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Conheça o caminho, mostre o caminho | A liderança leva à mudança em Beheira

Um profundo compromisso, um plano ambicioso, contactar a Angels, e liderança no sucesso – estes são os motores da transformação dos cuidados de AVC que está a salvar vidas na província de Beheira, no Egito.
Angels team 29 Maio 2023
Dr Hany Gemeah transformed stroke management in Beheira governorate in less than a year of becoming Undersecretary of the Ministry of Health.

ANGELS wear many disguises. But if an angel really wanted to keep out of sight, they might consider unclipping their wings and installing themselves behind one of those regular brown desks that instantly proclaim, “government office”, perhaps with a small official flag near their right elbow for extra camouflage. 

It is behind such a desk that we find Dr Hany Gemeah, who in March 2022 became Undersecretary of the Ministry of Health in Beheira governorate, one of Egypt’s coastal governorates overlooking the Mediterranean Sea.

A popular destination for travelers interested in history, archaelogy and lakeside scenery, Beheira is home to over six million people, most of whom live in the rural areas east of the Cairo-Alexandria desert road connecting Egypt’s two largest cities.

While stroke services in Egypt have improved significantly since government support for acute stroke management was obtained in 2016, and over 20 hospitals have subsequently won WSO Angels Awards, none of these were in Beheira governorate. In fact, the nearest stroke centres were in neighbouring governorates, and the time it took to reach hospitals in Alexandria or Tanta meant that many stroke patients from Beheira arrived too late for treatment.

But in March 2022, that began to change.

The first Angels workshop at Kafr El Dawar General Hospital.

DR HANY is not behind his desk, nor in his office – the natural habitat of government officials pretty much anywhere in the world. This is because Dr Hany has a fight on his hands, and it’s one that he started. Even before arriving in his new position, he’d made up his mind that the people of Beheira should have access to stroke treatment within their own governorate.

He identified the cities where his campaign would start, and looked for an ally that could help him realise his vision.

To say that Mohamed El Rayes, Angels consultant in Egypt, was surprised to receive a call from the Undersecretary is an understatement. Communication more typically flows in the opposite direction, sometimes with disappointing results.

The next surprise was learning that Dr Hany’s vision included not one but four hospitals to become stroke-ready centres simultaneously.

“Usually,” says Mohamed, “we will start with one key hospital and once it’s successful, roll out the programme to surrounding hospitals. But Beheira is a large governorate and Dr Hany wanted people across the region to all have access to at least one hospital that provided thrombolysis for acute stroke, as soon as possible.

“It turned out to be the right decision.”

The first Angels workshop at Kafr El Dawar General Hospital.

IN MAY 2022, Kafr El Dawar General Hospital became the first stroke-treating hospital in Beheira governorate. It was the first success in a rigorous programme that included two major stroke workshops offering hands-on training to neurologists, emergency, intensive care and internal medicine physicians, and nurses. Professors from Alexandria, Tanta and Mansoura came to Beheira to share their experience and best practices, some at the invitation of Dr Hany himself.

Like a row of dominoes, the other hospitals fell in place. Rashid General Hospital started treating stroke at the end of August, Itay al-Barud General Hospital in late September. In October, Damanhour Chest Hospital in the capital came on stream, so by the end of 2022 there were stroke-ready centers along the length of the Tanta-Alexandra agricultural road that cuts across the territory from north to southeast, as well as in the northeast where the Nile meets the sea.

At the start of 2023 all four hospitals started registering their patient data in RES-Q, and in May it was confirmed that Kafr El Dawar General Hospital had won Beheira governorate’s first gold WSO Angels Award.

Although proud of his hospitals and grateful to the stroke teams who are giving substance to his vision and saving lives, Dr Hany isn’t terribly interested in awards. What he does care about is how data pinpoints what his hospitals need in order to get even better.

A stroke network is the goal, so that stroke patients can benefit from a connected system of care, and a June workshop attended by over 100 physicians from hospitals throughout Beheira would be a significant step in that direction.

Dr Hany at the workshop at Kafr El Dawar General Hospital, now the winner of a WSO Angels gold award.

IF DR HANY is not behind his desk or in his office it’s because he is out talking to the public about stroke, explaining in the simple language of the local dialect about the symptoms of stroke, the need to act fast, and the four stroke-ready hospitals where life is given a second chance.

Television appearances, posters and social media are also part of the public awareness drive, but Dr Hany understands the value of community platforms especially for reaching rural areas. Local radio shows, community newspapers and public health educators in small primary health care units carry the message into villages and homes; priests share the news during Sunday services and imams spread the word after Friday prayers.

The zeal with which Dr Hany pursues his stroke care goals for Beheira has its roots in personal tragedy.

When his own mother suffered a stroke in 2010, thrombolysis had been the standard therapy for ischaemic stroke for over a decade, but in Egypt less than one in 100 patients was receiving this life-saving treatment. With no acute treatment available at the hospital where his mother was admitted, Dr Hany felt helpless, but when his mother passed away after 10 devastating months, his grief turned into passion.

Over the next decade, his ideas for developing stroke services in underserved communities would encounter several stumbling blocks including the disruption of healthcare as a result of the pandemic, but he never lost sight of the goal to make treatment available to every stroke patient, no matter how poor or how far. And when his influential position in Beheira finally brought that goal within reach, he set an agenda that stretched every resource, and engineered success that defied every expectation.

In the next round of WSO Angels Awards, Beheira will fare even better, Mohamed believes, earning the stroke teams at these hospitals the recognition they deserve, and raising the bar for future performance. And although he doesn’t really care about awards, it will bring honour to a leader who (in the words of John C Maxwell), “knows the way, goes the way, and shows the way”.

Before taking office in Beheira governorate, Dr Hany's work in stroke care improvement included working with EMS teams in Mansoura City.


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