Having a stroke, one of the world’s leading causes of death and disability, can be debilitating even with access to the best health-care systems.
It’s even more devastating in poor, remote areas of the developing world, but with the clever use of basic and ubiquitous technologies like cell phones, a Peruvian researcher says, it doesn’t need to be.
J. Jaime Miranda, a Peruvian physician and public health researcher who specializes in chronic and non-communicable diseases, recognized the desperate need for stroke rehabilitation services in rural regions of his country. Miranda’s team at Cayetano Heredia University in Lima, Peru, published a case study earlier this month to highlight the need for more practical delivery of stroke-related health services.
Cardiovascular diseases like stroke are a leading cause of death in poor countries. WHO
Rather than attempt to bring costly healthcare facilities and professionals to these communities, the researchers propose providing local health-care workers and family caregivers with the necessary knowledge, training, and tools to provide at least a basic but appropriate level of care.
They say the most realistic way to do this is to utilize technology that already exists, such as mobile phones.
“Usage has also been rising dramatically and reached high levels in many [low- and middle-income countries],” the report notes. “Only in the last 10 years, cell phone subscriptions (per 100 people) have increased from 20 to 110 in Peru and nearly to 180 in African countries.”
If used properly, Miranda argued that it is possible to use even simple mobile devices to provide relatives and other caregivers with evidence-based treatments.
He said many post-stroke rehabilitation techniques recommended by rehabilitation specialists – such as early mobilization and continued conditioning of disused muscles, which can prevent muscle deterioration, risk of fractures, recurrent stroke and even premature death – could be taught in video and picture formats.
“Things such as how to move a patient, how to maintain the flexibility of their arms and legs, those things can be taught in a visual manner,” Miranda said. “How to provide information about the strength and duration of certain exercises. We use that now, when we go to the gym and there’s a training program, there are even apps for that. … The technology is already there to be used.”
In rural Peru, the need for such services is significant. Four thousand meters above sea level and locked in by mountains, locals have little to nonexistent access to professional health care, much less specialized services for people who have suffered a stroke.
“How are you going to mobilize someone who’s had a stroke, who cannot eat properly, swallow properly, talk, not even walk, in those circumstances?” said Miranda. “And then you have the geographical limitations of the jungle, the Amazon. Six hours by boat to get to a helper – not even a clinic, a helper – who will not be trained, to tell you something minimal and basic.”
Compounding the problem in Peru is the enormous burden on family members who often adopt the role of the patient’s caretakers.
“I don’t know if it’s the Latin way of doing things, but most collaterals are absorbed by the family,” he said. “People having to rearrange their houses to look after a relative with a stroke, people having to stop working, fights and [other]problems.”
This struggle is echoed by people seeking post-stroke care across the developing world. According to the study, stroke affects 62 million people annually — 87 percent live in low-and middle-income countries — yet rehabilitation services are either inadequate or unavailable in the majority of the world. Part of the problem in developing countries is that health systems are not focused on chronic conditions but on providing care for acute and infectious diseases.
Although stroke mortality rates have recently decreased due to improved medical treatments, the number of individuals living with the residual effects of stroke is rising. According to the study, around 40 percent of stroke survivors experience moderate-to-severe disabilities, and the condition is becoming an increasing contributor to productivity loss, poverty, and premature death.
Miranda is optimistic that cell phones can help with the delivery of health services, but says it’s complicated dealing with a chronic condition in regions with low understanding and acceptance of western medicine.
Those with the most simplistic devices can’t receive video or pictures, he said, and some will need the information provided in simple and direct language – something easier to be said than done.
Perhaps the most significant challenge is that stroke impacts so many aspects of a person’s physical and mental well-being, and has a wealth of associated health conditions and consequences. For this reason, the study said health-care delivery would also need to be context-specific and culturally acceptable, and be tailored to an individual’s risk profile and stage of recovery.
Miranda says these barriers can only be overcome with collaboration between app developers, stroke patients, health-care providers, public health personnel and researchers to produce interventions that are both sustainable and effective.
“We tend to think that everything’s going to be perfect through a magic bullet. Vaccines are a perfect example; they work so perfectly and so well. But when we have complex problems, we lag behind,” Miranda said. “But by connecting the dots and bringing these tools together, we have an opportunity to advance healthcare delivery.”
