BARBADOS’ CMO remarks at CPE session on Neurorehabilitation for Stroke and Traumatic Brain Injury

Good afternoon and welcome to this continuing professional education session on Neurological Rehabilitation for Stroke and Traumatic Brain Injury.
I am very pleased to have been asked by Hibiscus Health Caribbean -the coordinators of this event, on behalf of JIPA –a care coordination service, to deliver these opening remarks and set the tone for this afternoon’s CPE.
The agenda promises to be intense and information filled not only because of the topics but also because the speakers are accomplished and experienced professionals. In fact I intend to stay and benefit from the knowledge that will be imparted.
The choice of topic for today’s CPE is extremely pertinent and timely. Only last Tuesday, the Ministry of Health received an analysis of the 5 year picture of stroke and myocardial infarction events for the period 2009-2013 from the Barbados National Registry, administered by the Chronic Disease Research Centre of the UWI.
The stroke statistics which I will share with you shortly are reflective of what is happening in the entire Barbadian population. The staff painstakingly gathers information from all sources –public and private, with a great deal of attention to accuracy and quality of the data. So this analysis lets us know with great certainty very alarming medical facts about Barbados.
Every year Barbados has approximately 593 strokes. That breaks down to 49 strokes per month. More than 1 Barbadian will have a stroke today! More than 55% of those are women. That is approximately 326 women every year. What was also revealed is that for the period 2009-2013, there were about 210 new strokes each year. This is similar to the US figures.
Unfortunately there were approximately 318 deaths from stroke for each of those years. That is 27 per month or just less than 1 person per day dies from a stroke. Barbados’ mortality rate per 100,000 persons increased during those 5 years.
Every year about 50% of stroke patients die, with 16% of stroke patients dying outside of hospital. We compare very unfavourably with Norway whose case fatality rate is approximately 7% vs. 32% for Barbados for persons aged 30 to 84 years.
Again women are more adversely affected as 57% of women die by 28 days as compared to 50% of men.
I will discuss some of the epidemiological issues which feed into these statistics, but I need to say that the more health professionals receive this type of CPE, the more hopeful I will become that these statistics will improve instead of worsen.
So far I have spoken only about stroke. Not one word about traumatic brain injury. This is an indication of the burden of stroke and the fact that we have so many people with risk factors for the development of chronic diseases and then so many persons with one or more of the chronic diseases. You begin to understand why our chronic disease burden is so destructive to the quality of life and the longevity of life. You also begin to see that this CPE is critical. It could save a life. Indeed a life of one of us in this room.
We health professionals have to work not only to prevent the complication of stroke and the outcome of death, but really we have to prevent the development of chronic disease at all. These statistics above give us an indication that you just cannot treat your way out of the chronic disease tidal wave.
So what are the latest chronic disease statistics?

One quarter of all Barbadians has at least one non communicable disease and another one quarter is at risk for developing a non communicable disease. This equates to 140,000 Barbadians either having a NCD or are at risk of developing a NCD in the near future. The Health of the Nation Study 2012 indicates that an alarming 65% of the adult population in Barbados is overweight and / or obese with women 1.5 to 2 times more likely to be overweight and obese when compared to their male counterparts. Eighteen percent (18 %) of the population has diabetes mellitus, representing a two (2) percentage point increase since 2007. In addition 25% of persons have been diagnosed with hypertension or are on treatment for hypertension.
The statistics for children are also worrisome with one third of the school aged population being overweight and or obese. Eighty five percent are not achieving the recommended 5 servings of fruit and vegetables per day, one third report eating meals prepared outside the home frequently and 50 percent are engaged in low levels of physical activity and exercise.
So apart from what I just said about the current status of stroke in our population, Barbadians are presently at great risk, for generations to come, of developing stroke. Disproportionately, our women and our children are making it possible for the NCDs to remain the leading causes of sickness and death. Over the last 10 years these were stroke, heart disease, diabetes mellitus and cancer
The value of statistics is that they allow us to focus on what is urgent and cost effective.
These statistics point to the need for prevention of NCDs, but they also show the obligation to provide early interventions along the stroke continuum to prevent lasting disability and death.
One of the first things is the need to inform the general population and specifically those affected by chronic disease of the need to maintain good exercise and healthy diet practises as well as the adherence to treatment prescribed and advised by the health professional.
People need to recognise early signs of stroke and know what to do, where to go and when.
Only then can we health professionals help them to receive care in the stroke unit before 3.5 hours have elapsed. Only then will the thrombolytic save a life.
So we need to ensure adequate numbers of trained staff at QEH and an unending stock or supply of quality pharmaceuticals.
But I will not get into a discussion of health financing today. Suffice it to say that this CMO knows that for Barbados to remain a viable developing country, that these many citizens in their productive years with chronic disease, must have access to the kind of care that so many will need.
In the not so distant past, Barbados spent much money on sending its citizens overseas for care but we are fortunate to have the services of some of the professionals addressing you today to provide much of the type of inpatient care and treatment necessary. For those who are discharged, resources for their re-integration into productive living are necessary as well.
To this end, the Ministry of Health has maintained a contract with the Heart and Stroke Foundation for rehabilitation of patients post MI and stroke, referred by QEH or polyclinic doctors. You will hear more of this later in the programme.
But so much more needs to be done from the perspective of not only the stroke patient, but also the victim of traumatic brain injury due to road traffic accidents and violence and unintentional injury.
The rehabilitation staff, equipment and facility which would provide very specific rehabilitation and long term care in the optimal manner is just not available. The Ministry did a self study through its own rehab staff of what was needed in the early 2000s. We did not have enough then furthermore in 2015 with fiscal constraints of this nature.
So an ounce of prevention is definitely worth a pound of cure in this case. Seat belt and motorcycle helmet legislation have helped considerably. I acknowledge that breathalyser testing would be a worthwhile legislative reform to prevent the many alcohol fuelled accidents on our roads. The agreement of all the stakeholders involved has not yet been realised. But I have faith in the work of the Barbados National Road Safety Council, to address this and other issues which can mitigate the effects of Road Traffic Accidents.
So I end on a cautiously optimistic note, looking toward the need for health in all policies, the political will to make bold evidence based policy decisions to create environments which make the healthy choice the easy choice, the continuing provision of the resources to prevent and treat stroke and traumatic brain injury and the gratitude for events, such as these which keep our health professionals informed and equipped to save a life, even if it is their own.
I thank you.
(N.B. The remarks were made by Dr. Joy St. John at the opening of the CPE session on Neurorehabilitation for Stroke and Traumatic Brain Injury at the Barbados Hilton, Sunday 26th, April, 2015)

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