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True Grit | Breaking Barriers In The Central Backcountry Of Brazil

The dedicated team at Regional Hospital of Sertão Central will let nothing stand in the way of offering excellent care to stroke patients in rugged Quixeramobim.
Angels team 02 June 2022

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Quixeramobim is a municipality located in the state of Ceará, Brazil. It is the second-largest city in the central backcountry macroregion and the 13th most populous city in the state, with an estimated population of 82,445 inhabitants in 2021.

This is farming country, but only if you’re tough and resilient. The climate is semi-arid with concentrated rains only from February to May, and a scorching and prolonged dry season with strong winds and partially cloudy skies. Despite challenging weather conditions for most of the year, subsistence agriculture and livestock still occupy an important space in the regional economy.

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The Regional Hospital of Sertão Central, one of three state hospitals offering specialised stroke care, is responsible for serving 20 municipalities in the region – an estimated population of 631,000 inhabitants. It has been treating stroke since 2018 and has 212 beds, of which 20 are intended for stroke patients, distributed across an acute stroke unit and a unit where patients are cared for in the post-acute phase. Once discharged, patients receive guaranteed follow-up care through telephone contact and the multi-professional outpatient clinic.

The hospital admits on average 60 patients with suspected stroke per month, of which 40 are ischaemic. On average, 9 intravenous thrombolyses per month are performed. The hospital does not yet have thrombectomy, referring the cases with indication to the capital Fortaleza 200 km away.

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The hospital’s partnership with Angels began in 2018, soon after the creation of the stroke service. This partnership has facilitated the optimisation of the stroke protocol and the flow of pre- and intra-hospital care, as well as skills-building for the multi-disciplinary team through training and simulations. The hospital is also committed to the collection of quality and process indicators that allows them to evaluate performance and identify opportunities for improvement.

The synchronous and agile work of the pre-hospital and in-hospital service has had significant benefits for patients. The number of intravenous thrombolyses increased from 42 procedures at the end of the first year of operation to 114 in the third year, with a significant drop in door-to needle-time from a mean of 40.6 minutes and median of 39.5 in the first year to 20.3 minutes and 17 minutes, respectively, in the third year.

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Commitment to quality and efficiency has earned the hospital five Angels Awards in the Platinum category and four in the Diamond category, which represents the highest level of performance.

“These professionals are angels who dedicate their lives to caring for other lives and do so with love and dedication,” says Renata Miranda, Angels leader in Brazil. “Many of these professionals who work in the hospital do not live in the city and on average spend around three hours getting to work, because every effort is worth it when we commit to saving lives.

“We at the Angels Initiative in Brazil are very proud to share this success story. We hope that it serves as inspiration in other regions whose climatic and geographical characteristics may hinder patients’ access to health care, but where patients can likewise count on people who do not give up in the face of difficulties.

“I congratulate all the professionals of this hospital and especially neurologist in charge Dr Alan Alves de Lima Cidrão and Nurse Mara Cibelly who together manage this protocol.”

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