Table 3 The current model tackled gaps and their solution within Matrouh and how common is it within other LMICs
The gap | The solution | Commonality |
|---|---|---|
Seasonal summer migration | - Reallocating trainees/neurologists during the summer months | Some LMICs have population densities in some regions with few doctors and hospitals [12, 13] |
Rising population density | - Increasing the number of hospitals, - Improving hospitals’ status to be turned into essential stroke service providers and later on into advanced ones | Population density is on the rise along different LMICs |
Absence of official data about stroke estimates | - Obtaining the closest data based on demographics - Activating database systems | Some LMICs might still not provide official data |
Shortage of trained physicians on stroke | - Improving salary and working conditions to retain specialists more generally - Reallocating trainees/neurologists during summer—to help deliver the service at the beginning and also to offer training to local staff - Improve Stroke knowledge of the teams that work on the ground and training them on the different major stroke scales | |
Absence of stroke units | - Turning the closest infrastructural equipped hospitals into hospitals with stroke units taking into consideration the population density they are to serve so as to properly calculate needed beds based on turned bed cycle and estimated stroke cases | Stroke units are not common in many LMICs with many countries dealing with stroke in general hospitals [20] |
Presence of ambulance services yet, the absence of code stroke | - Training EMS on proper assessment and identification of stroke signs within patients through the use of common pre-hospital stroke scales | Many LMICs have no properly designed approach to deal with stroke including code stroke [20] |
Unavailability of thrombolysis | - Thrombolysis is endorsed in Egypt yet not equally distributed throughout the entire country - Delivering thrombolytics to assigned hospitals | Many LMICs still do not have thrombolytics [20] |
Making use of telestroke | - Telestroke is present in a single center in Egypt—Ain Shams University Hospital and its virtual hospital - Improving communication infrastructures will make telestroke accessible | Many LMICs are deficient in telestroke [20] |
Absence of proper stroke awareness | - Translating the Angels Heroes initiative to Egyptian Arabic and delivering its materials to school children | Awareness of stroke is still low in many countries worldwide [20] |
Absence of stroke database | - SITS and RESQ are already used in different Egyptian stroke units – training local staff to apply them within targeted hospitals of Matrouh | Many LMICs do not have stroke database monitoring [20] |