According to WHO definition, “stroke is caused by interruption of the blood supply to the
brain, usually because a blood vessel bursts or is blocked by a clot” (World Health Organization). This leads to stopping of blood supply and flow of nutrients to the brain, hence leading to damage to the brain cells. According to the report of the World Heart Federation, 2010, the incidences of stroke have increased by 100% in the developing nations while the same has decreased by 42% in developed countries, considering the same time frame. The report also says that in the last 40 years, the ratio of persons affected with stroke has changed from 52 per 100,000 persons in 1970 to 117 per 100,000 in the last 10 years. Whereas the same has gone down in the developed countries, ranging from 163 per 100,000 to 94 per 100,000 in the same time span. The average stroke mortality was 27% for the developing countries, as compared to the 25% figure in the developed countries. Here also the rate is higher in case of developing countries (World Heart Federation).
Stroke rehabilitation in Nigeria is below the mark. There is not much development in the field of medical sciences in Nigeria. There are limited availability of resources, deficiency of manual labor, lack of well organized stroke unit in the country, improper neuro imaging services, insufficient number of ambulances, lack of knowledge about stroke, both on the part of the patients and the doctors and finally impractical use of thrombolytic medications, all these reasons together contribute towards inadequate care of the stroke patient in Nigeria (Ogunbo et al). However the condition is little better in India. Stroke rehabilitation centers have been opened in various parts across the country, but most of them are under private sector. But larger populations of India live in the rural areas and are poor. There is lack of well organized stroke services and emergency transport services in the public sector. Thus even if treatment is available, it is primarily concerned in the urban areas. This makes the rehabilitation inaccessible and unaffordable for the common Indian citizens (Pandian et al.). in india, stroke rehabilitation program are not yet stable enough to provide adequate care to the stroke patients. In an article by Mishra and Khadilkar say that India is still not well equipped to handle the stroke patients, an Indian ‘Fight Stroke” program is needed urgently to meet the requirements of the ever growing stroke patients of the country. Stroke is a multisystem disease, hence expert advice of all the fields of medical science may be required. The neurologist may not be sufficient enough to handle such cases, a case of stroke may require a cardiologist, pharmacologist, geriatric and even an endocrinologist. They are asking for Strokology as a separate field of study in which the experts of different fields will be responsible for handling the patients (Mishra and Khadilkar).
Very surprising facts came into the surface regarding the rehabilitation of the stroke patients in the developing countries. In the Jordanian community, majority of the people are Muslims. It was observed during an interview that the gender of the stroke survivor had a bearing on the rehabilitation treatment. Only male therapists work for the rehabilitation at the homes, and in Islam it is considered wrong for a woman to be touched by a man other than her husband. So the females are bound to receive treatment from traditional healers. Women suffering from disabilities as a result of stroke suffer more from lack of treatment than males with similar manifestations of the disease (AL- Oraibi, Saleh). That was the cultural influence on the stroke rehabilitation program in a developing nation.
Then comes the Economic part, stroke rehabilitation centers are mostly built in the cities, as if they have been targeting the urban population only. They are out of reach for most of the rural dwellers in terms of distance and also in terms of being cost effective. These rehabilitation centers are mostly under the private sectors. This further makes stroke rehabilitation program difficult for the common people. Thrombolysis therapy, which is required for the treatment of stroke is still not available in all the developing nations. Few nations have started using the same, but a large number are still left behind (Ghandehari).
Thus it can be said that although there has been lot of modernization even in the developing countries, but they are still lagging behind in certain aspects of medical care.
In another study conducted in Musanze in Rwanda district with the patients who were the survivors of stroke, it was seen that they encountered three types of environmental barriers in receiving stroke rehabilitation treatments. They were social, attitudinal and physical. Socially, they were not acceptable for the community a normal individuals, attitudinally, they did not have much faith in the rehabilitation program, which made it difficult to treat them. And the third was their inability to access the toilets and the pathways to the rehabilitation centers on their own (Urimubenshi and Rhoda).
Not just rehabilitation centers are required, people need to be trained about the symptoms of stroke and their acute management that can be conducted in a home setting. Even such small steps can reduce the risk of stroke mortality to a great extent. Also every community should work individually to develop community rehabilitation centers. These approaches can give good results in the long run (Mohd. Nordin et al.).
Hence, barriers are many in the path of development of proper programs for stroke rehabilitation. Ranging from economic to cultural hindrances, developing countries are still lagging way behind. They need to improve the quality of their health services. Even if rehabilitation centers are there, they are privatized and hence not accessible to all. The government of such countries should take adequate measures to make the rehabilitation treatments available for the poorer sections of the society. Inability to build proper rehabilitation programs, developing countries are still showing high incidences of stroke and stroke related mortality. The solution is advancement in the field of medicine in these countries. They need to have more man power, better machineries for diagnosis of the complications, proper transportation vehicles with adequate staff and all major facilities provided in the ambulances. Cultural hindrances should be removed at the earliest. People should be taught about the importance of life rather than giving undue importance to the meaningless cultures and superstitions. They should be made aware of the effects and complications of stroke and the requirement for rehabilitation. Basically, education for the physician, other medical disciplines and common people is required for establishment of proper rehabilitation for stroke in the developing countries.
References
AL-Oraibi, Saleh,. 'Demographic Characteristics Of Stroke Patients In Developing Countries: Example From Jordanian Government Hospitals'. Journal of Public Health and Epidemiology 4.5 (2012): n. pag. Web.
Ghandehari, Kavian. 'Barriers Of Thrombolysis Therapy In Developing Countries'. Stroke Research and Treatment 2011 (2011): 1-4. Web. 20 Apr. 2015.
Mishra, NishantK, and SatishV Khadilkar. 'Stroke Program For India'. Ann Indian Acad Neurol 13.1 (2010): 28. Web. 20 Apr. 2015.
Mohd Nordin, Nor et al. 'Exploring Views On Long Term Rehabilitation For People With Stroke In A Developing Country: Findings From Focus Group Discussions'. BMC Health Services Research14.1 (2014): 118. Web.
Ogunbo, B et al. 'How Can We Improve The Management Of Stroke In Nigeria, Africa?'. African Journal of Neurological Sciences 24.2 (2008): n. pag. Web.
Pandian, J. D. et al. 'Poverty And Stroke In India: A Time To Act'. Stroke 38.11 (2007): 3063-3069. Web. 20 Apr. 2015.
Urimubenshi, G, and A Rhoda. 'Environmental Barriers Experienced By Stroke Patients In Musanze District In Rwanda: A Descriptive Qualitative Study'. PubMed 11.3 (2011): 394-405. Web. 20 Apr. 2015.
World Health Organization,. 'Stroke, Cerebrovascular Accident'. N.p., 2015. Web. 20 Apr. 2015.
World-heart-federation,. 'Stroke Incidence And Mortality Rates Increase In Developing Countries'. N.p., 2010. Web. 20 Apr. 2015.
