Chhattisgarh, which means “thirty-six forts”, was originally the name given to the territory of the Haihaya dynasty of Ratanpur, founded around 750. It’s a landlocked state in Central India, sharing its border with seven states – Uttar Pradesh to the north, Madhya Pradesh to the northwest, Maharashtra to the southwest, Jharkhand to the northeast, Odisha to the east, and Andhra Pradesh and Telangana to the south. Home to 30 million people who live in 33 districts, it is the seventeenth most populous state in India.
Like every state in India, Chhattisgarh has a larger geography with rivers, rough terrain and deciduous forests which impose a challenge for the transportation of critically ill patients to the main cities in time for treatment. Furthermore, a large area of Chhattisgarh is under the control of Naxalite guerrillas – the armed wing of a group of communists supportive of Maoist political sentiment and ideology. Indeed, in several pockets of Bastar division in the south, state law has at times failed to function, and the conflict has hampered the development of this fertile area.
Despite these challenges, Team Angels India decided in 2021 to go to work in this underserved region with a view to strengthening its stroke ecosystem. For me, based in Delhi, the assignment was an opportunity to meet a need and make a difference. I was initially hesitant. This would be my first time working outside of Angels headquarters, and in a region that was likely to present safety issues. However, after long discussion and the creation of a clear strategic plan that addressed all the issues, I was able to make my decision, embrace the challenge in a positive way and aim to turn it into achievement.
The initial plan was to cover Raipur, the capital city of Chhattisgarh, to establish referral centres and gradually build the confidence to cover more remote territories. I identified seven hospitals in Raipur, including primary and comprehensive centres, and embarked on the consultation process at each – from observation to quality monitoring. All these hospitals are now registered with RES-Q. Within the first year I was also able to develop two new stroke-ready centres in Raipur. The Ramakrishna Care Hospital and MM Narayana Hospital achieved door-to-treatment times of 48 and 30 min respectively and increased their recanalization rate from 0 to >5%.
It was around this time we recognised that collaborating with the government would help us expand our reach and impact. In early January 2022 I initiated a discussion with the Non-Communicable Diseases (NCD) Department of Chhattisgarh and made them aware of how, by working together, we could build capacity and optimize stroke care infrastructure.
Persistence paid off. In July 2022 the state issues a letter of endorsement for the Angels Initiative and agreed to support our work in three underserved district hospitals as a pilot project along with Raipur District hospital.
Exploring the newer challenges
My first visit to Raipur District Hospital Raipur immediately revealed a new challenge when I discovered this hospital had no CT facility. It was a discouraging setback, coming so early in our plan. However, I could only compose my thoughts and complete the observation. I sent a report about my visit to the authorities from whom it was an eye-opener. This hospital was in the capital city of Chhattisgarh and lots of influential people sought treatment there. The department undertook to provide the necessary infrastructure and suggested I continue working with the other three hospitals that were part of the pilot project.
So after some discussion the project was expanded to three underserved territories namely Dhamtari, Janjgir Champa, and Dantewada. All three regions were untouched parts of Chhattisgarh. It set new challenges for me as I had to travel from Raipur to explore conditions in these districts. The distances between the territories were dauting because local transport is not always available and being a Naxalite area added an extra layer of risk.
Dhamtari is around 80 km south of Raipur and patients travel from here to the capital for treatment. It was therefore of great consequence to create stroke-ready centres in Dhamtari. To equip the Dhamtari District Hospital as a stroke-treating hospital, a capacity-building program was started for all the doctors and nurses. The big challenge in this district hospital wasn’t the availability of a CT scanner but the fact that no technician was available after hours. I had to go back to the NCD Department and escalate the need. Thankfully they recognized our effort and seriousness, and the CT facility became operational 24/7 within two months of the discussion.
In Janjgir Champa, located around 170kms south of Raipur, the challenge was that stroke was not a priority. Here the task was to start from scratch and convince the hospital that stroke was a medical emergency, and speed was of the essence. Within a few weeks of starting the capacity-building program stroke patients arriving at this hospital received urgent care and eligible patients (with no contraindications) were being treated with thrombolysis.
Dantewada, the third district in our pilot program, lies around 360 km south of Raipur, and security risks in the region ruled out in-person consultation. With the support of the NCD Department I was however able to arrange virtual sessions with the healthcare professionals at this district hospital. They were already treating stroke patients with thrombolysis, but few patients reached the hospital within the treatment window. It was therefore critical to make the population aware of stroke symptoms and what to do if they occurred. The plan to make Dantewada District Hospital stroke-ready therefore had to be expanded to Community Health Centres and Primary Health Centers so we could engage the support of doctors and nurses at these centres to spread the message to the local population.
Success is an inevitable journey
I am hopeful that continuing with a solution-centred approach towards stroke care optimization will bring more positive results. The experience has broadened my own perspective as I had never travelled before. I was impressed by how ready local hospitals were to embrace me and by the NCD team’s support for my work.
It took courage to prove myself against so many odds, particularly as a woman. But I am motivated by the desire to challenge the status quo and establish stroke-ready centres not only in Raipur city but across the entire state of Chhattisgarh. My next goal is to implement the Angels Regions strategy and turn Chhattisgarh into a safe region for stroke.
