ANGELIQUE BURGER was 16 years old and visiting her grandmother when a catastrophic event occurred that would influence the course of her life.
The first sign that something was terribly wrong was that her grandmother seemed disorientated and there was something odd about her speech. “What’s wrong with granny?” Angelique remembers asking her parents.
I felt so out of control,” she says. “I didn’t know what to do. That was when I made the decision to go into nursing – because of the care she got or rather didn’t get. Because of the difference the right people could have made for her.”
Her grandmother’s stroke made her realise the importance of having access to “the right person” during such a life-altering event, so Angelique made the decision to be the right person.
As care co-ordinator at Life Eugene Marais Hospital in Pretoria, Anqelique administers the patient pathway, getting all the moving parts working and ensuring nothing is overlooked. She is also in charge of data capturing and entering stroke patient data in the stroke care improvement registry RES-Q. And she is part of a nurse-led drive to improve stroke care at their hospital that in Q3 of 2023 was rewarded with their first gold award.
Troubleshooting and goalsetting
On 1 lutego 2024, trauma unit manager Sr Helet Viljoen marked 33 years of being the right person. The stroke pathway at Life Eugene Marais Hospital where she has worked since 1991, quite literally starts with her. Any time of the day or night, it is she who receives prenotification alerts from the ambulance service on her cellphone, passes the word to reception, arranges for a file to be opened and ensures the stroke patient has priority access to the CT scanner.
She wouldn’t dream of doing anything else.
The road to improved stroke care at Life Eugene Marais Hospital began in late 2018 when the hospital formed a partnership with the Angels Initiative. The first multi-disciplinary meeting took place in March 2019, and Sr Janneke Verster became coordinator of the newly created stroke pathway, overseeing a programme of training, simulations, weekly meetings, and community outreach. Although the hospital had no neurologist, a dedicated team introduced measures to shorten the time to treatment, and dysphagia screening became an integral part of care.
In 2020 the Covid pandemic disrupted stroke care worldwide and after Sr Verster left the hospital in October of that year, the stroke care improvement programme lost momentum. But in 2022 the spark was relit by general nursing manager Sr Amelia Marais who poured heart and soul into the mission to provide better care to stroke patients, and infected her colleagues with her passion. It was she who reinstituted the multi-disciplinary meetings that Angels consultant Carla Scholtz believes was the keystone of their success, and with clinical training specialist Sr Marina Tsiane and Angels support mobilised the training of nurses throughout the hospital.
After the hospital enrolled with RES-Q in January 2023, the meetings became a monthly forum for troubleshooting and goalsetting, their progress towards a gold award measured by Angelique’s presentations of their stroke treatment data.
“The answers are in the RES-Q results,” Carla reminded them whenever they fell short of the target, sending them back to their dashboard to identify quality gaps and fix them. But there was one gap for which they had no action plan – there was no neurologist to lead the team.
Starting over
Dr Maropene Maloma became the right person midway through 2023 when she joined Life Eugene Marais Hospital and found a stroke system already in place. At her previous hospital – a crowded state facility with very limited resources – the stroke programme faced overwhelming challenges. She’d made the move from a desire to grow, discover her abilities, make decisions and put her knowledge to work.
For the nurse-led stroke team, she was just what the doctor had ordered. Dr Maloma understood the goal and shared the passion, and by August 2023, Carla says, “the award was so close we could feel it”. Angeliques’s data report showed just a single metric where they fell short of gold and they had an action plan to fix it. As Q3 of 2023 drew to a close, she was putting in long hours to capture all the patient data in time for the awards deadline.
Dr Maloma’s interest in neurology and stroke was triggered while working as a physiotherapist. The work brought her into contact with stroke survivors and she became intrigued by the science and mystery of the human brain.
“Even during my training I was fascinated by how they knew where the lesion was, and why the weakness was on one side when the lesion was on the opposite side of the brain.”
Her work in rehabilitation was helping survivors manage the deficits caused by stroke, but she wanted to know more.
“So I started again,” she says. “After two years as a physiotherapist I went back to school and right from the start I knew I wasn’t going to become a generalist. I would have to specialise and neurology was on my mind.
However circuitous the route that lead to her current role, her background in rehabilitation enriches her work as she has seen first-hand the difference the right person or their absence can make.
Love’s labour
October 2023 is a month she will never forget, Carla says. “I spent a lot of time at Life Eugene Marais Hospital during stroke week and there was joy everywhere.” The Q3 results were about to be released and, like every year in the build-up to World Stroke Day on 29 October, there were stroke awareness activities such as prizes for the best stroke awareness poster and a cake decoration competition, both of which Carla had been invited to judge.
Prizes were handed out at the end of the week, but the biggest one was saved for last – the announcement by the hospital manager that Life Eugene Marais Hospital had finally won a WSO Angels gold award.
It was the fruit of a little more than nine months of hard work and determination and upon hearing the news, Sr Marais exclaimed: “I have finally given birth to my baby!”
Although Sr Marais has since left, there is a team carrying on her legacy to ensure the baby isn’t destined to be an only child, and a circle completed with Sr Verster returning as Sr Marais’s successor to continue the work of delivering the best possible outcomes for stroke patients and their families. Meanwhile Carla and Angelique are both keeping a close eye on the hospital dashboard in RES-Q as the action plan to become a platinum- winning hospital unfolds.
As word of the award got out, Sr Viljoen reports that ambulances that used to bypass them en route to hospitals further away, are now more frequently bringing stroke patients directly to their hospital. The gold award tells them what they need to know – that stroke patients will find the right people there.
