Doctor Ignacio Girolimini loves dogs.
On his Facebook page, pictures of strays waiting to be adopted are interspersed with posts about where to get your flu shot and shares on behalf of a group that raises funds for the local hospital.
But early in 2023, Dr Girolimini had something new to ask the 25,000 residents of San Miguel del Monte – he wanted them to take part in a survey about stroke awareness. The survey was part of a project to establish a stroke unit at Zenón Videla Dorna Hospital, he explained in a video shared on 17 February. Ten days later, this project would save a life and change the future of stroke care in this tranquil rural town.
Treating acute ischemic stroke had always been on Dr Griolimini’s radar. It was the reason he registered with the Angels Initiative in 2021 and completed nearly all the elearnings in the Angels Academy – from the ASLS course for EMS practitioners to Stroke Basics For Nurses. It was the reason he participated in the ROPU Mentoring Programme through which he connected with Dr Claudio Jiménez, a neurologist at diamond winning Simón Bolívar Hospital in Bogotá, Colombia, and got to know the Angels team in Buenos Aires province.
The tipping point came in June 2022 with the acquisition of a CT scanner for San Miguel del Monte’s 124-year-old hospital. For Dr Girolimini that was the moment when treating acute stroke ceased being an intention and became an obligation.
Ignacio Girolimini was raised in San Miguel del Monte where life centres around a 720-hectare lagoon so beautiful that it has its own Instagram account. He is the first doctor in his family, and when he first went away to study at the University of Buenos Aires, and later to specialise in internal medicine, he only expected to be back for the occasional weekend. But although he liked working in the big, cosmopolitan capital city he didn’t like the traffic jams and he missed the lagoon, his family and the tranquility of smalltown life.
He came home in 2020 to San Miguel del Monte’s only hospital, with the goal to “take excellent care of the needs of our small town”.
With the nearest stroke-ready hospital 45 minutes away, the residents of San Miguel del Monte were in the same boat as the majority of Argentines living far from major cities. Stroke patients including Dr Girolimini’s grandmother, were effectively left to their fate, as vast distances and low awareness meant few reached acute treatment in time.
Spurred on by the brand-new CT scanner, and with the support of the hospital directors, Dr Girolimini started working on a stroke protocol for his hospital, a process that gathered speed after Angels consultant Daiana Michel visited San Miguel del Monte on 1 février 2023. The pathway they devised centred around the new CT scanner – it was where the emergency services would deliver suspected stroke patients and where, if the patient was eligible, treatment would commence. But to ensure that patients arrived in time, the population had to be educated about stroke, and that was what Dr Girolimini’s survey was all about.
“In a minute you can lose two million neurons,” his video message began . . .
Shortly after 8 am on Tuesday 28 February, just four weeks after her first visit, Daiana received a WhatsApp message that she immediately shared with Angels consultants all over the world. “Buen día Daiana!” the message began. “Hoy cerca de la madrugada... Primera trombólisis en el hospital.”
Zenón Videla Dorna Hospital had thrombolysed its first stroke patient at dawn.
The patient was a 61-year-old visitor who was passing through San Miguel del Monte when he had a stroke. He was in many ways a lucky man because, just 30 minutes after symptom onset, he arrived at the only hospital for miles where he could receive treatment with thrombolysis. He was treated within 60 minutes of his arrival and made a remarkable recovery.
“It was important,” Dr Girolimini says, “because he was a mechanic, someone who worked with his hands. It was important to him and to us to keep him working.”
Dr Girolimini also keeps working. To reduce the door-to-needle time, steer a stroke awareness campaign, initiate research about location-specific causes of stroke, expand their service to nearby towns, start building a regional stroke network, and to convince other hospitals that it can be done.
It’s not that hard, he says to those that do not treat stroke patients despite having the resources to do so. “Get organised. It’s an obligation.”
