There are acts of care for which there is no award. Like the diligence of a stroke nurse placing a pillow under a patient’s affected arm when she turns them onto their other side. The patience to show a stroke patient’s frightened family how to care for their loved one, and then to gently explain it all over again. The kindness of a junior nurse moistening parched lips with ice cubes in the middle of a long night.
And it is hard to imagine an award that would do justice to three decades of engineering hope.
Thirty years have passed since Dr Wiebren Duim became a neurologist, in the same year a paper appeared in the New England Journal of Medicine that would change stroke care irrevocably. The breakthrough came in a landmark study that would establish thrombolysis as the standard of care for treating ischemic stroke, potentially changing outcomes for millions of stroke patients around the world.
He’d developed an interest in stroke early on, Dr Duim says, and he was an early believer in the impact of stroke unit care and early rehabilitation. The advent of thrombolysis for acute ischemic stroke made him a believer in miracles too.
“It sends a shiver down the spine,” he says, describing the effect of successful recanalization. “In casualty if you see someone with acute stroke they will look at you with a blank face. No movement; no expression besides fear.”
But if you do the right thing and treat them with thrombolysis in under four-and-a-half hours (because that is all the time you have to change the outcome of a disaster), then you won’t believe your eyes.
“While you are still writing your notes, doing the paperwork, arranging for a ward, you will notice a movement. And two days later, you will see that patient walk out of the hospital. It’s like a miracle, I cannot explain it, but if you see it, you are a convert.”
And that has been Dr Duim’s intention all along – to turn you into a convert.
“Once I have a convert,” he continues, “they become a stroke champion. Then, no matter what time of the day or night, no matter the circumstances, come rain or shine, they will do what is necessary.”
And he really does mean “do”, because not every patient is a two-day miracle. For those for whom life will never be the same again, who must travel a long, hard road with no clear destination, hope begins when you “do something”.
“You do a thing,” Dr Duim explains. “The physio gets you out of bed and makes you stand. She augments your strength with her own, she puts her back into it. And the next time you see the patient they have a smile on their face, because something has happened, there is progress. Yesterday they could not move, but today there is a new shimmer of hope.”
Hope builds over time. And when at last the patient is discharged to a life they may not recognize, the work of building hope is transferred to the stroke community. In 30 years Dr Duim has often witnessed how a stroke unleashes the goodwill of a community prepared to make plans, press on, and bear a burden together.
“It brings tears to your eyes,” he says.
“We sit together and figure it out”
Life Groenkloof Hospital, formerly The Little Company of Mary, is a private hospital located in Pretoria, South Africa’s administrative capital. Dr Duim’s clinical home for the past 20 years, it had a reputation for stroke care excellence long before they won their first Angel Award in 2024. Once a year on World Stroke Day, the hospital is bathed in green light as part of the stroke awareness programme run by communications coordinator Karen Landsberg. This campaign highlights the critical roles emergency unit nurses and doctors play in the emergency management of persons affected by strokes. For emergency unit unit manager Sr Elaine Lubbe, this is a moment when pride feels like a lump in your throat.
Life Groenkloof Hospital is where you have the honour of meeting some of Dr Duim’s converts – among them speech therapist Megan Barnes, and Sr Lydia Lwanga, unit manager for the acute neurology ward, St Francis, who together with Sr Elaine drives the quality monitoring process that has seen the hospital go from gold to diamond status in under a year.
The neuro ward is located on the same floor as the gym where stroke patients undergo three hours of therapy per day, Megan says. “Then the nurses repeat what they have seen us do.”
Teamwork is more than a catchphrase, and each patient’s recovery is an ongoing conversation. “We sit together and figure it out,” Megan says, adding that they speak “a hundred times a day”.
Megan has been on Dr Duim’s team from the start, preventing complications and teaching stroke survivors how to have the best life they can. Family meetings are part of the protocol, and hope is served with a side of reality. Rehab is hard.
Educating families reduces readmission rates, and the Life Groenkloof Hospital team do everything possible to prepare patients’ families for what is almost inevitably a gruelling time ahead. When relatives are scarce, as when the adult children of elderly patients are living abroad, it may fall to the team gently but firmly pry someone away from their independence.
Megan says: “We are also there when big life decisions are made.” It isn’t easy telling someone they cannot go home.
Sr Elaine arrived at Life Groenkloof Hospital 18 years ago, and recalls being handed a booklet and being told that “this was Dr Duim’s process”. “His passion has rubbed off on all of us,” she says. Her own passion is ignited by having a positive impact on other lives, inspiring her younger colleagues and “seeing a patient wave goodbye with the arm that was affected by stroke”.
In 2023, she and Sr Lydia decided it was time for the stroke team at Life Groenkloof Hospital to be recognized for their work. “We wanted to be on the map,” she says. Submitting their patient data on RES-Q gave them instant feedback on what could be improved and a visit to their colleagues at Life Eugene Marais Hospital (already an award winner) helped get them past the post.
All Life Healthcare acute hospitals enrolled in the Stroke Restore program are stroke-ready hospitals and have implemented the integrated stroke pathway. They all provide critical interventions like intravenous thrombolysis and offer immediate access to neuro-rehabilitative services. Eleven Life hospitals have so far won WSO Angels Awards, including 12 diamond awards, two of which would stand behind Life Groenkloof Hospital’s name by the end of 2024.
At the end of quarter one, their first gold award had confirmed that they were already very good. In quarter two a platinum award signalled they had gotten even better. Becoming a diamond hospital solidified their position among the world’s top stroke-treating hospitals. It doesn’t get any better than that.
“We nurse differently”
Sr Lydia Lwanga thought she had found her niche in obstetrics until she came to the St Francis neuro unit in 2013 and discovered stroke nursing. “It blew my mind,” she says.
She loves to see patients go from helpless to “home and healed”, and keeping in mind that they have a family waiting for them to come home, feeds her empathy. “You treat them as if they’re your mother, your father, your sister, your brother,” she says. “Everyone gives their best.”
“We treat every patient as we would want someone in our family to be treated,” Sr Elaine concurs. Emergency nurses typically thrive on adrenalin, but Elaine says they have “a softer touch”. This compassionate approach to caring for their vulnerable patients seems intuitive with everyone on the team. “It’s in the drinking water,” Sr Elaine quips.
Stroke nursing is a unique discipline, requiring vast depths of empathy combined with a steely resolve. This is no typical ward where you will find the patients neatly tucked in, and the bedding pristine.
“We nurse differently,” Megan says.
On Sr Lydia’s ward, they want the patient to feed themselves, to learn to manage without a catheter, to take those hard steps towards their second chance. Sometimes it’s necessary to be strict.
“We want them to go have a life after they leave, so they have to adapt themselves to a new level of functioning. The stroke ward does that. It may look like chaos, but you want the chaos, it’s about managing the chaos.”
Recovery can get messy, like life itself.
“We all share a vision,” Megan says. “We all know what to do. And doing it with patience and love, is good for morale. It’s why we keep doing it. Seeing our patients’ quality of life improve is good for our souls.”
