“Dainik Statesman” on March 20

One fine spring morning……

Debabrata Chakraborty

“I was born in a remote village called Nayachak, away from the town of Budge Budge in West Bengal. I aspired to be an engineer but ended up becoming a doctor. My father was an advocate in the Alipur Civil Court and it was his wish that I should become a doctor in order to serve the poor and helpless rural people of this area as my forefathers were Ayurvedic  doctors .I was initially  admitted to the engineering course in IIT Kharagpur. However as per my father’s wish I was later admitted to the Medical College,Calcutta where decades later I became the Head of the Dept. of Neurology”’ reminisces Prof.(Dr.) Dipes Kumar Mandal, my next door neighbour. We got engrossed in such friendly chatter sitiing in his ground floor clinic in our housing complex. Today, being Sunday his patients would start queuing up a little later than usual.

“What happenend to the dream of serving the rural people, in remote areas?” I prodded Dr.Mandal.”The need to provide service to the rural people always occupied my mind. Years back I used to visit my native place of Nayachak every week. However I felt that the  horizon of  work needed to be expanded. I pondered about involving a wider section of the society, reaching out to them with the message of health awareness as well as medical treatement. Stroke kills many but many more may survive to be paralysed  and lead a meaningless life(a life without a real life).We read the Western text books saying that stroke afflicts people mostly around  seventy years of age.However in our country stroke strikes people  the age group of 40- 60. Stroke or brain attack is an important  and devastating disease of the brain. Devastation is either in the form of death or disability. Disability is more painful and frustrating than death as it causes physical and mental handicaps.

Thus started Stroke Foundation of Bengal on 24th of June 2006.

“Does your Foundation provide awareness as well as treatment?” I quizzed Dr.Mandal.”Stroke is easily preventable in over 90% cases” replied Dr.Mandal.” Those who suffer from high blood pressure should follow certain norms like consuming less salt (<3gm/day), daily exercises like walking about 40-60 minutes, maintaining a healthy body weight and avoiding mutton or beef. Fish and egg white may be had. Oil, butter and sweets should be restricted. Fruits and vegetables must be had in plenty” advises Dr.Mandal. I was taken aback and blurted out “Then what will I eat! We Bengalees are proud of our gastronomic habits. As the great poet Sukumar Ray wrote – “Khai Khai koro keno? Eso bosho aha re..!”( Why do you feel hungry so much? Come, Come and sit to eat…)

Warnings, whatsoever, will the average Bengali stay away from mouth watering food? In spite of the soaring prices the Bengali foodie manages to  take home a loaded bag from the market. As the humorist writer Sivaram Chakraborty had once observed “These days you do not get a bagful of goodies with a pocketful of currency rather it is the other way round; to take a bagful of money to procure a pocketful of articles.”

Dr.Mandal  burst out laughing at these musings and remarked “We should eat to live and not live to eat!” But I was not to be pacified. I mumbled that if we were to follow such strict dietary discipline, Bengalis would die of unhappiness and depression.

Dr.Mandal resumed ”Tobacco consumption is to be stopped totally. Alcohol  should be restricted.Medicines are to be taken only with the doctors’ advice.Please do not become your own doctor.Check your blood pressure regularly. If your blood cholesterol is high consult your doctor and take medicines. If you follow these rules you will prevent, not only stroke but also heart attacks.”

I had drawn up a delicious  menu of mutton for lunch today…that mutton which I managed to buy after walking miles to the CK market and making a beeline behind scores of people eagerly waiting for their turn, thanks to the disappearance of the roadside meat shops as a fall out of the beautification drive of Salt Lake City. Alas! here I was , dreams shattered after this conversation.

Emono basanta dine bari phero mangsho kine..( On such a bright spring morning, come back with a bagful of mutton)  these famous lyrics of the Bengali Band “Chandrabindu” echoed in my ears. I had  wanted to  buy a CD of this song from CC Saha’s at Esplanade. The man tending the store was amused “No Sir, no such CD exists.” I learnt later  from my son that Chandrabindu had never recorded this song in a CD or cassette. The reason for not doing so dawned on me now! Dr.Mandal’s warnings aroused me again “Eat right, maintain a healthy body-mass index(BMI). Do not put on weight. Another important fact is that low income and lack of education are related to the incidence of stroke .Government policies to eradicate poverty,  provide better education and health facilities to the public will play a positive role to reduce the burden of Stroke and other Non-Communicable Diseases(NCDs).”

I wondered whether this Sunday would be the last one of lunch with mutton. Henceforth I promise to eat fresh fish, vegetables and fruits. But will they appease my taste buds? Another doctor  friend of mine who had smirked” Those food items which are good to taste are bad for health!” I had retorted ”Does that mean that things that are bitter to taste, soyabeans, tea without added sugar are good for health?” He had then nodded in the  affirmative ”Yes. Exactly !”

Dr. Mandal does not smoke or chew paan (beetle) or tobacco and relishes tea without sugar. I used to reassure myself that had I not been an artiste I would have been as disciplined as Dr.Mandal is. I would have entangled myself in strict norms. Can an artiste and that too, in the world of journalism survive without vices?

Visions of mutton Chaap from Royal, Amenia’s Rezala, fried rice from Mainland China, Crystal Chimney’s pepper fish, Chop suey, Manchurian, chilli chicken, friied prawn and the delicious crabs from China Town wafted in front of my eyes. Dr.Mandal broke into my reverie “Look, you are becoming unmindful again. This also has a medical reason.” “Oh No! No! “ I recovered myself.” I was  mentally making up a list of things to give up to make my life healthy.” Dr.Mandal laughed “Life will be more beautiful if you follow these rules. I have already emphasized that stroke is preventable as well as treatable through  Awareness ,Access and Action. For this necessary measures need to be adopted. We have brought out the Stroke Riskometer app in Bengali which will inform you about your Stroke Risks Factors(RFs) and the preventive strategies. Stroke happens when the blood supply to a part or parts of the brain is hampered. Brain cells are damaged and later die without proper blood supply to maintain the nutrition. Stroke symptoms depend upon the area of the brain affected and could range from paralysis of limbs, speech problems, even problems in thinking, memory and emotions. Seventeen million people are affected every year all over the world of which six million die. Twenty six million stroke survivors  live with disabilities  globally. Stroke may affect anyone and at any age. The Stroke Riskometer app has been developed for stroke awareness and prevention in over twelve languages all over the world including Bengali. This will cater to 5.6 billion people in 160 countries. This mobile technology will reach all the smart phone users in every nook and corner of the globe at a minimal or no cost at all. Millions will be able to participate in stroke awareness and prevention” explained Dr.Mandal. World Stroke day is observed on the 29th of October every year, primarily for spreading Awareness.Prevention and also Management

I was wondering ”Did Sridevi (an Actress,who died recently in her early fifty)  know about all these risks or did she choose to be ignorant?” Albeit, at the end of this day I have been enlightened through this friendly gossip with my neighbor. A spirit of awareness has been generated inside me. Truly, these hard facts had to be known. I am grateful for this interview. That such tète- à–tète bring out important messages for life to the readers need not be emphasized.

The cool spring morning was growing into a warm afternoon. It is time to go up to my flat, refresh myself under the shower and settle down to a sumptuous lunch. Will this be my last plate of rice and mutton? I am in two minds…

Let me have my fill today and then I will resolve to adopt the concept of stroke awareness and prevention.I made my mind to modify my lifestyle irrespective of clubs, parties, functions and other invitations.

Basanta Jagrata Dware( spring knocks at the door..) sang the famous bard,Rabindranath Tagore. The lyrics of the song”emono basanta dine( on one such fine spring morning..) filled my heart. Holi, the festival of colours was round the corner. As people splash each other with myriad colours in play, my life too needs to be painted with fresh colours. I press the button for the elevator.

 

 

**********************************************************************************************************************************************************************************************************************************

 

 

**********************************************************************************************************************************************************************************************************************************

Stroke, also called ” Brain Attack” is the commonest devastating disease of the brain. It is the leading cause of adult disability and second cause of death worldwide. It affects most people before 60 yrs of age in Indian population, when compared with western data.

The Global Burden of the Disease study (GBD) revealed that of the 9.4 million deaths in India, 619000 were from “stroke” and the DALY (Disability Adjusted Life Years) that were lost, almost accounted to 20.5 million.

 

Stroke Awareness Leaflet 2017
Stroke Awareness Leaflet 2017

Asians die more from stroke than coronary heart disease. It appears that high incidence of stroke in the east is due to increased incidence of hypertension -undiagnosed and /or inadequately treated. Risk factors of stroke include high blood pressure (Hypertension), smoking, high cholesterol and sugar(Diabetes) level in blood, heart disease – ischaemic or arrhythmia, obesity , lack of exercise, increasing age and genetic factors. Unhealthy lifestyle and food habits predispose to hypertension, diabetes, hyper-cholesterolaemia, obesity etc. which in turn precipitate stroke. High incidence of haemorrhagic stroke is directly related to high blood pressure (Hypertension), which is so common in our population..

Stroke results mainly from diseases of the arteries or blood vessels supplying the brain. A stroke occurs when such a blood vessel that carries oxygen and nutrients to the brain is blocked by a clot (Ishaemic stroke), or when it ruptures(Haemorrhagic Stroke) resulting in blood coming out of vessels in the brain tissue .

Warning Signs of Stroke (Symptoms)

Stroke symptoms may have different manifestations. Two stroke cases may present in absolutely dissimilar ways.
The manifestations may be as follows:

  • Sudden numbness or weakness of face, arm or leg or all, especially on one side of the body
  • Sudden development of trouble speaking or of comprehension.
  • Sudden change of mood, personality or behaviour
    Sudden loss of vision on one side.
  • Sudden vertigo, double vision, dizziness, lack of balance or coordination on walking
  • Sudden unexplained headache, vomiting and impairment of consciousness.

 

 

Stroke-awareness-Leaflet-2017

If these symptoms are seen in an individual, the patient should be shifted to a hospital, where stroke care facilities are available. It is to be remembered that “Time is Brain”, as millions of cell die each moment after stroke. Delay in initiation in management will adversely affect the outcome in terms of mortality and disability. So unnecessary delay should be avoided.
Stroke disability is frustrating to the victims, to the family members and the physicians.
Disabilities include paralysis of limbs, problems of locomotion, feeding, toileting, loss or impairment of speech, vision memory, ability to read or write(i.e Activity of daily leaving); there may also be disturbance of psychological and intellectual functions.

As the outcome of stroke is unpredictable in majority of cases, the emphasis is given mostly on its prevention ( Prevention is better than cure) and rehabilitation.

Though devastating, stroke can be prevented in more than 70% cases by controlling the risk factors especially high blood pressure.

Stroke is neglected because of extreme lack of awareness among the public, professionals and policy makers.

SUMMARY

  • Stroke or “Brain Attack” is devastating.
  • Stroke is the leading cause of adult disability.
  • Stroke is the second leading cause of death after heart attack worldwide.
  • Stroke is preventable easily in more than 70% of cases by the control of risk factors, most important of which is high Blood Pressure (Hypertension). Its prevention is better than cure.
  • Stroke is treatable in most cases, but patients must seek immediate medical care.
  • Post-stroke disability needs proper rehabilitation to bring the patient back to his normal life
  • All persons should be aware of the signs and symptoms of stroke.