It’s now been more than two decades since the NINDS study revolutionised stroke treatment. Stroke became an emergency as for the first time there was something that could be done to remove the clot and save the patient’s brain from dying. Yet as recently as 2016 of all the roughly 51,000 stroke patients who sought help in Bulgarian hospitals, only 329 received recanalisation therapy. This was despite years of effort and hard work by the Bulgarian stroke community.
A team of Bulgarian experts under the leadership of Academician Ivan Milanov, chairman of the Bulgarian Society of Neurology, were eager to fix the situation though. After reviewing the number of stroke patients vs the number of stroke units within Bulgaria, they knew that they had to establish more stroke ready hospitals within the country. In 2016 Bulgaria had only 8 stroke centres in the country and if they wanted to improve the treatment of stroke they would need closer to 40 and they had to ensure a good geographical coverage of the new units. 20 years of experience told them that this was not so easy to achieve so they were open for any assistance they could get. It was probably for this reason that in June 2016 a delegation led by Academic Milanov attended the Angels Initiative European kickoff meeting in Mainz, Germany. Was this the unexpected spark they needed?
It’s a bit hard to say what exactly made the difference and precisely which aspect of the Angels Initiative created the spark but since then, the Bulgarian stroke community has gone from strength to strength and have expressed that they have no intentions of stopping where they are at.
They have successfully established 13 new stroke ready hospitals in the country, having only had 8 in June of 2016 they now have 21 spread all over the country. Despite the growth in the number of hospitals being phenomenal and the aim being focused on further increasing this number, the Bulgarian stroke community knew that they could not only focus on increasing the number of hospitals within the country. They needed to direct focus into ensuring that the new hospitals were functioning optimally and were seen as “better” hospitals. They felt it was important to ensure that the new hospitals were groomed, pruned and mentored correctly. For this they have been very active doing training workshops, dummy patient simulations and implementing standardised checklists and stroke bags in all hospitals treating stroke patients.
After all this time it almost seems difficult to believe it was so difficult in the past, but perhaps that’s the value of community, of being part of something larger than oneself. Something that can create a spark in the right people, people that can make such unbelievable growth all of a sudden seem easy.