Angels consultant in Kenya Annie Kariuki had been in her position less than a month when the first Angels Train the Trainer event in East Africa pushed her in at the deep end. There was to be no soft landing for this “baby Angel” as new consultants are sometimes referred to. Instead, the immersive experience of cohosting her first Train the Trainer event fast-tracked her introduction to the world of stroke care transformation and gave her the momentum she will need to tackle one of the toughest challenges in the Angels universe.
Only a handful of the 30 healthcare professionals who attended the event currently treat acute stroke, says the Angels core team’s Rita Rodrigues who, together with her colleague Madeline Bucher, had traveled to Nairobi to support the event.
But it was not for a lack of courage or skill.
“We found these doctors were knowledgable about the treatment including the latest research and when using the virtual patient simulator Body Interact they were highly capable of decision making and working as a team,” Rita said, adding that “they showed a strong will to collaborate”.
Most patients however arrive outside the treatment window, often two to three days after their stroke. If they do arrive in time for life-saving treatment, scrambling to find the money to pay for the treatment (which currently isn’t reimbursed by governments) squanders whatever precious time is left.
Annie is a microbiologist and not a neuroscientist, but she has first-hand experience of how difficult it can be to access acute treatment, and the devastation that follows in the wake of stroke. She was a teenager when her grandmother, after first complaining of a headache, began to show the signs of stroke. “She didn’t live near a city,” Annie explains. “So when she went to the nearest hospital, they said they couldn’t help her.” Doctors referred them to a bigger hospital where the same thing happened: Annie’s grandma was told to go to a hospital in the capital city. “By the time she got to the right hospital it was too late. She was permanently disabled on her left side, and I watched her become a shell of the vibrant person she used to be.”
Annie, who during the Covid pandemic worked on the frontline as an advanced emergency medical technician, applied to join Angels about a year after her grandmother passed away, and can now help shape a future where more grandmothers in East Africa will reach the right hospital in time.
To support the training in Nairobi, Jan and his team had invited two international stroke experts – Dr Francisco “Pachi” Moniche, stroke coordinator at renowned Hospital Virgen del Rocio in Seville, Spain, and Dr Louis Kroon of Sub-Saharan Africa’s first diamond-awarded public hospital, Steve Biko Academic in Pretoria. They headlined a training agenda that included an introduction to stroke guidelines followed by parallel workshops on CT imaging, stroke pathway optimization, and post-acute care including the Arrow Project that was developed in Spain to standardize stroke unit nursing.
An NIHSS workshop on day two showed a marked improvement in the accuracy achieved by participations after instruction by Dr Kroon. “A great teacher makes a great student. We are grateful for the opportunity,” Dr Kodichimma Onwuka, an internal medicine specialist at the University of Nigeria Teaching Hospital, commented in the event app.
Drs Kroon and Moniche also conducted the patient simulations that concluded day two, which saw Annie and team leader Matteusz Stolarczyk from Poland shine in the respective roles of concerned wife and stricken patient.
Annie barely had time to let it all sink in. “If you need anything, talk to Annie,” Jan had said in his opening presentation, and the delegates took him at his word. While fielding questions and invitations, Annie took joy in seeing participants enjoy the presentations, hearing the feedback and sharing the website resources which the attendees were surprised to learn were free.
“I went in prepared to learn and to network,” Annie says. “Although I still have a lot to learn, I can already make a difference. My background isn’t in stroke care but the doctors I talk to can see the value and that pushes me to be even more dedicated to becoming an expert.”
Matt encouraged Annie to use the momentum generated by the event to fortify relationships with the stroke community, and she has been delighted to encounter more goodwill in the hospitals she has visited. “Doctors will tell their colleagues, ‘Annie will help us’,” she says. The embrace of the local stroke community has been swift and warm.
Rita and Madeline, too, were struck by the positive tone that permeated the event. “There was a strong sense of optimism,” they report. “Participants were sharing their problems but not in a pessimistic way. They weren’t complaining, just sharing, and they were finding solutions within the group.”
Indeed, when it came to Africa’s reputation for valuing community and sharing its burdens and benefits, the gathering did not disappoint. Annie says: “Doctors from one hospital would say we have this challenge, and then someone from another hospital would say, this is how we overcome that.”
She also felt the power of the Angels community: “It felt real, the sense that we do have support, even here in Kenya.”
Making treatment affordable will be a key objective in this as in other developing regions, and it’s one that will ultimately need government support. A stroke can wipe out a family’s income and support system in an instant, with vast costs accumulating to society and the economy. To influence policy, authorities need to be made aware of this burden and become convinced that there is a solution that works.
“We need to have a success,” Rita says.
They made not have very long to wait. The Angels journey in East Africa may have only just started, but if the first event is anything to go by, community holds the key and success is the destination.
