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Stroke Awareness | The Rule Of Three

With stroke awareness as their common ground, these three young neurologists from different parts of Ukraine have discovered both friendship and fellowship. They talk about making FAST Heroes part of their awareness programme, why stroke is everyone’s business, and why knowledge that can save a life has never mattered more.
Angels team 19 March 2024

THE number three has always been invested with a mysterious power. The shortest and most memorable pattern detectable by our pattern-seeking brains, the number three has been used to express some of humanity’s noblest ideals – such as the French Revolution’s cry for liberty, equality and fraternity, or the Olympic motto: swifter, higher, stronger.

The rule of three is itself captured in three words, in the Latin phrase omne trium perfectum, meaning everything that comes in threes is perfect, or, every set of three is complete.

The spell cast by the number three lends extra charm to meeting a trio of 20-something neurologists on a mission to educate the citizens of Ukraine about stroke.

Meet, in no particular order, 25-year- old Dr Oleksandra “Sasha” Holod of Kamianets-Podilskyi in western Ukraine; 25-year-old Iryna Sheredko from Novoyavorivsk near the border with Poland; and 28-year-old Yuliia Mykolaienko of Sumy Central City Clinical Hospital near the northeastern front.

They are close friends as well as colleagues, but if you imagine they have been best friends forever, you’d be wrong. Their first and so far only in-person meeting took place in April 2023 at the Young Stroke Physicians School held in Kyiv.

“It was five days of learning, lectures and coffee breaks,” Yuliia says. It was during those coffee breaks that the first ties of friendship were forged, and common ground was established.

There first joint project, initiated by Sasha, went live just 11 days after the school ended. Timed to coincide with stroke awareness day in Europe on 9 May, they created an Instagram account for the Ukrainian Stroke Medicine Society (UTIM) as a platform for sharing information about stroke. Then they took the platform offline, to schools and town halls and, on occasion, air raid shelters, with their public educational project, kNOw_ STROKE.

Their reasons were clear: “In Ukraine there is quite a low level of public awareness about stroke, leading to higher mortality and disability from stroke compared to countries in Europe. It is especially important in times of conflict for ordinary citizens to have the knowledge needed to manage many different emergency situations.”

Dr Oleksandra Holod

EVERY set of three may be complete, but for their project to have the reach they envisaged, Yuliia, Iryna and Sasha needed others who shared their vision. They are deeply grateful to those that did.

“Twenty participants from 16 regions of Ukraine joined the project, investing their efforts and time simply so that more people would know how to save the life of someone with a stroke. The project was driven entirely by the enthusiasm of the participants who did not expect any financial reward. Since they were also stroke unit doctors or medical interns with experience of such patients, they all understood that public awareness would increase the number of people who would seek help promptly if they or someone nearby had a stroke.”

A trial project in May reached 350 high school students and cleared the way for a more ambitious undertaking – full implementation of the kNOw_STROKE project that would target more regions and a wider age category. This was how it came about that Yuliia, Iryna and Sasha made the acquaintance of a family of superheroes who have been locked in battle against the “evil clot”.

With the support of Angels consultant Lev Prystipiuk and communications specialist Anastasiya Klysakova, they made the FAST Heroes awareness initiative part of their education campaign and, in the course of 50 events in 16 regions between September and December, discovered something educators have long known – that it is easier and decidedly more fun to impart new knowledge to primary school children than to groups of all-knowing teenagers.

“The FAST Heroes experience is unusual but very vivid,” Yuliia later wrote in an article shared with Angels. “The kids very quickly noted the peculiarities of the main characters and in the process of learning logically came to conclusions about how stroke manifested in each of them, even before I told them about it.”

Undeterred by air raid alerts that punctuated lessons in cities in northeastern Ukraine, the kNOw_ STROKE project added 50 dots to the map on which the World Stroke Organization records stroke awareness activities around the globe on their website. And the doctors who started it all gained some valuable insights about teamwork:

“Throughout the project we had the opportunity to realise that helping a stroke patient is the result of teamwork, and we are extremely happy to be a part of this great inspired team. Perhaps this is the key idea that we took away f rom our collaboration
with the FAST Heroes project and other participants – that the issue of stroke concerns all of us, not just the medical community, and only through teamwork on every front can we achieve more.”

Dr Yuliia Mykolaienko

It’s something magical

The kinship formed during coffee breaks has continued to grow via an exchange of text messages as the three co-create content for the UTIM Instagram account, but they don’t only talk about projects, they also talk as friends, Sasha says.

Right from the start, over coffee in Kyiv, they had talked openly about their work and shared experiences, including sad ones.

She’d found it strange at first to be so forthright even about painful everyday situations, Yuliia says. “In my previous experience, you only talk about the good things and there is silence when things go wrong. But it is very important to understand that we all have the same problems, that it is okay, that it’s normal.”

Although they keep in touch constantly, they haven’t all three been in the same city since last April. Yuliia and Sasha did meet up in December when Sasha came to Kyiv for a workshop. They say: “We missed Iryna very much.”

YULIIA, Iryna and Sasha became neurologists via different pathways. Iryna followed her gynaecologist grandfather into medicine from a sense of wanting to help others. Neurology offered the attraction of the unknown: “There was a lot to learn about disease etiology, opportunities to explore and discover something new.”

Yuliia was fascinated by the human brain and as an intern became aware of the rising interest in stroke care in Ukraine: “Thrombolysis was becoming more widely used, there was lots of information, and more and more questions. It was new, a first in neurology, and it impressed me very much.”

Dr Iryna Sheredko

Sasha was going to be a surgeon but during her internship observed the transformation in a patient who had undergone thrombolysis for ischaemic stroke. “It changed his life,” she says. “He got better.”

It is at this point that their pathways intersect. Iryna says: “With access to thrombolysis and thrombectomy there is the possibility of someone coming in with hemiplegia and within hours you can have a healthy person. I realised I could help these people.

And Yuliia: “It is great – it is something magical when someone changes so they can speak to you. They came in with hemiplegia, and then an hour later they are shaking your hand and saying thank you, doctor.”

To conjure up more of this magic, they need more stroke patients to reach their hospitals within the treatment window, and they’re not waiting for someone else to make that happen.

Much as one might admire their determination to raise stroke awareness despite the war, the truth is that it is also because of the war.

“We have a lot of wounded soldiers,” Iryna says, calling to mind heartbreaking images of fighters returning home with devastating, life-altering injuries. “We don’t need more disability as a result of stroke.”

Knowledge saves lives, Yuliia says. “Especially now when lots of children are with their grandparents, they may be the only ones who can call the emergency services, and they have to know what to do.

“At this moment, any knowledge that can save a life is important.”


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