“IT was Lev’s idea,” says Dr Sabina Medukhanova, a neurologist and public health specialist who heads up the Republican Coordination Center for Stroke Problems (RCCSP) in Astana, Kazakhstan. The fact is, they’d been thinking about it for some time – the impact a stroke simulation center could have on the region.
New stroke centers were popping up in Kazakhstan all the time, staffed by young and inexperienced physicians who needed to be trained. Sabina and Dr Yerzhan Adilbekov, a neurosurgeon and stroke specialist who is chairman of the Kazakh League of Stroke, reasoned that a stroke simulation center in Astana could even train doctors in neighboring countries.
The idea became more concrete in the autumn of 2023 when Sabina and some of her colleagues attended an Angels Train the Trainer workshop in Frankfurt, Germany. “I’d been talking to Lev,” Sabina says. “He told me no worries, I will organize it.”
A well-equipped simulation center (that had so far only been used to train trauma specialists) already existed at the newly constructed National Coordination Center for Emergency Medicine. And Angels consultant Lev Prystupiuk knew just where he would find experts to run the first simulation.
Since 2018, a state-of-the-art simulation center in Kaunas, Lithuania, had transformed stroke training in Lithuania and become a catalyst for stroke care quality improvement in the region. Located at the Hospital of Lithuanian University of Health Sciences (LSMU), it benefited from the combined expertise of four stroke specialist– Prof Antanas Vaitkus and Dr Prof Vaidas Matijosaitis from the Department of Neurology at LSMU, and Dr Prof Aleksandras Vilionskis and Prof Dalius Jatuzis, respectively the head of the stroke center at Republican Vilnius University Hospital, and of the Clinic of Neurology and Neurosurgery at Vilnius University. During ESOC 2024 in Basel this past May, this foursome received an ESO Spirit of Excellence Award in recognition of their contribution to stroke training in Eastern and Central Europe. The simulation in Astana would be only the second one conducted outside of their center, for which they would draw on recent experience in Moldova.
Dr Aleksandras Vilionskis was no stranger to the Kazakh stroke community, having on more than one occasion led training at the annual School of Stroke in Kazakhstan. But for Dr Matijosaitis who accompanied him, the visit to Astana in October 2024 would be his first.
Learning while laughing
Kazakhstan’s stroke services have seen significant improvement since 2016 after the ministry of health approved a four-year implementation roadmap for stroke management. Thrombolysis rates have increased from 1.33% in 2016 to 5.40% in the first half of 2024; and the rates for endovascular thrombectomy have risen from 0.05% to 2.10%. At the same time, the number of stroke centers has increased from 40 to 81, comprising 30 comprehensive stroke centers and 51 primary stroke centers.
The School of Stroke scientific and practical conference has taken place every year since 2017, bringing together experts who are passionate about improving stroke treatment and care. Success has followed. Shortly after the simulation workshop in October, it was announced that five Kazakh hospitals had won ESO Angels diamond awards in Q3 of 2024, three more than the previous year.
Of course more stroke centers meant more doctors had to be trained in how to implement treatment guidelines and optimize their stroke pathway. This, along with a focus on quality and outcomes, accounted for the significance of October’s inaugural stroke simulation. The stroke specialists who attended would subsequently spread their knowledge to colleagues at their own hospitals.
“It was a great experience for our physicians,” Sabina says of the two days of masterclasses, pathway simulations and decision-making workshops. “It was very, very interactive and everyone enjoyed the role-playing, they had a great time. When people learn by laughing, the learning sticks.” The enthusiasm carried over onto social media, creating a demand for more such interventions. “A lot of physicians who weren’t part of it also now want that kind of workshop,” Sabina says.
He could generally gauge the success of a simulation by the questions asked, Vaidas says, adding that Q&A sessions in Astana had elicited even some controversial questions the participants might not have felt comfortable about raising elsewhere.
The simulation boosted both knowledge and confidence, Lev concurs. “It was a safe space where doctors could share their experiences and talk openly about how things were done at their own hospitals without being afraid to raise certain topics and issues.”
Representatives of the World Health Organization (WHO) and a government health think tank were also present, and the WHO subsequently recommended the Angels Academy as an education platform in a letter to the Minister of Health.
The Kaunas-Astana connection
Lev explains why a stroke simulation center in Astana is important. For doctors from Kazakhstan and its neighboring countries, attending similar events thousands of kilometers away in countries like Germany was costly for a start. “But it’s also a matter of access, with visa requirements and sometimes political reasons acting as barriers,” he explains. And then there’s the matter of language.
Lithuania and Kazakhstan both come from a Soviet past. After the countries regained their independence they had different development pathways, but doctors from the older generation in Lithuania are still able to use Russian for communication which allows them to share their knowledge and experience.
Lithuania is a few years ahead of Kazakhstan in terms of stroke care access, with their own breakthrough occurring in 2014 when the national stroke care network was established. As well as the transfer of skills, the Kaunas-Astana partnership allows Kazakhstan to learn from and be encouraged by Lithuania’s proud decade of stroke care development.
But since learning is a two-way street, what new insights did the Lithuanian doctors carry home?
Aleksandras Vilionskis says the important lessons have to do with understanding the specific and systemic problems encountered by hospitals in Kazakhstan and adapting their simulation for local conditions. He says future events are likely to include in-situ simulations at participating hospitals so they can observe the pathway from door to treatment and pinpoint the gaps that are causing delays in those hospitals.
For Vaidas Matijosaitis on his first visit to Kazakhstan, the experience confirmed something he already knew. He says, “Even if there are differences in the system, we all share the same aim, which is to help people with stroke. That is the same no matter where we go.”
