On Saturday morning 10 декабря 2022, Sister Lindiwe mhakamuni Nyambi was making her way to Sandton, the city within a city that is known as Africa’s richest square mile. Her destination, the Sandton Convention Centre right next door to Nelson Mandela Square which, with its six-metre-tall bronze statue of the country’s first democratic president, is also the most fashionable destination in Johannesburg.
But Sr Lindiwe wasn’t going shopping. She was joining over 100 doctors and nurses from across South Africa for a two-day conference about stroke. She’d been one of the first to declare, ‘I am going,’ when an invitation to Angels Day reached Life Wilgeheuwel Hospital, a private hospital serving an ageing population in Roodepoort on Johannesburg’s West Rand.
Also headed for Sandton was her colleague in the emergency department, Sr Christine Zikalala. Besides working together, these nurses have something else in common. Christine’s grandfather had a stroke at 72 and was only discovered the following day. When Lindiwe was in high school her stepfather had a stroke and died one month after being discharged from hospital. That they had both lost a loved one to stroke was part of the reason they were on this Saturday morning mission.
Also on his way to Sandton was Dr Frederik (Ricko) Rossouw, an Emergency Medicine doctor at Life Wilgeheuwel Hospital. The hospital team were looking forward to masterclasses on optimising the stroke pathway and decision-making in acute stroke. After the coffee break the group would split and while Dr Ricko attended a masterclass in imaging in acute stroke, Christine and Lindiwe would participate in a workshop on acute and post-acute nursing care.
Sunday’s speakers included Dr Louis Kroon from Steve Biko Academic Hospital, the first in South Africa to win a WSO Angels diamond award, and Dr De Vries Basson of Karl Bremer Hospital, another state facility that provides exemplary stroke care to a high-risk population.
Fanatical about growing and learning
The weekend prompted a review of Life Wilgeheuwel Hospital’s stroke patient journey. A key area was the recording of valuable stroke data. As a result of the hospital capturing their patient data in the stroke care improvement registry RES-Q they won two consecutive WSO Angels Awards.
She was ecstatic, says Sr Judy Naidoo who, as Life Wilgeheuwel Hospital’s emergency department unit manager, provides thoughtful leadership to the emergency unit nursing team. She subscribes to a transformational leadership style derived from Canadian writer Robin S Sharma’s view of leadership being about connection and influence.. “I believe in team empowerment. The more my team is empowered, the more engaged they are, which makes reaching goals attainable.”
Srs Lindiwe and Christine had been selected to attend Angels Day because they were “fanatical about growing and learning”, but also because experiencing the impact of stroke at first hand deepens one’s understanding, Sr Judy believes. She lost both her grandfathers when she was too young to know them, but a close family member took their place – a “positive, happy, vibrant and active person” who then also lost his independence following a stroke. Despite his disability, his life continued to be an inspiration, and his legacy helps power her drive to prevent the devastating consequences of stroke through teaching, training and empowerment.
We knew what to do to improve
Dr Michael Waldeck, Head of Life Wilgeheuwel Hospital’s Emergency Unit starts every day with a prayer for his staff and patients. Deeply committed to offering the best possible care and delivering the best possible outcomes for his patients, he joined Life Wilgeheuwel Hospital in March 2019, and Dr Ricko joined three months later. It’s no coincidence that that was also the year they started introducing the Angel’s protocols in the treatment of acute stroke patients, caring for their stroke patients as conscientiously as for all the others, and welcoming the support of the Angels Initiative as kindred spirits who shared their desire to make a positive difference in people’s lives.
After Angels Day, however, a new story unfolded for stroke care at this hospital.
“Angels Day was phenomenal for me,” says Dr Ricko whose interest in stroke, that like of his nursing colleagues, is personal. He was just four years old when his paternal grandmother was left bedridden by a severe stroke but by the time she died five years later, he was old enough to recognise the impact on his father and uncle.
He says, “It is great that we can give someone their life back, so they have more time to spend with their family, the opportunity to be productive members of society. That’s what drives me and the rest of the team.
“After hearing the success stories from Steve Biko and Karl Bremer, I felt inspired. I thought, if they could do this, then so could we. We knew what we had to do.”
Embracing the idea that you cannot improve what you do not measure, his first step was to capture stroke patient data from the previous month. Once they knew where they were, they could reach for where they wanted to be.
“The data meant I could make it tangible for the doctors and nurses,” Dr Ricko says. “Rather than say we must improve, I could give them targets and measurable outcomes based on actual data. I could also take the data to Radiology and explain that to get our numbers down we had to work with a sense of urgency when moving patients between imaging and the emergency unit.”
A sense of urgency also affected two new stroke champions whom the conference had empowered and motivated. “I learnt I had to be the stroke champion in the Emergency Unit and ensure the stroke pathway is maintained,” Sr Christine says. As well as monitoring, recording and responding to patients’ clinical needs, nurses are the alarm for the stroke code, responsible for sending alerts all the way down the pathway – from Neurology to Radiology and the lab.
Training their nursing colleagues is part of the brief, so when a stroke patient arrives, everyone, whether in emergency or in triage, knows what to do and how to follow the stroke protocols. When Sr Lindiwe went home that Christmas, she took her training mandate with her. In rural Limpopo province where her mother and grandmother live, ambulances can take hours to arrive if they arrive at all. “I told them, if you see symptoms of stroke, don’t wait for the ambulance to get you to hospital, take the car.”
Secret weapon in the admin department
Proud as they are of their recent achievements, a gold award doesn’t quite reflect the Life Wilgeheuvel Hospital team’s ambitions. At their last multidisciplinary team meeting, they set aside time to study the criteria for platinum and diamond status and devise a plan to get there. Dr Waldeck says, “As a team we have set ourselves a goal. We are pleased to have won gold, but we’ve not yet reached the summit.” Their plan includes treating more patients at CT, expediting transfer to a comprehensive centre for thrombectomy, and raising public awareness so more patients arrive within the treatment window.
The team is bolstered by the intense commitment of neurologist Dr Comfort Shaba, and recent recruit Dr Zahraa Khotu who declares herself “on board with the Angels stroke programme”. She singles out Dr Ricko’s “passion and motivation” as the drivers behind the team’s success. “He is phenomenally active and productive,” she says. After six years in emergency medicine, Dr Khotu is familiar with the devastation of stroke and its disruptive impact on families. She says, “It may be our hundredth stroke, but for the patient and their family it’s the first.”
There is finally also their secret weapon in the administrative department, Tina Cilliers, whose meticulous record-keeping is vital for data capture.
“Administration and record-keeping can really play a role to improve the system,” she says. “Its importance is often overlooked but it is a vital foundation of any business..”
Keeping track of information becomes even more crucial if your “business” is preserving life.
