International focus: mutual benefits out of Africa

Cath Sackley, professor of rehabilitation and head of physiotherapy at King’s College London, is leading a new £2million National Institute for Health Research (NIHR) programme for stroke patients in Sierra Leone, West Africa. The development marks the first time in the UK that a major global health grant is being led by a physiotherapist as part of a multidisciplinary team.

The three-year programme aims to establish NHS-style stroke care in a country where there is currently no specialist rehabilitation provision of this sort. It is part of the NIHR’s Global Health Research programme, which was launched in 2016 to apply the UK’s research expertise to addressing health issues affecting the poorest countries through international aid funding. 

According to the World Health Organisation (WHO), stroke is now one of the leading causes of death and disability in Africa, responsible for an estimated 451,000 fatalities a year.  Sierra Leone is the 8th worst affected country in the world, and, with a population of nearly seven million people, there is currently no dedicated stroke unit and very limited physiotherapy capacity. ‘There are only six qualified physios in the entire country’ says Professor Sackley, a senior NIHR investigator,who has recently returned from her first fieldtrip. 

It made sense to focus on Sierra Leone as KCL is already in partnership with the country’s main hospital, The Connaught, where it deploys specialist-trained volunteers. At the same time, the country’s first BSc physiotherapy programme is about to launch, with funding from Norway. 

The first step of the programme will be to identify the main causes of stroke locally to inform improvements to the healthcare system. 

‘Currently, the physio department at the Connaught has two qualified physios and nurses who help with rehab. But few people can afford to get to the hospital and pay for care and they don’t have stroke beds so it’s going to be hard,’ she says.

It is estimated that 1,000 stroke patients are admitted every year to the two largest hospitals in the capital, Freetown. The reasons why people have strokes vary regionally and between different ethnic groups. ‘We know there is a genetic predisposition, along with lifestyle risks, including high diabetes rates, unmanaged high blood pressure and smoking’, says Prof Sackley. 

‘The average stroke age is also much younger than in the UK, so it can hit the breadwinner and the consequences are more devastating for the whole family.’ She has also learned that rehab may be delayed because of a belief among some people that stroke is a spiritual affliction and they might see a traditional healer first.

The KCL team in conjunction with the University of Sierra Leone, will develop a a blanket referall route, and  a register to record stroke patients as they come into the hospital akin to the Stroke Audit in the UK, so care can be monitored long-term.

‘At the moment we don’t know what happens with stroke in Sierra Leone. People who can afford it come to hospital, and nobody has ever followed them up in the community,’ she says. ‘Physiotherapists are dependent on referral and there’s currently a lack of a process, which is a problem.’ 

Interestingly of the few who do return to hospital for outpatient care, its been noted that they are more likely to opt for physiotherapy than pills. ‘I think they see more in it, because they feel like they are doing something,’ says Prof Sackley.

Two physios from KCL have begun training Sierra Leonian physios and nurses, as part of a team of seven in-country project members and are supported by two volunteer physios working on the programme in the UK. 

‘I’ve met with the physios from all over the country and they are very excited. They all want to learn and will be using outcome measures, so I’m very hopeful we’ll be able to deliver,’ adds Prof Sackley. The programme will start at the Connaught, and as the team follow people out they are hoping to start including other centres.

‘By the end of the programme the idea is to have developed a system whereby stroke patients are managed optimally. So, they move from A&E to a dedicated stroke unit. This will serve as a hub for stroke care and education,’ she explains. 

‘We’ll also know more about stroke care in Sierra Leone which will help with prevention and secondary prevention,’

There will also be the mutual benefit of training places for KCL’s physio students. ‘I think the placements will be really useful for developing leadership, education and influencing skills,’ says Prof Sackley.

She hopes the programme will create further opportunities. ‘NIHR is very keen for research to be led by the professions it affects. If programmes like this are successful there will be more funding,’ says Prof Sackley. In 2008 she was ranked as one of the top 100 researchers in the UK across the board. ‘I’ve been championing physiotherapy research for 35 years. It’s really important we have a seat at the table so we can influence what’s funded,’ she says.

Prof Sackley’s eminent career is to be recognised with a CSP honorary fellowship at Physiotherapy UK this week. ‘It’s a real honour,’ she adds. 

More information

The KCL Sierra Leone team is currently recruiting members. For details contact: catherine. sackley@kcl. ac.uk

Author : Louise Hunt