroke identification and early referral, along with the EMS staff.
And this is where my journey begins – getting to know the Department of Huila and visiting previously unfamiliar places. To help you understand the region better, let me provide a brief description.
Huila is one of the 32 departments that make up the Republic of Colombia. Its capital and most populous city is Neiva. It is located in the southwest of the country, in the Andean region.
It has 37 municipalities and 128 population centers. Its economy generates 1.62% of Colombia’s GDP. Tt has an estimated population (2024) of 1,192,273 inhabitants, corresponding to 2.2% of the country’s total population.
It is mainly formed by the great valley of the Magdalena River enclosed between the Central and Eastern mountain ranges that fork in its territory and then head parallel to the north, giving it special characteristics such as having all the thermal floors, from a desert area to snow on the summits of the snow-capped Huila. Its undulating topography makes it difficult to access by land.
In the Department of Huila there are currently two indigenous associations legally constituted and recognized by the Ministry of the Interior and Justice. These are the Association of Indigenous Councils of Huila (ACIHU) and the Regional Indigenous Council of Huila (CRIHU). The population of ethnic origin in indigenous reservations corresponds to a population of 7,523 inhabitants (0.6%) and a total of 17 indigenous reservations in the territory are located in different ethnic groups.
As I have been telling you, of the 37 municipalities that make up the Department of Huila, only two have institutions prepared to treat patients with stroke – Neiva, the capital, located to the north, and Pitalito, the second city in population, located to the south.
Now the plan is to train the 37 municipalities that have low-complexity health care institutions in the timely identification of stroke and early referral.
I began my adventure in 2024 by reaching very distant populations, up to 8 hours by land from Neiva but two hours from Pitalito. With the support of the Departmental Health Secretariat and the hospitals trained in caring for stroke patients, I have managed to train 326 people from first-levels health providers and prehospital care. In total I have given seven trainings in different locations that were also attended by guests from nearby towns.
For me it has been very satisfying to see the progress in stroke care that the region has had. Each year it exceeds the immediately previous one in the number of patients favored with thrombolytic therapy. I hope that this work of training at first levels, relief teams and prehospital personnel will contribute greatly to the strengthening of the stroke network.
I will continue during 2024 with training for these teams and my wishes are that in my next story about the Department of Huila, I can demonstrate with figures the growth of the rate of thrombolysis in the region.
