Al Qurayyat General Hospital is located in northern Saudi Arabia in a small city no more than 30 km from the border with Jordan. “A beautiful city right on the edge of our country,” in the words of Dr Shahid Ahmed, the passionate physician who, as assistant director of emergency, is responsible for the day-to-day running of what must surely be among the busiest emergency departments in the Middle East.
The hospital admitted no fewer than 12,427 patients in June, Dr Ahmed says, including numerous referrals from hospitals in the surrounding area. But among these more than 12,000 patients, for Dr Ahmed one stands out. This patient arrived at the hospital on 26 June with slurred speech and left-side weakness – symptoms that had started an hour earlier. Ninety minutes later, still well within the therapeutic window, Al Qurayyat General Hospital treated its first ever stroke patient with thrombolysis.
“Within 15 minutes of starting the treatment, he was speaking normally,” Dr Ahmed reports. “We were so happy to see these signs of recovery; it was a goosebumps moment.”
The first thing Dr Ahmed did after congratulating his team, was to call his mentor Dr Amr Mouminah, a stroke specialist from Jeddah, and ask him to spread the word to his more than 20,000 Twitter followers. This Dr Mouminah did right away:
Today is considered history for @gurayathealth and its people. After hard work and concerted efforts of all relevant employees of the region and overcoming all difficulties, the stroke pathway was activated, and the solvent was given to the first patient in #Quarayyat_General Hospital. Under the direct supervision of the #Health_Virtual_Hospital stroke team in Riyahdh. Accordingly, inform the people of #Quarayyat that there is a stroke service in the hospital. And I advise everyone who has signs of stroke to quickly go to Quarayyat General Hospital (not Jordan) within the first four-and-a-half hours of the onset of symptoms so that we can help you. Time is the most important factor. If it passes, we will not be able to do anything. And the next is more beautiful, God willing.
Dr Mouninah’s Tweet said exactly what Dr Ahmed wanted it to – that the stroke team at Al Qurayyat General Hospital was ready to serve their city. And between the lines it told the story of a quest that began in March 2022 when Dr Ahmed was assigned the task of creating a stroke pathway at his hospital.
“They told me this is new, and you will lead it,” he recalls. “I had no idea what this project was about.”
Initially under the impression that building a stroke pathway would involve just four people – the medical director, hospital director, a neurosurgeon and himself – Dr Ahmed got a rude awakening when he sought advice from Dr Mohamed Aljuhani from Madinah. Learning that the pathway would involve a multidiciplinary team that would include doctors, nurses, lab technicians, radiologists, and the pharmacy, was a shock, he says. He would need more than advice.
“I told [Dr Aljuhani] my deficiency, my weakness. I said I needed his help, I needed everyone’s help.” That was how Dr Aljuhani became the first in a chain of benefactors who would walk beside Dr Ahmed over the course of the next year.
By now the the idea of converting Al Qurayyat General Hospital into a stroke-ready hospital had gripped his imagination. It was already more than a project – changing the prospects for stroke patients in Al Qurayyat had become, he says, “my ambition, my aim, my dream”.
Armed with a 100-day plan for implementing the stroke protocol used at the hospital in Madinah, Dr Ahmed started the hard work of winning over the leaders of departments he needed to support his pathway. A problem immediately presented itself – the hospital had no neurologist. Then, in what he describes as a tragedy, its two neurosurgeons both resigned at the same time.
“I took this very personally, very emotionally,” Dr Ahmed says. “I was in tears for many days. I did not know what to do. But by the grace of God some angels come into your life.”
Help with training and organisation came from Angels consultant Sherif Ali and his team who supported the project from beginning to end. The next angel that appeared to Dr Ahmed was Dr Majid Bakheet, stroke leader in the ministry of health, who helped him refine the stroke protocol and convince others, including referring hospitals, to join the project.
“He had some beautiful words for me,” Dr Ahmed says. “He came and spoke to all the leaders and convinced and motivated them. He told them we would be starting this treatment at our hospital and that we needed their help to ensure the patients arrived in time.”
Thus encouraged, Dr Ahmed faced the next hurdle – navigating regulatory complexity to obtain the thrombolytic drug for his hospital. “I cannot wait that long,” Dr Ahmed said when the pharmacy predicted a delay of one month. Not for the first time, he appealed to the regional director who stepped in to help. Then, with the drug procured after an anxious 10-day wait, and a part-time neurologist in place, a third angel appeared in the form of Dr Amr Mouminah.
By now Al Qurayyat General Hospital had an organised pathway but the newly assembled stroke team lacked experience. Dr Mouminah suggested pathway simulations to test the pathway and build the team’s confidence in themselves and each other.
“These mock stroke codes really helped orientate many of my doctors,” Dr Ahmed says.
The final piece of the puzzle fell into place when, thanks to the Angels Initiative, Al Qurayyat General Hospital became part of a telestroke network that connected them with the Health Virtual Hospital stroke team in Riyahdh. And when the stroke patient arrived on 26 June, this virtual connection to top stroke experts finally helped turn Dr Ahmed’s dream into a success story.
It’s the dawn of a new reality for stroke patients on the edge of the country. There’s no longer a need for time-consuming border-crossings to reach the nearest stroke-ready hospital in Jordan, 100 km away. Al Qurayyat General Hospital is already seeing around five stroke patients a week, a number that is certain to rise as Dr Ahmed’s enthusiastic public awareness intervention gathers speed.
Dr Ahmed has first-hand experience of how stroke impacts families. When his own mother had a stroke seven or eight years ago, she came to Saudi Arabia from India, but there was nothing he could do. Taking care of her was not just an emotional burden but a financial one too, he says, which was “shared between the government and me”.
Now the quest that began last March and achieved its goal on 26 June means other mothers and other families will be spared the same burden.
“I am emotionally happy to be doing something good,” Dr Ahmed says. “I feel very happy, and very proud of my team and all the people who supported me, helped me, encouraged me to get us to this stage.
“We are going to help the people of this city.”
