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Jeyaraj Pandian: The silent epidemic of Stroke needs attention to prevent long-term disabilities PDF Print E-mail

© Neena Bhandari

Since childhood Jeyaraj Pandian aspired to be a doctor. His paternal grandfather was a Legalised Medical Practitioner, as they were called before India’s independence. Whenever, he visited his ancestral home Tuticorin in Tamil Nadu, his grandma would show him his grandfather’s medical kit, intact with a stethoscope, syringes and basic first aid equipment, which was securely kept as a treasured heirloom.

He chose to follow his childhood passion and enrolled in Tirunelveli Medical College [Madurai Kamaraj University], Tamil Nadu. He then completed his residency from the Christian Medical College [CMC] in Ludhiana [Punjab] and did his post-graduation in Internal Medicine. It was while doing his Master’s that he did a thesis in Neurology and that really kindled his interest in the discipline.

“In early 1990s, there was no treatment for Stroke. The only thing that we would treat was post-infectious problems, such as meningitis and encephalitis. I felt there was a great need to address neurological diseases, which are the leading cause of disability in later years. Topping the neurological disorder is Stroke, followed by headache, epilepsy, and degenerative disorders like Alzheimer’s and Parkinson’s diseases. One in three persons in the world will have a neurological problem in their lifetime and two-thirds of these neurological problems occur in low and middle-income countries”, says Dr Pandian, who did his doctorate in Neurology from The Sree Chitra Tirunal Institute for Medical Sciences and Technology in Thiruvananthapuram [Kerala].

He returned to CMC and upgraded the Neurology department, but he was overwhelmed with the number of Stroke patients coming to the hospital. He felt the need for more training and research in the field. He got a Stroke Fellowship and worked in the Royal Brisbane Women’s Hospital for three-and-a-half years before getting his registration as a Neurologist.

INTERACT2 TRIAL

It was during his time in Australia that he met Professor Craig Anderson, Professor in Neurology and Epidemiology at the University of New South Wales in Sydney and the current Executive Director of The George Institute China at Peking University Health Science Centre in Beijing [China]. Professor Anderson was extending the Institute’s work in India in collaboration with the Byrraju Foundation in Hyderabad [Andhra Pradesh]. He was planning the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial 2 [INTERACT2] and around the same time Dr Pandian was returning to India.

“In December 2007, we had a meeting in Hyderabad for South Asia – India, Sri Lanka, Pakistan and Bangladesh for the trial, which ran from 2008 to 2010. So, my association with the Institute began in Australia and then continued in the early phases of the Institute’s work in India”, says Dr Pandian, who was on the Institute’s first Advisory Board and served a six-year term. He is currently the Deputy Director for Research and Development at CMC Ludhiana.

MOVE TO DELHI A GAME CHANGER

The Institute was based in Hyderabad, far away from the powers that be of Delhi, and so it had little visibility. “Even though the Institute was doing some very good grassroots work and running high-end research programs, there was no local funding. Most of the funds were coming from Australia, the United Kingdom [UK] or through multinational organisations, such as the Wellcome Trust. The Board’s initial advice was to establish an office in New Delhi and that has been a real game-changer. In the past years since moving the headquarters to Delhi, the Institute has got more recognition and local funding from Indian Council of Medical Research [ICMR], the Department of Biotechnology, the Department of Science and Technology, the Public Health Foundation of India and the Centre for Chronic Diseases Control in New Delhi”, he adds.

STROKE REHABILITATION

The main challenge with Stroke care in India has been lack of proper services. When a person develops the symptoms of Stroke, he/she first needs to recognise that it is Stroke and that they have to reach the hospital without losing any time. But not all hospitals are Stroke-ready and there is limited provision for calling an ambulance. Many hospitals lack even the basic Computed Tomography (CT) or Magnetic Resonance Imaging [MRI] scanners. Even if these facilities are available, the patients often receive medical treatment and then they are discharged. There is no provision for Stroke rehabilitation for these patients to regain function and return to work.

To solve this problem, Dr Pandian introduced the system of empowering the family and relatives to take care of the patients and aid with rehabilitation - physiotherapy, occupational therapy, speech therapy – in a home setting. “We designed the Family-led rehabilitation after Stroke in India (ATTEND trial) with international collaboration (Australia, UK and India). The pilot trial was carried out at CMC Ludhiana with seed funding from The George Institute of Global Health, Sydney. After the pilot trial, we received funding from Australia’s National Health and Medical Research Council with Professor Richard Lindley from the George Institute in Sydney and me as the lead Co-Principal Investigators in the grant. We completed the trial in 14 centres across the country in June 2016 and I presented its findings at the World Stroke Congress in Hyderabad in October 2016. Later this trial was published in Lancet Journal (August 2017). ATTEND Trial helped us to develop an Indian Stroke Clinical Trial Network [INSTRuCT], which has been now expanded to 27 centres and we have received funding from the ICMR for the next three years”.

ALTERNATIVE THERAPIES

Almost half of Stroke patients use complementary and alternative medicines and therapies in addition to allopathic medication and treatment. The INSTRuCT is undertaking a study to compare the efficacy of Ayurvedic treatment with conventional treatment in Stroke rehabilitation. Once the trial is completed in a few years, a clearer picture will emerge on whether these therapies really work or just have a placebo effect.

THE JOURNEY AHEAD

He feels that the Institute should increase its focus on Stroke, Kidney, Respiratory diseases and Infectious diseases, such as Malaria and Tuberculosis. He would like the Institute to work with the Government of India in health system research and implementation research. “We need to ensure through implementation research that a low-cost treatment is sustainable and can be made available in a rural setting”, says Dr Pandian, who has developed Stroke units managed by physicians in government hospitals in seven districts of Punjab.

“Advocacy, sensitising policymakers, and support from bureaucrats would be essential to drive the programs for Stroke services”, he concludes.

 

 

 
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