Angels Initiative (AI): We often meet stroke doctors who tell us that everything changed for them when they met you. Doctors like Miguel Vences who met you at a stroke meeting in Colombia in April 2022 and, having been captivated by you, returned to Lima intent on replicating your example in Peru. Doctors like Claudio Jiménez who told us, ‘Dr Sheila Martins always says that ‘a will and a tomograph’ are all that is required to treat a stroke.’ Doctors like Diógenes Guimarães Zãn whose city, Sapucaia do Sul, was celebrating becoming the second Angels City in the world. And on the night he described as the happiest of his life, he said that your presence in the auditorium was of great significance. How satisfying is it for you to hear that young people are doing wonderful things thanks to you?
Sheila Martins (SM): Well, it’s a surprise for me, these testimonials. And of course, I know that I stimulate them, and I’m so proud of all of them, Claudio, Diógenes, and Vences. And I’m happy to hear, because they didn’t tell this to me. And I think this motivates me. I know that I have some skills to convince people to join others, to be together, and to work hard because we know that we can change the reality in our hospital, in our city, in our country, on our continent. I have seen this, traveling around the world, doing the same in other regions, bringing together people with goodwill who want to change the world for the better. And really, I’m lucky that I found a lot of people like this in several parts of the world, and I’m so proud to hear that they really are motivated by me.
AI: Dr Gabriela Orzuza from San Bernardo Hospital in Salta, Argentina, also recalls meeting you and hearing you speak about the WSO certification campaign for stroke units in Latin America. Gabriela didn’t think her small hospital could become certified. But you told her she could, and then she did. How important is it for people to hear that they ‘can do it?’
SM: So important, so important, because it’s so interesting to see with this program of certification that people look at the criteria, and think no, I don’t have this, but you can have it. You may not have it today, but you can have in one month, in two months. You can be prepared. We can guide you to prepare your hospital to be better, and this can help you to convince your director of the hospital. We saw this with Gabriela when I went to her hospital together with Luciano Esposato for the certification. Luciano is from Argentina. He was so touched when he saw, well, I obviously was touched too, because Argentina was so special because of this. Poor hospitals with little infrastructure, but with people that really want to change. And everything was there. Everything that the patient needs, and this is important. I don’t need the beautiful walls or floors or chairs. I need everything that the patient needs and they can do this. Gabriela did and I was so touched to see how simple the hospital was but she had everything there. So I’m happy to hear from her. She never told me this, but really it’s amazing to hear from you.
AI: You said in a previous interview that you you really used the opportunities you had. Tell us about that.
SM: Yeah, well, this I always teach them. Don’t waste any opportunity, because they appear in a moment and you need to really use them for good. So for me the first one, I’d started to organize in my city, together with a colleague, the private hospital. Thrombolysis was approved in Brazil in 2001. We started to organize it and everything was working well, collecting data from the first patient treated. I did my master’s in science on this, showing that it was feasible.
In 2005, I could not accept that public patients could not receive the same treatment [as private ones]. I went back to my public hospital, and convinced the director and the head of neurology to organize the system there. After this, I went to the health secretary of the city, and organized the city. And because of this, I was invited two years later, in 2007, to talk at a congress for emergency but with a lot of people of the Ministry of Health [present]. They invited me, come say what you want about stroke. You have one hour.
I hadn’t prepared anything. I told them I will talk about what the country’s doing, what we as stroke neurologists are doing, different in each part, but with good results. So this was so touching because I called my friends and I told them I have a good opportunity, I’m going to Rio Grande do Norte, Natal, for a congress where the Minister of Health will be there. Send me everything you have from your region and your data bank and I will present it.
And all of them sent me the data, each one collecting one by one. So I put everything together and I present it to the Minister for Health. So this is the opportunity that I mentioned. I presented for one hour, not talking about how to thrombolyse, this is a different approach. We need to talk about how to implement and change stroke care in the country, the first cause of death in Brazil at that time.
I presented the examples from different parts, and at the end I put up a Brazilian map showing the hospitals that were doing the same as international results, and that we have the brain as a society, and a dream to work together with the Minister of Health to build a national system of stroke care.
And when I finished, a person in the middle of the audience told the audience, ‘I am the new coordinator of urgency and emergency of the Ministry of Health, and together with Dr Sheila, we will implement a national plan for the stroke.’
It was such an important moment in my life. Within one week I was in the Ministry of Health and everything started in Brazil. So this was a great opportunity. It was not the only one, but the most important one because it changed everything.
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AI: What about the way you grew up made you want to be a doctor?
SM: This was so interesting because I applied for engineering. I like numbers, I like computers, and I would like to work with this. I was in a line together with my father to apply. Everything ready, waiting for my place to apply. And he asked me, Sheila, why don’t you apply to be a doctor? What? I never thought in my life I’d be doctor! I cannot see blood. It’s not possible. Then he told me, but you like people. You like to help people. You can imagine poor people that you can save. I think you should be a doctor. I changed my application to medicine, and I thank him until today because really this is what makes me happy.
AI: And the decision to specialize in neurology?
SM: Well, I liked neuroanatomy since the first year. Of course, I liked everything during medical school. But at the end, when I started to assist patients, I decided that this is what Iwant to do. It’s a challenge, it’s difficult, you need to think a lot, make a diagnosis. We didn’t have too many treatments, or any treatment for the stroke, and I hated stroke because we didn’t do anything [back then]. But I liked to assist in the emergency, so neurology, emergency, I liked it, so I became a neurologist. In the first year of my residency, the NINDS trial was published showing that thrombolysis can decrease disability and I went to my professors and said, now we have this treatment, we can apply it to our patients. Sixty percent of neurological patients are strokes and we are not doing anything. So we can use this. ‘No, this can harm the patient, it’s not safe, we will not do this well.’ So I finished my residency and went to work as neurologist in a private hospital, in emergency, on call several times a week, until [thrombolysis] was approved in Brazil and we start to organize the services. We find a way to really see the difference in the patient outcome. And it’s so beautiful to see when you treat the patient that cannot speak and when we finish the treatment, the patient can speak, can move their arms. It’s really wonderful.
AI: You went from changing the system in your own hospital, to organizing the national stroke program in Brazil, becoming president of the World Stroke Organization, and you continue to have impact all around the world. What drives you to keep doing what is after all very hard work?
SM: It’s a lot of work. But the best thing I do, I have my patients in my outpatient clinic. I have students and residents that I love. I love to be with them. I have a lot of research and very important research that can really change public policies. But what I like to do [best] is what I’m doing globally because I’ve seen how this really makes a difference. I can see in different parts of the world that I can stimulate people. People can have courage to really do things and change the realities.
I saw this in Ethiopia, it was a beautiful example because Professor Mehari from University of Texas is from Ethiopia. And he saw me talking at a congress and came to me to say, ‘Sheila, please help us to put acute treatment in Ethiopia because we are all working to decrease door-to-needle time and they have nothing.’ And I said, yes, I know that will be a challenge, but I will do it.
I arranged with our World Stroke Organization Future Leaders to teach courses every week. I did meetings with directors of the hospital, with doctors to teach them how to organize a stroke team, what they need. I did virtual visits during the pandemic. We donated a telemedicine tool, created an international group that I called Project Telestroke Without Borders to help them in real time, and nothing happened. Six months and no case treated. ‘Oh, the patients arrive late, this and that. We don’t have patients on time, so it’s not possible.’
I’m going there, I told them. I bought flight tickets, went to Ethiopia together with Professor Mihari to see the reality, to do rounds at bedtime, to see this stroke unit, very impressive.
It was a very poor hospital, in the emergency room there were people on the floor because they didn’t have enough space. And we opened the door to the stroke unit, it was an oasis in the middle of the war. They really organized to give the stroke patients better basic care, but the thrombolytic was there and they didn’t treat any patient.
I gave them training, I told them, we are with you, we are here, you can send me a WhatsApp, we will support you all the time. The next day they started to use the thrombolytic drug. In a few days, they used four. So really, the confidence to be together really makes a difference. And this is so beautiful to see, it is priceless, it’s really amazing. We see that you can transform lives. We can make a huge difference.
And for this, I’m still working in this hard work.
AI: You’ve continued to work globally after your term as WSO president ended – how has your role changed over the years?
SM: I have been in the WSO since 2008. I was invited because of the work in Brazil, initially as an honorary member. I started Latin American ministerial meetings in 2018, always with the support of the presidents. And I saw that I could engage the ministers after I created a bigger, that is, a global stroke alliance, not only to meet with ministers, but also logistics implementation meetings.
During the pandemic I contracted in Brazil a platform for education together with Brazilians and Latin America, and we had weekly meetings throughout 2020. And if sometimes we didn’t have the meeting for some reason, ‘Oh my God, where is the Global Stroke Alliance? We are here waiting.’
A thousand people connected, it worked really well. And from this, we started to think about a certification program before I became president. So the majority of programs I created before I became president.
The first thing I did as president was I launched implementation task forces, and invited everybody in the world that wanted to work like us. A lot of people joined. And with this, we created mentors that could help in different parts of the world.
I accelerated the certification that had started in Latin America through other parts of the world. In India, Malaysia, Indonesia, it was amazing. And the idea was to go to these places and to find people that could be multipliers there for implementation and for certification.
So I did this before, then accelerated during my presidency. And I continue working with everybody who wants my help.
