To make a sombrero vueltia, one of the most famous hats in the world, you start by removing the veins from the tall leaves of the arrow cane plant and drying them in the sun until they fade from green to white or beige. Next, the beige leaves are soaked in black mud for several days, dried and soaked again until they’re a uniform black. Then the black and white strips are woven into braids and the braids woven to form the sombrero.
This hat, which is as handsome as it is symbolic, is an iconic symbol of Colombia, but its headquarters, so to speak, are here in Montería, a municipality and city located in northern Colombia, about 50 km inland of the Caribbean on the banks of the Sinú River. Montería is the capital of the Department of Córdoba and home to about half a million people – all of whom are now safer, following the creation of the first stroke care network on Colombia’s Atlantic Coast.
This stroke network did not develop on its own. Its story is woven together, like the braids of the sombrero, with that of the Sistema de Emergencias Médicas (medical emergency system or SEM), which simultaneously aims to organize and improve the patient transport service in the municipality. Since 2017 such a system has been a requirement for category one municipalities such as Montería.
Nurse Francy Velásquez, who was appointed by the Health and Social Security Secretariat to lead the management and implementation process of the SEM, did the weaving. As a result of her work, 12 healthcare providers, the Emergency and Urgent Care Regulatory Centre (CRUE) of Córdoba, and the Health Secretariat of Montería are all working together to ensure better care and outcomes for stroke patients in the region.
Nurse Francy is no novice when it comes to implementing large and complex projects. In 2020, she established the Non-Communicable Chronic Disease Prevention and Healthy Lifestyle Promotion Program in Montería’s Health and Social Security Secretariat. She is also a seasoned emergency medicine professional who for the past 12 years has served as an instructor on Basic Life Support, Advanced Cardiac Life Support and Paediatric Advanced Life Support courses. Once the SEM is up and running, the operation of the stroke care network within the SEM will continue under her leadership.
Montería’s Health Secretariat had already embarked on the process of establishing the SEM when the Angels Initiative presented them with the concept of a stroke care network in July 2023. As the reference for the Emergency and Disaster Program of the local authority, Nurse Francy immediately recognized the potential for synergy with the SEM. The Angels Initiative was also an excellent strategic ally for achieving the SEM goals, Nurse Francy says.
Organizing and progressively consolidating the network required a series of important actions. These included the selection and classification of prioritized healthcare providers based on their resources and problem-solving capacity, the formation of implementation teams in each, the training of healthcare and support personnel, technical assistance for the development of Code VIDA (the standardized stroke protocol for the network), and the initiation of quality monitoring.
Creating alliances for the rapid identification and referral of stroke patients from low to high complexity care, as well as awareness and communication campaigns directed at the community to improve timely access to health services, were also part of the strategy.
As yet, not all the hospitals selected for the project are stroke-ready centres or enrolled with Angels, but it is their goal to achieve this status for every hospital in the Montería stroke care network, Nurse Francy says. As part of the education program that supports this goal, certain courses in the Angels Academy have been earmarked as mandatory for some hospitals, and simulation training has facilitated the adoption and adaptation of the standardized stroke protocol in institutions accustomed to different practices.
Even support teams including administrative staff, porters and janitors have been trained to identify the symptoms of stroke and activate Code VIDA. This sets in motion a sequence of responses, from quick patient assessment to CT scans and therapeutic decision-making, all with the emphasis on speed.
Whereas previously most of the hospitals in the network did not have quality indicators for evaluating their stroke care, several now keep track of treatment times and key priority actions, Nurse Francy says. This allows them to know their current status or baseline for improvement, Seventy percent of the hospitals are already submitting their data on a quarterly basis and can look forward to receiving feedback via RES-Q.
The implementation of the stroke network in the municipality of Montería is a response to the need for prioritized care networks within the framework of the SEM, Nurse Francy says. This is particularly urgent given the high incidence of pathologies that are significant risk factors for stroke.
Public servants have a responsibility to lead initiatives that improve people’s environment and quality of life, Nurse Francy believes. “The privilege of having authority is not for our own benefit but for making good things happen. It is the sum of passion (what moves us personally) and purpose (what we can do for others with our gifts and talents). It transcends and motivates others to move in a common direction, to work together and achieve objectives through inspiration.”
Not yet two years old, the collaboration within the stroke care network and the standardization of the Code VIDA protocol have already improved the quality of care for stroke patients in Montería, Nurse Francy reports. This is a fundamental source of pride.
“I believe that Montería’s stroke network is the result of coordinating the resources offered by Angels in terms of technical assistance, monitoring, and capacity building, combined with the leadership of the local authority, and the perseverance, commitment, and motivation of the different stakeholders who have gradually joined.”
Working in coordination with the Angels Initiative, the hospitals and strategic allies of the system has been an honour, but Nurse Francy identifies the role of the health authority as essential for the success of the project.
“Another crucial point for the success of the network was leadership from passion and purpose. This makes the stakeholders feel that they belong to something that is having significant impact and creating changes in people’s lives.”
There is finally also the power of shared pride about an initiative that has put Montería on the national stroke care map. Nurse Francy wants to weave together not only the pride but the credit.
She says: “It is thanks to the committed work, enthusiasm and excellent attitude of each network member that we were able to establish the first stroke care network established on the Atlantic Coast, joining the successful experiences of Bogotá, Cali, and Pasto at the national level.”
