Anna Kiełkowska: The story begins in 2021 when I was contacted by the chief neurologist at St. Łukasz in Bolesławiec. Dr Justyna Straszak-Trzeciak had heard about Angels and wanted to meet. At the time they had no stroke unit but they were working on it and Dr Straszak-Trzeciak was confident they would succeed. She is a shiny person – strong, with an open mind and a heart for people.
Justyna Straszak-Trzeciak: We wanted a stroke centre in Bolesławiec so that stroke patients didn’t have to be referred to facilities 50 km away and arrive too late for optimal therapy outcomes. Although we weren’t yet fully funded for thrombolytic treatment, we had the consent of our medical director Kamil Barczyk to treat patients with reperfusion. He said we were supposed to ‘treat, not count’.
Our first such therapies were a bit chaotic in terms of organisation, but Anna Kiełkowska showed us the importance of perfect organisation in those critical moments when we are fighting for the patient’s life. Simulation showed us how important each team member is, and that cooperation is based on the communication of reliable information that makes decision making easier.
We always look forward to our next Angels meetings, knowing they will drive new changes in our hospital. And Jacek Skóra, who is also a certified ASLS trainer, passes the learnings on to his EMS colleagues and implements them in daily practice.
Jacek Skóra: My first stroke patient was a long time ago, before it was widely understood that time is brain. Back then stroke patients were generally condemned to permanent disability or other psycho-physical dysfunctions for the rest of their lives. But the last two years have radically changed the approach and treatment options for cerebral infarctions in our hospital. These new ways of treatment challenge us to make very quick decisions and act fast.
Justyna: We started implementing fast-track procedures even before we had a dedicated stroke unit. It was important to develop an ideal model of work from the start. We know there are hospitals where the patient waits for a neurological consultation in the ER, but in Bolesławiec it’s our team of nurses and a neurologist waiting for the patient, not the other way around.
Head nurse Ewa Gadzińska: We have a bag with all the necessary medicines and equipment and a second bag with additional equipment, which is very heavy. The nurse can barely carry it, the bag bumps around her ankles, but when we receive a stroke alert there’s no second thought. If sometimes it’s faster to go through the courtyard, our nurses won’t even notice that they’re not properly dressed for the weather. Sometimes they run in the pouring rain, or in light shoes up to their ankles in the snow.
Justyna: Our trained rescuers prenotify the neurologist on duty who reserves the CT lab. The patient is registered in the ER before they arrive, and taken directly to CT. If they’re eligible for reperfusion, thrombolytic therapy is administered in the CT laboratory. In post-acute care we focus on early rehabilitation, establishing the cause of the stroke, and secondary prevention.
Ewa: Neurological patients require more care. They are sometimes tired of their illness and do not always cooperate with the staff. This requires special personality traits, especially self-control, firmness and, to some extent, resistance to human suffering. The work can lead to sadness and tears but also to joy. These emotions accompany us every day, but we get through it all thanks to a smile and support, especially from Justyna.
Justyna: Ballroom dancing, my passion growing up, taught me that professionalism is never a coincidence. Passion breeds professionalism, and professionalism produces quality. Director Barczyk always emphasizes that quality is the most important and will defend itself. I am impressed by his commitment, passion and striving for perfection. I'm learning consistency and patience from him. He always motivates me to act, pushes me forward when I come to him with another idea. He always says: Let’s do it! He never lacks courage in making decisions.
Director Kamil Barczyk: I am full of admiration for Dr Justyna Straszak-Trzeciak, for her commitment and determination in pursuing her goals. Her hard work and dedication, her desire for development and the pursuit of perfection made it possible to create an ambitious team of specialists who could become one of the best stroke teams anywhere.
Justyna: Our plans always include a specific goal; the stroke centre was the first. Initially it raised some doubts among local authorities, but dreams are there to be realised and our goal was to create the best facility in Poland, managed according to the latest guidelines. When we opened our Centre for Stroke Prevention and Treatment last April, we had the feeling that now we can do it! With this passion we infected more people.
Kamil: It is people who change the world. Ambitious, properly selected and passionate staff not only achieve the goal, but are also a driving force to broaden horizons. An important element for the development of medicine is investing not only in fixed assets, but above all in human resources.
Justyna: The start is individual, but the work is a team, so it is extremely important who I surround myself with. My co-workers give me strength to act. The doctors behind our success are Agata Rojek, Marta Trapszo-Myga, Danuta Rodkiewicz, Łukasz Ratajczak, Maciej Mączka, Anna Kosiak, Hanna Siemieńska, Vitalii Hrushkevych, Juliia Babkina, Katarzyna Mielcarek and Piotr Duda.
Their average age is 36. They are a solid team that I know I can rely on and who are aware of their own potential. My goal is to educate neurologists in areas slightly distant from neurological specialisation, from neurosonology to the treatment of post-stroke spasticity with botulinum toxin, so that our team can be fully self-sufficient.
We are aware that transporting the patient to a facility 120 km away for mechanical thrombectomy is our weakness, so our next goal is building capacity for treating patients with thrombectomy.
Kamil: Good management is setting yourself bigger and bigger goals, and then the whole process of making and implementing specific decisions that will enable implementation. For good management to be possible, one must first of all know the specifics and subject matter of the industry.
I have been associated with the health service since childhood. I was born and raised in the border town of Zgorzelec in the Lower Silesian region. My mother, as the director of the hospital in Zgorzelec, often took me to work, where I could observe and learn from an early age.
After graduation [with master’s degrees in Management and Production Engineering and in Mechatronics] I started working in a hospital in Zgorzelec, dealing with fundraising. To this day, I attach great importance to obtaining external funds that create unlimited development opportunities. The experience I gained in Zgorzelec, my knowledge of the industry and the desire to develop and make my dreams come true prompted me to apply for the position of director in Bolesławiec. My goal is to create a health service worthy of the 21st century and prove that unorthodox solutions are good and effective, you should not be afraid of them.
Justyna: In order to ignite others, you have to burn yourself. This is why I always try to be maximally involved in my work. As a manager, I also lead patients, I participate in every stage of the patient’s diagnostic and therapeutic process. While on duty, I meet with further problems that my colleagues on these shifts also have. Active participation in patient care is my inspiration for further changes that can improve our work.
I was born in Lwówek Śląski. In high school, I realised that my dream was medicine, and in 2002 I started medical studies at the Medical Academy in Wrocław. During the post-graduate internship, the idea of a specialisation in neurology was born. Why neurology? Because it is a very dynamic branch of medicine where, thanks to modern therapies, the doctor has a sense of agency, and this is what I value the most!
I learned from doctors for whom it was very important to follow the latest guidelines. They made me aware that there were no limitations to therapeutic possibilities regardless of where you worked. They showed me how to manage a ward and cooperate with others, and how to care for human relations.
Ewa: I wanted to be a nurse for as long as I can remember. I was born in Bytom, and before moving to Bolesławiec we lived in a small town in Lower Silesia with no health centre.
As a child I was often ill and the only effective treatment was intramuscular injections, so my mother would take me on a bicycle to the health centre several kilometers away. The weather was not always favourable to us, it often rained. I knew how much effort it cost my mother, and I thought that by learning to give injections I would solve all my family’s health problems and we wouldn’t have to travel so far.
Jacek: What attracted me to this profession is, in short, great job satisfaction and the opportunity to help others and perform activities that affect their safety and health. I was born and raised in Bolesławiec and graduated from the medical school here as one of the first in the country to qualify in this field. From the beginning, I focused on working only in emergency.
Ewa: The nurses and medical carers working in neurology are unique people who have a huge heart, amazing layers of empathy and, despite a momentary doubt, never give up. Beatka, for example, has wings on her shoulders and an open heart. More than one storm has turned her life upside down, but she’s still patiently waiting for rainbows. Natalka is a refuge of calm on the outside, and inside, two elements, water and fire. You can always rely on her. Małgosia is warm, kind, calm, whatever happens; Ania soothes all tensions with a smile.
Kornelka, the smiling sunshine of the ward, has the ability to enjoy the smallest things. The patient feels warm with her. Agnieszka rarely emanates emotions outside, but she always has open hands to lift broken wings. Angellika does not spare words that bring comfort, never closes her heart to another human being ...
Of course it happens that the patient does not go to the hospital on time and their life is deeply impacted by stroke. Then begins the fight of this patient, their family and the whole team. Long hours and days go by and the patient does not always recover. But even in such moments the family thank us because they know that until the last breath, the patient had such care as if they would get up tomorrow and go home.
Kamil: Quality staff and creating conditions for their development is the most important indicator of the unit’s potential. I try to use innovative hospital management techniques, introducing a number of new solutions that significantly improve functioning of the facility. But it’s people that allow us to view the future of healthcare with optimism.
Justyna: Reporting our data in RES-Q has been another important quality measure. We Polish usually don’t like having our mistakes pointed out, we are afraid of criticism. But reporting specific data shows us our potential weak points and is a driving force for change.
What is our strength? Our thinking and long-term plans! Everything new is an opportunity and a challenge that we want to take up!
We are also impressed by the attitude of paramedics who participate in the first stage of this diagnostic and therapeutic process with great commitment. Their work is excellent.
Jacek: The changes in stroke care at our hospital, and evidence that we can prevent disability in many people, have created a very positive perception among our group of paramedics. Our work has even been recognised with an EMS Angels Award. I remember bringing a patient with aphasia and confusion to the hospital and when I met the doctor in the corridor an hour later, he told me that after thrombolytic treatment this patient had recovered completely. I felt then the value and importance of the changes, I felt that it all made sense.
Ewa: It is not always possible to separate my personal life from work. I would like only wonderful, happy days, only fast-healing patients, but every life is different and every fight is a step forward. But if we asked ourselves why we are doing all this, we might as well ask: Which wing does a bird need to fly? Right or left?