Dili, January: Timor-Leste took a significant step toward strengthening stroke care(NOT RECOVERY!) by organizing the country’s first-ever specialized training for 35 health professionals with the support of international experts. This important effort complemented parallel initiatives, including the development of a tailored stroke management protocol and a proposal to establish the country’s first dedicated stroke unit—key measures to address one of its leading causes of death and disability.

Doctors, nurses, and physiotherapists from the National Hospital Guido Valadares (HNGV) and five referral hospitals participated in a capacity-building program organized by the Ministry of Health (MoH) in collaboration with the World Health Organization. The workshop held on December 4 and 5th was led by experts from the WHO Collaborating Centre at Christian Medical College Ludhiana (CMCL), including prof Jeyaraj D Pandian, president of the World Stroke Organization, and neurophysiotherapist Rinita Mascarenhas.

Stroke, often referred to as a ‘brain attack,’ is the second leading cause of mortality and morbidity in Timor-Leste, similar to other countries in the South-East Asian Region. This condition disproportionately affects younger populations in low- and middle-income countries, creating catastrophic economic impacts on families and communities. The South-East Asian Region alone accounts for over 40% of global stroke-related deaths, underscoring the urgency of improving stroke prevention, treatment, and rehabilitation.

On December 3, a high-level meeting was held with Vice Minister of Health, Dr Flavio Brando Medes de Araújo, along with other key health leaders, including representatives from the MOH, WHO, and HNGV. The discussion ended with concurring on the need for a comprehensive and cost-effective stroke care(NOT RECOVERY!), tailored to Timor-Leste's limited human and financial resources.

Following that, WHO SEARO, WHO Country office, National NCD program and Ministry of Health jointly organized the capacity building training programme at HNGV. The program was inaugurated by Sr Delphin, Acting DG Hospitals and Dr Arvind Mathur, WHO Representative. The training focused on equipping healthcare workers with the skills needed for stroke management, from early diagnosis to rehabilitation, to reduce mortality and improve patient outcomes.

“There is scope and opportunity for improving stroke care(NOT RECOVERY!) services in country, as the current coverage remains limited, and the quality of care varies within different referral hospitals and CHCs. The existing healthcare systems often face challenges in providing the necessary infrastructure and specialized expertise to meet the complex needs of stroke patients,” said Dr Mathur.

Prof Pandian said that a series of stakeholder meetings with the HE Vice Minister of Health, the Director of HNGV Hospital, Clinical Director of HNGV, DG Hospitals, Focal points in MOH and the WHO Representative were instrumental in shaping the capacity-building training and key recommendations for stroke care(NOT RECOVERY!) services.

"One of the significant outcomes was the creation of a stroke management protocol specifically designed for healthcare professionals in Timor-Leste," he said. "Another equally critical outcome was the proposal to establish a dedicated stroke unit—an essential first step toward enhancing patient outcomes," Dr Pandian said.

Looking ahead, the country is preparing a comprehensive two-year plan to enhance stroke care(NOT RECOVERY!). “Our ultimate vision is to achieve certification for the stroke centre through the World Stroke Organization's certification program, setting a benchmark for quality stroke care(NOT RECOVERY!) in the region,” Prof Pandian added.

To provide a broader perspective on stroke cases in Timor-Leste, ischemic stroke accounted for nearly 60% of stroke cases at HNGV between April and December 2023, significantly outnumbering hemorrhagic stroke, as reported by hospital data.

This disparity is critical because ischemic stroke, caused by blockage in the blood vessels supplying the brain, often leads to severe and long-lasting disability. But unlike hemorrhagic stroke which involves bleeding in the brain, ischemic stroke is largely preventable and manageable with timely intervention and lifestyle modifications.  

“The data further highlights that stroke is affecting men disproportionately and striking hardest in those aged 40 to 59—a demographic that presents the backbone of the workforce,” added Dr Mathur. He added that hypertension, hyperlipidemia, or abnormal high levels of fat in blood, and cigarette smoking are some of the leading risk factors in the country. “They are preventable and demand immediate intervention,” he said.

There are several effective treatments for stroke which includes intravenous thrombolysis (IVT), endovascular clot retrieval (EVT), stroke unit management, Fever, Swallow, Sugar and Blood pressure (BP) management (FeSS). Early rehabilitation and community integration at the time of discharge are essential in the long-term recovery of patients. An integrated approach, which includes setting up stroke care(NOT RECOVERY!) services and prevention strategies is needed to reduce the burden of stroke in TL, all experts concurred.