Hemorrhagic Stroke By Dr. Teddy Totimeh


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Hemorrhagic Strokes (Bleeds) | American Stroke Association

It was almost midnight. I had just finished a procedure that had not really gone the way I wanted it to. And the Black Stars had lost their match whilst we were operating. It was just one of those unhappy nights. So when the police man stopped me and said: Boss, your boys are on the ground oh…, I found it difficult to smile. I did tell him I was from work. He smiled back and waved me on after pretending to inspect the inside of my car.

As I drove on I was reminded of my own powerlessness in that short engagement. Both of us knew how inappropriate his request was. We both knew that if I acted on it, there was a significant likelihood of illegality. But here I was, humouring him, because life at midnight is much simpler that way. He had the power. I have tasted enough the consequences of that power abused, to want to keep things simple, especially at that time.

We were only able to keep the lady alive for a week, and then she passed. It was a hemorrhagic stroke. She was a hypertensive who had returned from a funeral, and woken up in the night with a headache. When she collapsed soon after, she was sent to a nearby clinic and kept there for a day, before being sent to us. Her CT showed the large collection in her head. We did the surgery to bring down the pressure on the brain. However, once the blood spills into the brain, mortality rate is closer to 60% no matter what one does. The brain is an electrical system which takes 20% of the blood pumped from the heart, but it does not have the colour of blood, because there is a blood brain barrier. Any blood spilled into the electronic circuitry of the brain has catastrophic circumstances. That anyone survives such catastrophe, is testament to the amazing degree of redundancy the brain operates with. There is layer after layer of back up after back up. It takes a catastrophe of significant proportions to take a brain down.

So it is worrying, if this catastrophe is happening more than once every week. On a regular basis, I am seeing young men and women with lives torn apart by hemorrhagic stroke. Families are losing breadwinners, and the few who survive, are left debilitated, dependent on someone for the rest of their lives for the most basic of life’s everyday demands. Sometimes the loss of independence for some, is more painful and expensive than death, for the family. Every single day, I am receiving calls from doctors who are managing this endemic. And we neither have the prerequisite human resource or infrastructure to intervene optimally and timeously enough to lessen the impact of such brain disasters. The herbalists claim they treat hypertension, and buy huge billboards to shout out loud. They are allowed to spew untruth, doctors are not allowed to advertise truth.

In this situation, as with so many things, it is the small things that matter. It is the things that are done at the base, that determine the stability at the top. It is the absence of good quality primary health care, that has unleashed this tragedy on the corridors of specialised surgery in Ghana. Just as the absence of organised Colts’ football has delivered such a lacklustre Black Star Team. And as my neuro team endures the deluge blocking out beds which could have been used for other pressing needs, I wonder what the way out will take.

We as a country have sacked football coaches, because we want to be called a country of good foot ball. I think sometimes we forget that no footballers would throw themselves aground with the commitment we see on the English premier league, without the reassurance of specialised surgical care. I was miffed by the abject mediocrity I saw on the football field every time our team was playing.

I was also reminded, that on this side of the Atlantic, practising medicine is committing to tolerance of subpar strategy, management, infrastructure and delivery. And as long as we do not have a national strategy for diagnosing early and dealing with hypertension, catastrophe will persist on our neurosurgical wards.

Excellence in health care delivery, impacts everything… even football.


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