Advanced stroke treatment in Southeast Asia

Cuong Tran Chi, MD, works in Can Tho city, situated in the Mekong Delta on the very southern tip of Vietnam. He was instrumental in establishing Stroke International Services (SIS) General Hospital, dedicated to providing stroke patients with the best treatment currently available. Another focus is on training doctors who can then replicate the success of SIS throughout Southeast Asia and beyond. The Mekong is a vast river, and the Delta region in Vietnam’s south is home to more than 20 million people. “Before we established SIS, the closest place that could provide good treatment for stroke patients was in Ho Chi Minh City,” also known as Saigon, says Cuong. Often the result was that it took too long for stroke victims to reach these hospitals.

A similar situation prevails in other parts of the country: Vietnam is an emerging economy, and although it is a successful one, it is still in the process of optimizing its infrastructure, including its medical infrastructure. Vietnam is similar to Germany in size but is more densely populated. The country has 95 million inhabitants, about 15 percent more than Germany and about a third more than the United Kingdom or France. There are around 200,000 stroke cases per year in Vietnam, and most of them do not occur within easy reach of the next hospital or advanced stroke center. As a result, only two years ago over 90 percent of patients reached the hospital six hours or more after the stroke occurred.

With stroke, however, more so than with most other conditions, rapid diagnosis and timely care are critical for the success of the treatment. The narrow timeframe within which optimal treatment is possible is known as “the golden hour”. It helps to explain why establishing a center like SIS in the Mekong Delta was so important.

Since its opening in 2019, SIS Can Tho Hospital has provided access to modern medical services for more than 90,000 patients. In addition to focusing on stroke treatment and cardiovascular disease therapy, the center provides the first port of call for extensive care related to musculoskeletal surgery, congenital heart disorders, arrhythmias, and advanced health check-up services. “This is an incredible number,” says Cuong.

This, says Cuong, would not have been possible without good partners. “To operate our stroke center requires substantial investment. Siemens Healthineers gave us very strong support.”

For Vietnam, SIS expects to train at least one or two interventional neuroradiologists for every province in the next five years, capable of carrying out neurological interventions in each of Vietnam’s 63 provinces. To further enhance the role of SIS as an international training center beyond Vietnam, the hospital hosted the first Asian Stroke Summer School in 2019, with the participation of more than 100 neuroradiologists and stroke physicians from Vietnam, Laos, Cambodia, and Indonesia, and as far afield as Pakistan and South Africa.

The Summer School took a unique format, combining plenary sessions and discussions with practical training. This comprised a series of teaching sessions, courses on acute stroke management, as well as hands-on training for interventional neuroradiologists. Cuong and his co-workers modelled the Summer School on the equally effective European Stroke Winter School, which is held each year in Bern, Switzerland.

"The fact is that there is a very high demand in our region for stroke treatment, but a low supply of expertise. In other words, there aren’t enough doctors," explains Cuong. This is what SIS and the Summer School intend to change. While Vietnam has gone through several decades of economic growth and is one of the leading countries in Southeast Asia in every respect, the situation with regards to stroke treatment in some parts of the country is dire.

“In some Southeast Asian countries, very few neurointerventional physicians can perform endovascular treatment for stroke patients,” says Cuong. “This is why we are working on creating a stroke network by extending our training opportunities to these countries, especially in the less privileged regions.” The need for good treatment is there, all over Vietnam and Southeast Asia. Cuong, SIS, and their partners are working to find ways to meet it.