The Bhutanese Leading the way.
Stroke remains one of the leading causes of death and disability worldwide. According to the World Health Organization (WHO), over 12 million people experience a stroke each year, leading to nearly 6.5 million deaths from its effects.
Once considered a condition affecting primarily older populations, strokes are now increasingly being reported among younger individuals, fueled by rising rates of hypertension, diabetes, unhealthy diets, and sedentary lifestyles.
While much of the global conversation around stroke focuses on prevention and rapid emergency response, the reality in many developing countries, including Bhutan, shows a more troubling picture.
In Bhutan, where non-communicable diseases (NCDs) are rising at an alarming rate, stroke has quietly emerged as a critical public health challenge. Access to specialized care, timely diagnosis, and awareness of stroke symptoms remain limited, especially in rural areas where reaching a referral hospital can take several hours or even days.
Rising stroke risk
According to the Bhutan Stroke Foundation (BSF), the country has witnessed several stroke cases in recent years, compounded by low public awareness and gaps in emergency response systems. Many strokes in Bhutan go unrecognized or are treated too late, reducing the chances of recovery and increasing long-term disability.
In response to this growing crisis, BSF in collaboration with the Ministry of Health, has taken proactive steps to address early detection and prevention of stroke across the country.
Since 2023, BSF has been conducting health screenings aimed at identifying individuals at high risk of stroke before symptoms appear. The Executive Director of BSF, Dawa Tshering, shared that the organization has screened more than 19,000 people to date. “Out of those we screened, about 70 to 80 percent (about 15,000) were found to be at high risk of stroke,” he said. “This includes people with elevated blood pressure which is a major contributing factor.”
Hypertension as a leading contributor
One of the key findings from the foundation’s screenings is that the majority of those at high risk were found to be suffering from hypertension (high blood pressure).
Comparing this year’s data, hypertension has been recorded at 73.2 percent, a significant increase from last year’s figure of 30.1 percent.
The screenings have revealed a concerning trend: strokes are not only affecting older populations but are being found in individuals from a wide age range, with strokes detected among those aged 25 to 70.
Recognizing this, BSF has expanded its focus to include younger individuals in its health screenings. The targeted population for these screenings, as stated by BSF, now includes those from the age of 15 onwards, highlighting the growing importance of early detection and prevention across all age groups.
Stroke cases in children
The data collected by BSF reveals how stroke is no longer confined to older populations.
When asked about the youngest known cases in Bhutan, Dawa Tshering shared that two children were among the country’s stroke patients. “We recorded a case of a 7-year-old boy and a 13-year-old girl who both experienced strokes,” he said.
From the foundation’s perspective, the occurrence of strokes in younger individuals, such as the 7-year-old boy and 13-year-old girl diagnosed last year, could be linked to genetic factors, alongside lifestyle choices like poor diet and obesity.
While genetic conditions, such as blood clotting disorders or heart abnormalities, can increase stroke risk in children, an unhealthy diet and lack of physical activity also play significant roles. These cases defy the common belief that stroke is a disease of old age.
While rare in children, pediatric stroke is often linked to congenital heart defects and infection.
Barriers to timely diagnosis and treatment
According to BSF, one of the greatest challenges in diagnosing and treating stroke, especially in younger patients, is the societal hesitation to seek immediate medical help.
“People are often struck between reality and myth,” Dawa Tshering said. “Once a person gets a stroke, they need to be brought to the hospital within four to five hours. But what often happens is that when a child or even an adult shows signs of stroke, the family thinks it’s better to perform rituals first. This delay can severely worsen the case,” he added.
This delay in seeking emergency care, often referred to as the “golden window” in stroke treatment, can mean the difference between recovery and permanent disability, or even death. Internationally, the first few hours after a stroke are critical for administering clot-busting drugs or surgical interventions that can restore blood flow to the brain.
Once that window is missed, treatment becomes more complicated, and outcomes far less favorable. In Bhutan, where traditional practices and spiritual healing are deeply rooted in everyday life, many families still turn to rituals, monks, or local healers before visiting a hospital.
Public education and prevention efforts
BSF believes that public education is key to bridging this gap.
BSF also shared that even when patients are diagnosed on time and prescribed medication, many do not follow through with the treatment plan.
Dawa Tshering said, , “There’s a widespread belief that taking medicine for long periods can lead to kidney failure.”
This misconception, he explained, often leads patients to stop taking crucial medication, and in doing so, they dramatically increase their chances of suffering another stroke or developing further complications. Despite having better access to health information, some even fail to take prescribed medication regularly.
“Some of them drink alcohol frequently, and as an individual should not drink alcohol while on medication, they stop the medicine instead.”
As part of its mission to prevent stroke and raise national awareness, BSF has already completed health screenings in ten districts across the country. Rather than only focusing on high-risk individuals, the foundation has strategically targeted groups with broad influence, including administrative officers and sector heads, in the hope that they will help extend stroke awareness within their communities.
“We chose these groups because they are decision-makers and educators. If they understand the risks and symptoms of stroke, they can help pass that knowledge on,” the BSF Executive Director said.
With screenings continuing to expand, the foundation now aims to reach one of the country’s most spiritually influential populations: the monastic community.
If monks are aware of stroke symptoms and the importance of timely medical care, they can guide families to seek treatment first, not just rituals.
A personal mission
For Dawa Tshering, the drive to spread awareness about stroke is not just professional, it is profoundly personal.
Years ago, his wife suffered a stroke. “The doctors said my wife’s condition had reached the last stage and could not be treated,” he said. That moment became the turning point in his life.
Determined not to give up, he began his research into stroke recovery, rehabilitation, and support systems. What he learned and implemented at home became the foundation of his broader mission: to educate, support, and empower other families facing the same devastating diagnosis.
“Through my research and support at home, my wife is now both mentally and physically stable. There is still some difficulty with her speech, but she has come a long way,” he said.
Preventing stroke
The most common reasons behind strokes are high blood pressure, diabetes, high cholesterol, and heart conditions.
Unhealthy lifestyle habits play a big role too, such as smoking, drinking too much alcohol, eating salty and oily foods, and not doing enough physical activity. When people don’t exercise regularly, it increases their risk of gaining weight, developing high blood pressure, and weakening their heart, all of which are major stroke risks.
In many cases, people may feel healthy but still have hidden conditions like high blood pressure, making stroke a sudden and silent threat.
Stroke is largely preventable through healthy lifestyle choices and regular medical check-ups. The most important step is controlling high blood pressure, the leading cause of stroke, by reducing salt intake, avoiding stress, and taking prescribed medication if necessary.
People should also manage conditions like diabetes and high cholesterol through proper diet, exercise, and medication. Quitting smoking and reducing alcohol consumption significantly lowers stroke risk.
Regular physical activity, such as walking or exercising at least 30 minutes a day, helps keep the heart and blood vessels healthy. A balanced diet rich in fruits, vegetables, and whole grains also plays a vital role.
In addition, routine health screenings to monitor blood pressure, sugar, and cholesterol levels can help detect risks early.
For those with a family history of stroke or other risk factors, timely medical advice and consistent lifestyle changes are essential in preventing a stroke.
