Project to set up a Stroke Unit in the Sudan and to aid Diabetes Service
Stroke is a life-threatening serious medical condition that happens when the blood supply to part of the brain is cut off. In most cases, a stroke is caused by a blood clot blocking an artery in the brain. In many other
cases, it is caused by bleeding inside the brain. Stroke is a medical emergency and urgent treatment is essential. People with stroke should be
treated in a stroke unit.
A stroke unit is a special ward
inside a hospital devoted entirely to provide care for patients with stroke. It is staffed by many different people who receive special training to provide care for stroke patients. These members have a special knowledge and a special expertise and skills to provide the necessary and essential care for stroke patients. An effective stroke unit is staffed by:
1: Doctors who receive special training
2: Physiotherapists who receive special training
3: Speech therapists who receive special training
4: Dieticians who receive special training
5: Occupational therapists who receive special training.
5: Stroke nurses who receive special training
6: Ward nurses who receive special training to care for stroke patients on daily basis, 24 hours a day.
7: Social worker.
All these staff members are ABSOLUTELY ESSENTIAL. A stroke unit will not be able to do its job if anyone of these members is not present.
Additional staff which would be of great help include psychologists, IT specialists, and administrators.
As mentioned earlier, all these people need to receive special training
to be able to take care of stroke patients.
Occupational therapists are people who assess what the stroke victim can and cannot do for themselves. They assess things like ability to eat, to walk, to have a bath, to dress etc. If they can’t do any of these functions properly, they will advice what sort of help they need at home and what sort of equipment they need to help them. The social worker will help to provide the equipment needed at home.
What does the stroke unit do?
The work of the stroke unit is:-
1: To take care of the person when he/she is brought to the hospital with a stroke. This is known in medicine as the Acute Phase. At this stage they may be given a special treatment to break away the blood clot, if available and if appropriate. This is usually given by the doctor. At this point, the person is seen by the doctor and the stroke nurse.
2: The ward nurses will take care of the patient 24 hours a day to prevent bed ulcers, infections, and to deal with problems of passing urine. They also wash and clean the patient.
3: The speech therapists will find out whether the person is able to swallow his food and drinks. If not, then the person will have feeding through a special tube passed from the nose to the stomach, known as the nasogastric tube.
The speech therapist also finds out whether the patient is able to speak or not. If not, they will provide help in many different ways.
4: The dietitian will make sure that the person is having enough food and nutrition either through the mouth or through the nasogastric tube. The dietitian will tell what sort of food to be used and in what form. Sometimes, people with stroke need a specially manufactured liquid feed which is very costly. This looks like a drip which is given through the nasogastric tube.
5: The physiotherapist will find out whether the person is able to walk or to sit and stand on their own. If not, then the physiotherapist will help to a great extent. Some people will not be able to recover completely if the stroke is bad enough.
After passing through the acute phase which takes many days, the person with a stroke is transferred to another part of the stroke unit known as the Rehabilitation Unit. In this unit, the person receives prolonged physiotherapy to give them the maximum possible recovery. They will also be looked after by the dietitian, speech therapist, occupational therapists, nurses, doctors, etc.
6: All staff of the stroke unit meet every week to discuss the progress of the person and to draw a plan for the period ahead.
7: After the person is discharged and leaves the hospital, they will be followed up by the stroke team. At this point, volunteers and family members play a good role and they will all receive education by the stroke unit. If there are enough resources, a special team will be trained to look after people at their homes. This team is known as the community stroke team. In Britain, this team is funded and run by a voluntary organisation known the Stroke Association. This relies on donations from the public. The British government does not provide funding for this team.
8: People are seen in the clinic one month and six months after discharge. This is to check their progress and to take steps solve any problems in collaboration with the community stroke team.
9: The stroke unit also runs clinics to see people with very minor strokes very quickly. This helps to prevent big strokes. In these clinics, steps are taken to deal with the reasons for stroke like narrowing in the artery of the neck, high blood pressure, diabetes, smoking, high lipids (fats), etc.
Can the stroke unit be outside the hospital?
No. People with stroke can get complications like heart attacks, problems with heart beats, infections in the chest and water works, and many other problems. A lot of them do have diabetes. Therefore, they need help from other specialists and they need access to x-rays and blood and urine tests quickly. All these can only be provided in a hospital setting.
This is the proper stroke unit in the Western World. The benefit of the stroke unit is quite great. The number of people who die from stroke are reduced to a great extent (From 17 in each 100 patients down to 7 in each 100 patients ). A lot of people regain their independence and go back to work and feed their families.
What is the situation in the Sudan?
There are NO stroke units in the Sudan. People with stroke either die immediately or remain disabled for the rest of their lives. Most of these people are bread winners for their families. Family members struggle to make their living and also struggle to look after the person with stroke at home. Children will miss chances for education. The impact of stroke on families is very severe.
At SOBA University Hospital, Khartoum, they started to set up a stroke unit. Still there is no trained team to look after patients in this small unit.
What is our mission?
Our mission is:-
1: To train a full team to help run the service in the growing stroke unit in Soba hospital. The training will be done in two parts. The first part will include lectures given in the Sudan together with some practical bits. This will be done by stroke teams from UK visiting the Sudan.
The second part will involve bringing the team members to the UK for extensive practical training.
Training in the UK is very important as there is no experience with stroke in the Sudan. People will see how the stroke units work here and take the experience back home.
2:To train some people to become trainers themselves. They will then train other people there to help spreading the service.
3: To help setting up a second stroke unit in the capital and then to set up more units outside the capital. People from outside Khartoum could receive training in these two units and then go back to start the service in their cities. In this way, the service will spread gradually across the country.
What is needed?
Money is needed to achieve this mission. We need money:-
1: To pay for the teams from UK who visit the Sudan. We need to pay for their tickets and other costs of travel such as insurance. We also need to pay for hotels in Khartoum.
2: To pay for the team members who will be brought here for training. We need to pay for their accommodation costs and living expenses. We also need to pay for their travel expenses. Initially, we need to bring 8 individuals to be trained here. This is the minimum number. We could bring more if we have the financial facilities.
We can bring more and more people in the future if we have the financial ability to do this.
3: To pay for necessary equipment needed for training and needed for physiotherapy in the stroke unit.
4: To pay for the costs of the consumables. Consumables are things which can only be used once and there is continuous need for them. These include things like medicines, nasogastric tubes, nutritional fluid, and many other things.
All these things will require regular flow of money.
What have we done?
We have started the proceedings of setting up a charity by the name: Stroke And Diabetes Education and Aid Foundation (SADEAF).
There will be a separate section about Diabetes.
We have asked a Sudanese solicitor in Manchester to go on with registering the charity (Mr Ameer Obeid).
We have opened a bank account by the name of the charity. The details of the account will be found in another part of this website.
We have talked to a lot of Sudanese people in the UK and they are happy to support the charity. However, we need to reach the maximum number of people in the UK and therefore we are putting this statement in the website to be read by all people.
We have also talked to some people in the Sudan who are happy to be involved in this project and will establish a branch of the charity in the Sudan.
We have spoken to Sudanese people in the Gulf States, Australia, America, Canada, and other European countries. They are all happy to support the project by participating in buying equipment and consumables.
Through internet search, we have identified an English stroke consultant who visited Soba hospital in the past and provided some training there. Her name is Dr Frances Harrington from the Royal Cornwall Hospital in Truro, south west of England. We talked to her and we are now in regular contact with her and probably she will return to the Sudan for another visit next year if funds are available.
Dr Indira Natarajan, the chief stroke consultant at North Staffordshire University Hospital, Stoke-0n-Trent, agreed to help us on behalf of his unit. They will help to train people in their hospital. This is a huge teaching hospital with a lot of expertise and experience. Training in a hospital like this will be very fruitful.
There are many Sudanese stroke consultants working in the UK and they are happy to help both financially and with their skills.
This charity does not and will not have any political association, affiliation, or motivation in its scope, activities, or funding that undermines its impartiality or independence.
What do we want from you?
We want you to support the charity with regular small monthly donations.
We have put a standing order in this website. We have provided four options:
Option 1: To pay £3.00 (Three pounds every month)
Option 2: To pay £5.00 (Five pounds) every month
Option 3: To pay £10.00 (Ten pounds) every month.
Option 4: Other:
This option will give people a chance to pay any other amount which could be anything more than 10 pounds or less than 10 pounds. For example, £4, £6, £8, £12, £17, £100, etc.
We urge all people to contribute to this important and badly needed project. Every contribution will help, no matter how little it is. We have put different options to suit the circumstances of all people. We have also put an open option for people wanting to contribute any amount.
People can pay using this standing order and then taking it to their respective bank or posting it to us to the address provided at the top of the standing order.
People can also set standing orders by internet banking. In this case they need to notify us and tell us their name and email address and postal address and mobile number. This is important for our records and accounts and to comply with the rules of anti-money laundering and anti-terrorist financing.
We appeal to people from all walks of life to contribute to this mission. This is not for doctors or healthcare workers only, but for all people living in the UK.
If this project succeeds, we can make a very huge difference to the lives of a lot of people in the Sudan.
This is the first service of its kind in the Sudan and the fourth in Sub-Saharan Africa.
Imagine if this mission ended up in 100 stroke units after 20 or 30 years. You will get reward (Ajur) for all patients treated in all these units forever. This will make an excellent continuous charity ‘Sadaqa Jariah’, no matter how little you pay.
Some people may argue that the training should be provided by the government in the first place. This is absolutely true. However, people should be realistic and pragmatic. The third world countries are poor countries. The budget for health services is very limited. This limited budget is used to fight diseases like malaria, diarrhoea, kalazar , and many other infectious diseases. In Ethiopia, Nigeria, and Ghana, they are setting up stroke units the same way we are doing now and they are not relying on government support. Nevertheless, the exit strategy for this unit is to bring it into the mainstream health service provided by public sector in Sudan when favourable conditions prevail. Thereafter, we will concentrate in setting up more units at other parts of the Sudan as well as prevention, education, training, and community stroke and diabetes services.
If we start this project on our own, then we will be able to find help from the ministry of international development in Britain and perhaps other European countries. They only help people who help themselves. They don’t provide help for governments. They only provide help directly for charities. They don’t provide help for any charity unless the charity is registered in the UK and in the Sudan and did some work in the Sudan for at least one year.
So, if we start our project and build it up successfully, we will be able to get more help from other sources in the future. We need to help ourselves first before anybody else could help us.
TRAINING IS VERY IMPORTANT. Both stroke and diabetes need very specialised care. People cannot provide this care if they are not trained on how to do it. We cannot ask anybody to drive a car if he/she is not taught or trained how to drive a car.
Will patients in the Sudan be charged for this service?
The intention of this charity is to provide service free of charge at the point of need to all service users. However, the charity will accept any voluntary unconditional financial donations from service users, if they wish to do so.
Will people leave the unit to work elsewhere after training?
We are aware of this risk.
We will choose people very carefully in the first place.
We will get them to sign a legally binding contract to work for the unit after training.
We have got robust plans to keep people working in the unit for at least five years. During these five years, they will provide the service and train other people.
This is about stroke. Next session will be about diabetes which is also a big and common problem in the Sudan.
Diabetes is very common in the Sudan. It affects children and adults. Diabetes has got many complications which stay with people for the rest of their lives. These complications happen gradually over a long period of time. They mainly affect the nerves and the arteries of the body. They can affect big arteries taking blood to the brain, heart, or legs. They can also affect very tiny little arteries in the back of the eyes and in the kidneys. People end up with blindness, kidney failure, loss of legs, foot ulcers, heart attacks, and strokes. Heart attacks and strokes can result in sudden death. Other complications keep on progressing till the person dies. Diabetes is known as the silent killer.
All these complications happen gradually over time and keep progressing till the person ends up with a disaster like a stroke, kidney failure, or blindness or foot ulcers or loss of a leg.
To avoid the end results of these complications, there are two very important steps which should be taken:
This means taking actions to prevent these complications in the first place. This is done by making sure that the sugars are under good control, the Blood Pressure is under good control, and the cholesterol is under good control. It is also important to avoid smoking, alcohol, junk food etc. Regular exercise and keeping healthy body weight are important as well.
Prevention requires people with diabetes to gain good knowledge about the disease and how to deal with it. They need to know what to do to keep the sugars under good control and they need to know how to do it. They need to know why it is important to stop smoking and alcohol. They need to know why it is important to have healthy food. They need to know why it is important to have regular exercise. They need to know why it is important to have healthy weight. They need to know what a healthy weight is and how to achieve it. They need to know why and how they should look after their feet in order to prevent losing their legs.
To achieve prevention, people with diabetes need regular and continuous Health Education.
2: EARLY DETECTION:-
These complications do not cause any pain or fever or any symptoms to make the person aware of them at the very early stages.
Early Detection means finding out about these complications at a very early stage. At these early stages, it will be possible to stop these complications from going on any further. Therefore, it will be possible to save loads of people from blindness, from having heart attacks and strokes, from losing their kidneys or losing their legs. This is done by regular examination of the feet, eyes, and kidneys. There is also need to measure the sugars and cholesterol in the blood and checking the blood pressure.
Examination of the eyes will require taking photographs of the back of the eyes by a special camera connected to a computer with a special software. Examination of the kidneys will require a special test done in the urine as well as a blood test. Examination of the feet is done by a specially trained person known as the Podiatrist.
Early detection will require cooperation and commitment from people with diabetes to come to the centres and hospitals to have all these tests done for them. People need to know why these tests are important and need to know what benefits they will get from these tests. Again this requires regular and continuous Health Education.
Health Education is the cornerstone of diabetes management. Diabetes is a complex disease and people need to live with it day by day and hour by hour. They need to know everything about all things mentioned above. This is in order to live a normal life free of complications from diabetes. There are specially trained people who provide education for people with diabetes. These are known as Diabetes Educators.
Ideally, people with diabetes should be looked after in the Diabetes Centre.
What is a Diabetes Centre?
A Diabetes Centre is a special place inside a hospital dedicated for people with diabetes. The staff members of this centre are specially trained to look after people with diabetes. These are known as the Diabetes Team. Members of the diabetes team are:
1: The diabetes consultant who receives training for years to become a diabetes consultant
2: The diabetes educator. This person again receives special training. The role of the diabetes educator is mentioned above.
2: The diabetes specialist nurse. This is a qualified nurse who receives a special training about diabetes. The diabetes specialist nurse teaches people with diabetes how to inject themselves and how to keep insulin safe and how to change the dose of the insulin.
3: The dietitian again specially trained about diabetes, advises about healthy eating and what foods to avoid.
4: The podiatrist who examines the feet regularly and also looks after foot ulcers till they heal completely. Also makes arrangements for special shoes to prevent foot ulcers and to help healing of foot ulcers.
5: The person with diabetes is at the centre of the team.
There is also a need for help from laboratory people, eye specialists, and surgeons who are specialised in surgery for blood vessels.
What is the situation in the Sudan:-
There are many diabetes consultants in the Sudan. The Sudanese Diabetes Association is doing excellent work to help people with diabetes .There is ongoing training for doctors and there are some diabetes educators as well as podiatrists and dietitians. Most recently, they opened a big diabetes centre in Omdurman known as Abdulla Khalil Diabetes Centre (Abdulla Khalil was the prime minister of the Sudan till November 1958 ).
There is ongoing training for doctors working in the health centres throughout the Capital of the country.
With all the excellent work done, there is still a long way to go as diabetes is very demanding and we can do a lot from here to support the Sudanese Diabetes Association. Diabetes is on the increase day by day and the service is very complex and very demanding and under considerable pressure.
What is needed?
We will be guided by the Sudanese Diabetes Association. They will tell us what they want us to do. We have already contacted them and they are very pleased to see us wanting to support diabetes service in the Sudan.
From here, we can do things like:
1: Buying cameras to photograph the eyes. This will help to detect some problems at the early stages and treat them to prevent blindness. These cameras are very expensive. One camera may cost £10,000 to £14,000. There is a need to train people how to use the cameras and to train doctors how to read the photographs. This training will cost money. All these costs will make a very heavy burden on the Sudanese Diabetes Association. There will be a need for many cameras and a need to train around 10 to 15 people. It is very difficult, if not impossible, for the Sudanese Diabetes Association to afford these costs which could reach tens of thousands of Sterling pounds. SADEAF could help with all that.
2: Buying equipment to help looking after the feet of people with diabetes. These will include specially designed tables, specially designed shoes, machines to check the arteries of the legs, and other equipment needed for examining the feet. All these are expensive and not available in the Sudan. They will end up in preventing amputations and people losing their legs.
3: Buying wheelchairs and special sticks and crutches and zimmer frames to help people to walk and move around if they lose their legs.
4: Helping with training more educators, podiatrists, dietitians, and diabetes nurses. The numbers present now are not enough and there is a need for much more. Training is costly and SADEAF could help with that.
5: If practically possible, SADEAF could buy insulin supplies and send them to the Sudan to be given to patients free of charge. We have already contacted some establishments in the UK about insulin. They are reluctant to help with this because of complex issues related to transport, chain of supply, and probably some commercial interests. However, we are working around all these issues and it will take some time before they are resolved one by one
6: Help establishing diabetes centres outside Khartoum, especially in peripheral cities in the east, west, north, and south. Help will include buying equipment as above as well as providing training of local staff.
These are just examples. However, we will do whatever the Sudanese Diabetes Association asks us to do.
All the above will cost considerable amounts of money and all these services will be ongoing and therefore there is a need for regular flow of money.
What do we need from you?
The same as with stroke. We need regular standing orders or direct debits. We have already mentioned the amounts needed from individuals in the section under Stroke.
We are asking for small donations from individuals. If thousands of people make these small donations, then they will add up to thousands of pounds. People are welcome to make larger donations if they are willing to.
What is very important is that the donations are to be in the form of regular monthly standing orders. This will help us to plan ahead for the future.
The same bank account will be used to support stroke and diabetes. The standing order mandate will be the same.
We will put our monthly income and expenditure in the website each month.
We will keep good accounting books. We have already identified two persons with accounting backgrounds and experience. Both agreed to help us to keep the accounting books.
Every donor to SADEAF is welcome to look at the accounting books if they want to.
We have already talked to a certified chartered accountant in Manchester and he kindly agreed to do our yearly accounts and submit them to the charity commission. His name is Mr Farouque Sayed, owner of the accounting firm Sayed & Co. Accountants in Rusholme, Manchester.
These accounts will be uploaded in the website for all donors to look at.
Due to money laundering and anti-terrorist finance issues, we cannot accept any donations from outside the UK.
It might happen that some people may want to make big donations. The donations will only be accepted if they are not too large. This will be discussed with individuals IF they are willing to make big donations.
All these precautions are in line with the policies of the monetary authorities in the UK.
All activities of the charity whether in the UK or in the Sudan will either be photographed or filmed and then downloaded to this website to keep everyone up to date.
We have already contacted many organisations and institutions in the UK who could potentially help us. Some of them supply medicines and drugs at a discounted price. Others supply equipment at a discounted price. On top of these prices, there are costs of shipping and storage etc.
We aim to spread the services gradually all over the country. We will incur costs for training, medicines, and equipment. All these costs will be ongoing.
We need to build long term relationships with organisations and institutions which could help us. Therefore, we need to make plans in advance for few years ahead. This implies the importance of having regular flow of money. We appeal to all of you to make regular donations through standing orders. Anything you pay will have a great impact on patients in the Sudan, no matter how little it is.
This is an ambitious long term project which will never succeed without God’s will and then your support. So, please donate and encourage others to donate.
It is not impossible to do this project. Each one person of us will be paying little amount of money. If a lot of people make these payments, then we can collect good amounts of money and we can easily achieve our goals Inshaa Allah.