An average of 15 patients in a month suffer from stroke in Bhutan, and approximately 3 to 4 people get referred to the national referral hospital weekly due to stroke. There are two types of strokes reported in the country, hemorrhagic and ischemic.
Health Minister, Dasho Dechen Wangmo, said stroke is comparable with the growing number of Non-Communicable Disease (NCD), especially cardiovascular disease. The medium age of the stroke patient is 65 years old. Mean age of the patients was 61.8 years.
Stroke in the young age group of less than 40 years occurred in 60 patients. Majority of the stroke occurred in the elderly aged 60 years and above, which is around 60 percent of the total cases. There are more males, (367 cases) than females (270 cases) that suffered from stroke.
37.5 percent of the stroke cases occurred in patients who were dependents (unemployed) and 43 percent occurred in farmers, the Health Minister said.
Annually, 15 million people worldwide suffer from stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on their families and communities. According to the latest WHO data published in 2018 stroke deaths in Bhutan reached 344 or 8.18 percent of total deaths. The age-adjusted death rate is 65.64 per 100,000 of population, and it ranks Bhutan 99 in the world.
There is very limited knowledge about the stroke and treatment in the country, despite it being preventable if recognized in time and referred for the treatment. Dawa Tshering, a founder of the Bhutan Stroke Foundation, pledges to help the stroke survivors in the country.
Sharing his own life experience, he said his life was hard back then when his wife Rinchen Pema, 32, collapsed at home in 2019. Since then his wife has lost her speech and other body movement and sensation.
He even took unpaid leave from his job for a year to look after his wife and their two children. While taking care of his wife, he realized that there could be many other stroke survivors who are struggling to survive.
There are many people who are unaware about the stroke, its signs and symptoms, realizing the fact the struggles faced by the stroke survivors, he came up with a stroke foundation that would benefit the stroke survivors. He founded the Bhutan Stroke Foundation in 2019, and officially registered as a Non-Governmental Organization (NGO) in 2020.
He said earlier the doctors could not diagnose her immediately as there were no MRI and CT scan machines. Doctors told him to take his wife to physiotherapy regularly, and as per his experience the facilities were not enough for the recovery for someone who went through a stroke, and it was a very difficult phase for him.
He said the real burden starts at home when there are no treatments for a stroke. With the least idea about stroke, and how to take care of his wife who is a stroke survivor, life became complicated and hard. He said nobody understands the socio-economic burden on the stroke survivors and their families.
“There is no stroke care in the country, no specialist, and there is lack or limited facilities at the physiotherapy,” said Dawa Tshering.
With the hard times Dawa and his wife went through, Dawa Tshering said, “I don’t want others to suffer,” since then the foundation has been creating awareness on how to prevent stroke.
The foundation provides daily intervention, counseling and other services to post stroke survivors. Dawa Tshering also shared apart from economic burden borne by the patients and the families, the divorce cases are another concerning issue.
“After they become disabled due to stroke and sometimes they tend to commit suicide. Counseling to the family who lives with stroke survivors is very much needed,” he added.
Another rising issue is the socio-economic burden. The foundation has been providing some financial help to make them stable. The majority of stroke survivors are women aged 30 to 70 years.
Similarly, Sonam Dema, 22, is also a stroke survivor. She is now a volunteer with foundation. She was only 18 years old when she had the stroke, and was wheelchair-bound for almost two years. She is now doing fine as any other normal person.
Currently, there are more than 100 stroke survivors registered with Bhutan Stroke Foundation. They also provide critical skill training on bakery. This is not only a livelihood for them but also an occasional therapy.
Dawa shared that his wife is able to contribute in simple household chores after completing the training. She can also speak some words. This has reduced a huge burden on him. All stroke survivors in the foundation are mentally and physically strong, he observed.
He has learned that if stroke patients get to the hospital within four hours, they are likely to prevent death and disability. So far only one case was reported in the JDWNRH, which they were successful in preventing stroke, and the person has recovered.
Stroke is a life-threatening medical condition that occurs when the blood supply to a part of the brain stops, which is known as a brain attack. It is one of the leading causes of death and disability worldwide.
The main risk factors for stroke are high blood pressure, high cholesterol and heart diseases, smoking, alcohol, old age, diabetes, being overweight, lack of physical activity and unhealthy diet.
B.E.F.A.S.T is an acronym that helps a person remember and identify the signs of stroke quickly so as to seek fast medical intervention. The first couple of hours are crucial time for a stroke patient. B is used to identify the sudden loss of Balance. E is for loss of vision in one or both Eyes. F is to check for unevenness in the Face. A is for Arm or even leg limpness or weakness. S is for slurred Speech or trouble speaking and confusion. T is for the Thunderclap headache, the worst kind you have experienced.
The signs and symptoms of a stroke can vary from person to person.