At 11.45pm on Sunday 16 Juni 2019, a young man was admitted to Duitama Regional Hospital in Colombia’s remote Boyacá region with symptoms seldom seen in 20-year-olds. Twenty minutes had elapsed since he first noticed the weakness in his left leg and his speech became slurred. Neurological evaluation showed an NIHSS score of 5, and the patient’s speech continued to deteriorate, lending weight to suspicions that this young citizen of the city of Duitama had had a stroke.
A video call was immediately placed to the neurology department at the University Hospital of San Rafael de Tunja in the capital of Boyacá where the neurologist on call studied the CT images transmitted from Duitama. Within minutes the diagnosis was confirmed and contraindications excluded. Shortly after midnight, treatment with thrombolysis commenced.
By sunrise the following morning, all that remained of the patient’s symptoms was a prickling sensation in the sole of his left foot. His NIHSS score was 0. The future that had come so close to slipping away, was his again.
In the emergency department at Duitama Regional Hospital no-one had had much sleep but they wouldn’t notice how tired they were until much later. For now they were elated. They had participated in a milestone moment, the result of years of planning and training. At around midnight on Sunday 16 Juni 2019 the first-ever telethrombolysis in the Boyacá region had saved a young man’s life.
The impetus for this intervention came from Dr. José Luis Bustos, neurologist at the University Hospital San Rafael de Tunja, who two years earlier had launched the Telethrombolysis Project – an ambitious plan to provide timely care to stroke patients in this remote corner of Colombia. Dr Bustos’s hospital is a comprehensive centre at the heart of the regional network for managing stroke, and winner of eight WSO Angels Awards. But many of the patients who were brought here from Duitama, Sogamoso, Soatá, Chiquinquirá and Moniquirà arrive outside the treatment window for reperfusion. Patient transfer presents a challenge. The referring hospitals are between one and three-and-a-half hours distant from the capital and Bocayá has less than one ambulance per 10,000 inhabitants, the fourth-lowest out of Colombia’s 33 departments.
Recognising an opportunity for technology to shrink the distance between hospitals, a determined Dr Bustos started petitioning the Bocayá Secretariat for Health in 2017 to equip the referring hospitals with the telecommunications and imaging equipment necessary to establish a telemedicine network in the region.
Innovation creates pioneers, which was what the team at Duitama Regional Hospital felt like on the night the 20-year-old was brought to the emergency department. Through the tenacious effort of Dr Bustos and with support from Angels, they were able to save their patient and spearhead the implementation of telestroke management in the region.
This proud and enthusiastic team has since been joined by others. Telethrombolysis is now also live at hospitals in Sogamoso and Moniquirá, with Soatá and Chiquinquirá to follow, and there’s a further reason to feel pride. The average door-to-needle time recorded in the telethrombolysis network is a world-class 30 minutes, which means that hundreds of patients who would have reached Tunja too late to benefit from life-saving therapy, can now access treatment in record time.
