Stroke in South Africa

In 1981 the first combined clinic between vascular surgeons and neurologists was started at the Johannesburg Academic Hospital, the teaching Hospital of the University of the Witwatersrand in South Africa. The focus of this clinic was on transient ischemic attacks and minor strokes; and all patients undergoing carotid endarterectomy were screened at the clinic before surgery and followed up post surgery. A number of successful publications in international journals followed the work of this clinic, and at least three PhD candidates successfully obtained their degrees through work carried out at the clinic. In other centers such as the University of Pretoria, Medunsa University, University of Natal, and University of Cape Town, similar stroke clinics were set up and clinical and academic work was carried out in each of these centers. Stroke Aid, a public group that ran weekly sessions for stroke patients was then established. The Stroke Aid group was entirely a charitable organization, and all the therapists and helpers worked in a voluntary capacity. This highly successful organization is still active in the community. It has branches in a number of areas, mainly indigent and poor areas, for stroke sufferers who have no access to any other help. There were also a number of other centers run by individuals, with no formal structure other than to assist stroke patients in the community. At that stage, the only government support was at the ordinary clinics and hospitals where stroke patients were looked after in general medical wards with only routine physiotherapy as a special report. In 1998 a Stroke Foundation was inaugurated in South Africa to educate the public about stroke. The aim was to raise public and medical awareness about stroke and assist in improving stroke prevention, acute stroke management and rehabilitation. This was the first national body in the country. The Stroke Foundation was not a government-supported organization. At the onset, finances were obtained from pharmaceutical companies and insurance companies, and the board and the management committee were all volunteers. However, with time the government became interested in more active stroke care in the country. National stroke guidelines were drawn up and published in the South African Medical Journal. These guidelines included protocols specifically for rural and outlying areas where no brain scanning facilities are available, and were based on international guidelines from Europe, USA, Canada, Australia, and the United Kingdom. The first South African Stroke Congress was held in conjunction with the Hypertension Society of South Africa. Since then the stroke congresses have usually been held along with other specialties such as vascular surgeons, family practitioners, rehabilitation experts, and cardiologists. In October 2006 there will be a joint World Stroke Congress held in Cape Town under the combined auspices of the International Stroke Society, the Mediterranean Stroke Society, and the South African Stroke Foundation. This will be a truly international stroke meeting with representation from all continents. For further information, consult the website: www.kenes. com/stroke2006. The number of stroke units in South Africa is increasing. Initially the units were developed only in private hospitals, with a total of 25 such acute stroke units in the country. The prototype stroke unit in a public hospital is at the Grootte Schuure Hospital in Cape Town, and this unit runs acute, acute/chronic, and rehabilitation facilities. The unit will also introduce an educational program, which will be recorded on CD and used as a teaching system for all nursing staff in hospitals that deal with stroke. There are good stroke units mainly aimed at acute/chronic stroke and rehabilitation in a number of former African townships in Cape Town and in Johannesburg. In addition, most academic hospitals now have acute/chronic stroke facilities, with referral to specialized clinics for early stroke rehabilitation. There are also a number of private stroke rehabilitation facilities in the country. The South African Stroke Initiative is a research program that is being run in a rural facility in Bushbuckridge, an outlying rural area. The initial results looking at epidemiology were published in 2004 in the journal Stroke (1). This program is a broad-based initiative that views all aspects of stroke prevention and stroke treatment in a non-urban area. There is a growing awareness of stroke in South Africa, but there are also major shortcomings. There are about 120 neurologists in a country with a population of over 30 million people, but only a handful of neurologists are specifically interested in stroke. Many see stroke patients, but do not work within stroke units and have no facilities for formal stroke rehabilitation. Most stroke patients are cared for by physicians, medical officers, and health personnel with no expertise or knowledge about stroke. There is very limited Government support for stroke care, mainly because of financial reasons, and although the Stroke Foundation has Correspondence: Vivian Fritz, email: dubb@ icon.co.za