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In conversation | Ecuador & Jordan

They live in different cultures, and in different time zones, but they have both felt the impact of stroke in their families, and are dedicated to giving stroke patients a second chance at life. We asked SOL PLAMENATZ, Angels team leader for Ecuador and Peru, to nominate a fellow consultant and ask her 10 questions. Sol nominated BAYAN ALFOQHA, Angels consultant in Jordan, who responded with questions of her own. Here is their conversation:
Angels team 22 March 2023



Sol: How long have you been an “angel”?

Bayan: In May 2023 it will be four years.

Sol: What motivates you the most about your work?

Bayan: It’s hearing about a patient’s life saved, and about the quality treatment they received at the hospital, and witnessing how excited stroke teams are about the difference they have made for every patient.

My maternal grandfather had a stroke and suffered for a long time. His name was Nemer, which is “tiger” in English, but it means he was a very brave, very tough, smart man. Unfortunately he suffered from diabetes which was managed with insulin but poorly controlled. Frequent exposure to hypoglycemia increased his risk of stroke. He had several minor strokes and due to lack of stroke awareness wasn’t treated in time.

The strokes affected his memory and compromised his motor skills. Eventually he could no longer recognise my mother – his own daughter – and he was angry that my grandma, who had been the love of his life, never visited him in hospital. He forgot that she had passed away and believed his love no longer cared about him.

Stroke doesn’t only kill brain tissue, it can also break your heart. That is why this work is my passion – so that other grandfathers will have a chance to remember all the good old memories and create new ones. Everybody deserves that.

Sol: How do you think you go the extra mile in Angels? Do you think you’d do the same in another job?

Bayan: Prioritising the patient is what makes me push my hospitals to provide the best quality care to their stroke patients. I do think I would have the same level of dedication in any other job, I will always go the extra mile, but in Angels, it’s the emotional part that drives you to do more.

Sol: Tell me about a rewarding experience in your time in Angels.

Bayan: The moment I realised that I was one of the reasons why a 23-year-old stroke patient and new mom would get to raise her baby with her mental and physical abilities intact. Especially because I am a new mom and I know how hard it is to take care of your baby.

Sol: Do you remember the first hospital where you worked as a consultant? What’s different now?

Bayan: At the first hospital I worked with, the neurologist had had a bad experience with thrombolysis and the hospital was very resistant. Now it is has a diamond award and is considering expanding its stroke unit capacity.

Sol: What do you think is the most difficult part of your job?

Bayan: In Jordan, state hospitals provide treatment to 70% of the population which means an enormous workload for staff. As a result they’re not very open to new protocols and pathways. The resistance, and convincing them of the difference they could make in stroke patients’ lives, is the most difficult part.

Sol: How do you manage to prioritise when more than one hospital asks for your help?

Bayan: I am the only Angels consultant in Jordan and I cannot manage a large number of hospitals at the same time. My strategy is to be honest about when I will be able to start the consultancy, and to highlight that it’s not because their centre is less important than other centres, on the contrary – it’s a matter of timing and capacity.

Sol: What do you think your country should work on to make the burden of stroke visible?

Bayan: Awareness, mostly, as patients unfortunately still arrive outside the therapy window, which severely impacts the thrombolysis rate.

Sol: Do you think the Angels model is unique? Why?

Bayan: Of course it is. I have worked in three therapeutic areas before and Angels has the highest impact on patients’ lives and on doctors. The help we offer and the way we communicate must meet high standards, and the respect they show us in return shows how unique the initiative is.

Sol: How do you see the initiative in five years’ time?

Bayan: Let me put forward two views. One is expanding to new countries, especially in the Middle East, as there are still gaps in stroke management in many surrounding countries. In Jordan itself, because we have limited numbers of neurologists, official sanction from the ministry of health for emergency doctors to handle decision-making in hospitals where there are no neurologists. This will help achieve my vision for saving 5,000 patients yearly in Jordan.




Bayan: How would you describe the current stroke management in your country?

Sol: With many opportunities for improvement. Although we have done a lot in these past four years, we still need important authorities (such as the ministry of health) to be more involved in creating awareness, especially in the community, so that people can recognise stroke symptoms and understand the importance of acting fast.

Bayan: What is your daily motivation?

Sol: Without a doubt, it’s knowing that every grain of sand that we put into our work will be reflected in the treatment of patients and in lives saved. When I go to a hospital and doctors mention that they know about Angels and I see that they are using our materials when treating patients, it fills me with pride and gives me the strength to continue.

Bayan: What was the moment you felt you had the most influence on stroke care?

Sol: Every time a doctor contacts me because they are interested in Angels courses, or they ask for materials, or because they want to replicate what we did at another institution. In those moments I feel that we are making a difference.

Bayan: What was the stroke patient story that inspired you the most?

Sol: It’s the story of a centre in Ecuador that went from a non-treating to a treating hospital in three months. We did multidisciplinary training in April, had a successful simulation in May, and in June their first patient was thrombolysed in record time. When the treating doctor told us the story, he was so excited that we were overjoyed. Not only did it save one life, but it opened the doors for that institution to start saving many more.

Bayan: Which of your hospitals are serving stroke patients with the highest quality? And why?

Sol: In Ecuador it would be the Eugenio Espejo Specialty Hospital, one of the biggest in the country. They’re lucky to have a medical director who is very involved with Angels and wanting to improve the treatment of stroke patients. They are trying very hard to win an Angels Award.

I also think of the IESS Hospital in Ambato, the first hospital in Ecuador to receive an Angels Award. During 2022 two doctors from this hospital reached 15 other institutions to tell them how they did it and to help improve processes in hospitals that needed it.

In the case of Peru, the National Institute of Neurological Sciences is led by a neurologist who has dedicated years to improving the processes and treatment of patients with stroke. It is one of two public hospitals in Peru that has WSO certification. They have the most patient data in RES-Q and constant analysis has helped them improve their door-to-needle times. They also conduct annual courses for the entire medical community, and launch a community-based awareness campaign every year in October.

Finally, there is Ricardo Palma Clinic, a private centre that achieved WSO certification in 2022 thanks to a stroke team that spends hours and hours finding the best way to treat stroke patients.

Bayan: What has been your toughest challenge in your Angels journey so far?

Sol: On the one hand, it’s reaching government authorities to ensure that stroke really occupies the space it deserves on the health agenda. We have been successful in Ecuador but in Peru we are sill trying. 

The other big challenge is time. We are only two people covering two countries, and sometimes we cannot respond to institutions as fast as we would like.

Bayan:  What makes Angels different from other healthcare initiatives?

Sol: I have not yet found, at least in Peru and Ecuador, an initiative that does what we do. We are allies of healthcare personnel, all pursuing the same objective, to improve the ratio of patients treated so that more stroke patients have another chance at life.

Bayan: How has working for Angels affected you personally?

Sol: When doctors tell us that their hospital started treating thanks to Angels, and our simulations and training, this me enormous excitement and satisfaction for the work I do.

I had a case of stroke in my family, and every time a doctor tells me about a successful thrombolysis I think of that family member who was waiting for their favourite person to walk out of the hospital, and their joy at seeing them healthy and being able to share new adventures together. Knowing that we are doing everything possible to generate new opportunities for millions of families is truly priceless.

Bayan: What has changed in your country since you joined? 

Sol: Undoubtedly the greatest achievement has been in Ecuador, where we managed to give stroke the visibility it needed. A few months after I joined Angels, an agreement was signed with the vice president of Ecuador in terms of which 30 hospitals would become stroke-ready centres within two years. We have also generated an awareness campaign with three different ministries to continue promoting awareness among the population.

Bayan: What is your best advice for fellow Angels?

Sol: That this is completely different from what they may have experienced in the past. I would also mention the satisfaction to be gained from seeing changes impact patients’ lives. I would tell them that the Angels team is awesome and that we all have a collaborative and empathetic spirit that I have not seen in other places.

We are happy when we see stories from countries we’ve never been to, we’re interested in replicating good practices from people we don't know, and we celebrate the successes of hospitals we’ve never heard of before. It’s not just with the doctors and hospitals, we are a motivation to each other.



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