On Tuesday 8 stycznia 2013, Rocio González Gutiérrez, a 32-year-old accountant from Borges Blanques in the province of Lleida, Spain, suffered a hemorrhagic stroke five days after giving birth to twin girls Valme and Paula.
When Rocio’s left leg suddenly gave way, she knew instantly something was wrong. The girls’ father, who was then also her husband, fetched a nurse who lived nearby and who arrived within minutes. After a quick examination, the local ambulance service was notified of a code stroke. It took less than 30 minutes to reach the University Hospital Arnau de Vilanova, the largest public hospital in the province, and when Rocio arrived the medical staff were waiting for her.
She spent a week in the ICU and another month in the stroke ward before she was referred to Guttmann Barcelona, a neurorehabilitation institute in the Catalan capital, Barcelona. She underwent multiple therapies but when state funding dried up 18 months later, Rocio was still a wheelchair user with right hemiplegia preventing the use of her right arm and hand.
She is now able to walk, albeit with difficulty, and while she has completely recovered from aphasia, she struggles with memory, logic and calculations.
Almost 12 years after her stroke, we see Rocio on a stretcher being wheeled once more through the corridors of Hospital Arnau de Vilanova. This time, however, she is wearing a red vest that is labeled “patient”, signaling that this is no ordinary emergency. Rocio is taking part in a simulation that neurology chief Dr Francisco Purroy hopes will help him identify gaps in the intrahospital pathway.
It does. En route to the CT, the pathway breaks down outside the special elevator that is supposed to facilitate speedy transfers. The elevator is card operated and neither one of the doctors present has a card. In the weeks that follow, a card will be issued to everyone dealing with emergencies.
If only all problems were as easy to solve.
But in fact, Lleida’s journey to Angels Region status will proceed relatively smoothly, and there’s a very good reason for that.
On the road with Paco
It begins in Basel, Switzerland, where Dr Purroy – Paco to his friends – visits the Angels booth in the exhibition hall at ESOC 2024 and learns of the 100 Angels Regions strategy. A picture taken on 16 May shows him sitting beside Angels consultant Maria Atienza. Paco is on the phone. He is also Lleida’s regional stroke coordinator and he is talking to neurologists at the two spoke hospitals in the stroke network – Pallars Regional Hospital in Tremp and Fundació Sant Hospital in La Seu d'Urgell – about making Angels Region status their common goal.
FAST Heroes is already implemented in the region. Paco’s hospital is headed for their second diamond, and the Medical Emergency System (SEM) managed by the Catalan Health Service has won a diamond award every year since 2022. Gold status for the two spoke hospitals is all that is needed for Lleida to become one of Europe’s first Angels Regions.
Another journey begins at 8 am on 13 June when Maria and Paco set off from Lleida on a road trip that will take in the towns of Tremp and La Seu d'Urgell. All in all they will spend four hours and thirty-six minutes in the car.
They’re each grateful for each other’s company. Paco because Maria is bringing a fresh approach that he hopes will refertilize the ground for his message about quality monitoring; Maria because access to new hospitals is much easier when you arrive in the company of the regional director.
Not many visitors come to this part of Catalunya to offer a path to improved care, so Maria receives a warm reception and after an introduction to Angels and the regional strategy, and a pathway analysis, dates are agreed for a simulation.
The simulations take place on 25 and 26 September. A steering committee is formed that same september and follow-up meetings agreed.
At the end of the third quarter of 2024, Pallars Regional Hospital and Fundació Sant Hospital each collect their first diamond award. Three months later Hospital Arnau de Vilanova clinches their third.
You have to fight
Taking part in simulation training – her first – was just one of the ways in which Rocio contributes to stroke care transformation in her region. Together with a fellow member of AMILL, the Association of Stroke Patients and Families of Lleida, she gives talks at institutes, associations, and municipalities to raise awareness of the disease that took so much from her 12 years ago.
Although the simulation triggered feelings of grief, nervousness and fear, she would do it again in a heartbeat.
Stroke has taught her that there are wonderful people, Rocio says. “You have to fight, especially when you are separated with twins, but there is life after stroke – and the small details, those we sometimes don’t give importance to, become very beautiful moments.”
Although the current stroke network in Lleida meets Angels Region criteria for stroke care coverage, Maria and Paco have their eye on a fourth hospital in a remote Pyrenean town from where accessing the current stroke network can present a challenge.
The road trip to Vielha leads through peaks that exceed 2,000 meters, and is expected to take approximately two-and-a-half hours.
