Cerebrovascular diseases, debate on their treatment

2023-08-15 19:51:09, Shëndeti CNA

In Albania, the treatment of cerebrovascular diseases has received special attention for experts, since they are among the main causes of death.

According to experts in the field, today there is a debate on the protocols followed for the treatment of cerebrovascular diseases in the public health system.

The lack of modern services, through non-surgical procedures, which have recently been offered for several years, raises many questions according to experts.

Some doctors with whom the Voice of America spoke said that the reason for their interruption is related to the lack of consumables. This has caused these procedures to be performed only in the private health system, with high costs for citizens.

In Albania, the debates on the deficiencies in the public health service took on a new dimension after the public call for a financial aid of 20 thousand euros from the family of the actor and director Genc Fuga, in order for him to be cured in a private hospital in Tirana after a stroke ischemic in the brain.

The speed of intervention for the treatment of cerebrovascular diseases is critical to save the patient's life. Mr. Fuga needed a thrombectomy. This service has been offered in the public system for several years, but is currently discontinued.

In the state structures, this disease is treated with the thrombolysis procedure, for the melting of thrombi, but that does not have the same degree of success, according to experts in the field.

The number of deaths from cerebrovascular disease, according to the Institute for Health Measurement of the Burden of Disease, a prestigious American agency, has doubled compared to three decades ago.

The growth trend has continued in the last ten years, and for 2019 this institute estimates approximately 5,600 deaths. The program of the Ministry of Health for the prevention of non-communicable diseases also refers to this trend.

However, according to the same institute, the age-standardized mortality in the last decade is decreasing (an indicator that avoids the deaths of the elderly population and refers only to the 30-69 age group).

The data for this age group are also confirmed by ISHP. But another PIH data, which for experts proves one of the most serious public health problems is related to hospitalizations from cerebrovascular diseases. Since 2015, they have increased by nearly 30%, reaching around 8 thousand cases per year.

According to them, these are important data for the attention that should be paid to the treatment of cerebrovascular diseases in the public health system, since they are not isolated cases.

Deputy The Dean of the Faculty of Medicine, Ilir Alimehmeti, told the Voice of America that the lack of life-saving intervention through thrombectomy treatment in the public hospital raises big questions, when it was offered a few years ago.

"It is unimaginable how the public health system, the Ministry of Health and the Albanian Government have so neglected this situation. It is unimaginable how the Albanian population can be left without a treatment, which was carried out before and today is carried out only in the private health system. Those people who need this intervention are not only under the pressure of the disease, but also of time because it must be performed as soon as possible and they must ensure such high numbers that the vast majority of the Albanian population can hardly find them within a few hours" - Ilir Alimehmeti, Vice President, told the Voice of America. Dean of the Faculty of Medicine at UMT.

Journalist Carlo Bollino expressed concern that citizens do not have the opportunity to make voluntary choices in the case of the thrombectomy procedure, as it is offered only at the American hospital in Tirana, a private institution. Mr. Bollino says that if the state is unable to provide this service in public facilities, then it should reimburse the patient's costs.

"A citizen was forced to go to private structures and what was even more scandalous, there was no support from the state, despite the fact that after the media noise, the government decided an amount of 2 million lek for him to cover the costs. In many other cases, people have paid out of pocket, taken loans from banks to afford a life-saving intervention because public structures do not offer it. In this particular case, the scandal was of clear proportions" - said Carlo Bollino, Report TV, for the Voice of America.

The Voice of America spoke with doctors of the neurosurgery service at QSUT, to learn about the reasons for discontinuing modern interventions for cerebrovascular diseases, which have a higher success rate.

The neurosurgeon, Mentor Petrela, leader for 3 decades in this service, said that the multi-year efforts to establish the STROKE and endovascular service were finalized in 2008, with the support of USAID and some of his doctor friends from France and Switzerland, making it possible, that through financial aid these procedures would continue for some time.

After their interruption, these interventions have not been carried out for 6 years. Mr. Petrela highlights as an important achievement the STROKE service that performs thrombolysis (a venous treatment that dissolves thrombi formed in blood vessels in the brain, and is used for ischemic strokes) at QSUT since 2015, but as he says, this is not enough .

While the interventional neuroradiologist invested alongside Mr. Petrela, in these treatments, in the public and private health system, (as the engagement of doctors in the private system is not prohibited by law) Arben Rroji explains to the Voice of America that the cessation of interventions without surgery for cerebrovascular diseases, it is related to the lack of means of consumption.

"The first procedures for these diseases, such as embolization of aneurysms and some others, were performed around 2010, while thrombectomy (intervention without surgery for the treatment of strokes) 4 years later, under the consultation of foreign doctors with donated materials and a monoplane investment apparatus of QSUT after the insistence of Professor Mentor" - says Mr. Rroji.

"These treatments, although few in number, continued with materials bought by the patients themselves, despite requests to the QSUT, to be equipped with them," he clarified.

Both Mr. Petrela, who has been practicing his profession for a year only in a private hospital, and Mr. Rroji underline the occasional requests to official authorities to finance such life-saving services in the treatment of cerebrovascular diseases.

"Currently, we are required to perform these procedures without meeting the minimum conditions for their performance" - explains doctor Arben Rroji, - "as would a biplane apparatus" (imaging equipment used during interventions without surgery) that reduces the dose of radiation. The device that was used for these procedures earlier was called a monoplane, and as Dr. Rroji says, it has high radiation, dangerous for the lives of the doctors and the patient.

Neurosurgeon Mentor Petrela argues for the Voice of America that medical costs are constantly increasing, and that this is not a problem of doctors but of policy makers.

Doctors in the neurosurgery service say that the number of patients who appear in state structures and need treatment through the thrombectomy method is estimated at about 30 per month at a cost of 300,000 euros, i.e. about 50% less than in private health structures. And yet they say that the procedure called thrombectomy is a modern method that even in developed countries is consolidating in these last 10 years and that the whole population does not benefit from it.

But one of the main obstacles in Albania for performing procedures without surgery in the treatment of cerebrovascular diseases, which have a higher success rate, including thrombectomy, is the insufficient number of specialized doctors for them.

In response to the request of the Voice of America, on efforts to increase services to citizens affected by cerebrovascular diseases, QSUT admits the lack of the thrombectomy procedure, but does not explain why it has been discontinued for 6 years, while listing several initiatives, among their establishment of the first center for the treatment of cerebral vascular accidents (thrombolysis) at QSUT in 2016, their recent expansion in the cities of Fier, Korçë and Shkodër, investment in diagnostic imaging devices, 3Tesla resonance, angioscanners, angiographs and arteriography ( DSA) for cases when it is needed, located in Fier Memorial Hospital.

The QSUT authorities clarify that for the addition of new emergency treatments, including thrombectomy, they are proceeding with a clear plan to continue with its performance in the near future.

The treatment of cerebrovascular diseases takes on special importance since the chances that the patient will remain disabled are great. Lawyer Adriatik Lapaj, who has pursued cases of not receiving timely or incorrect treatment in court, told the Voice of America that the lack of investment in state structures for these diseases translates into costs for the entire society.

"A part of these diseases leave you disabled, and our society then has the cost of paying for the disability and care. The injured person is a missing force in the labor market that would bring income to the state, pay insurance, taxes and duties. And in that sense who is the big loser here? The first is the one who remains disabled and his family and then the society" - argued Adriatik Lapaj, lawyer.

In order to minimize these consequences, doctor Ilir Alimehmeti highlights the importance of adding services to the state health care for cerebrovascular diseases.

"It's time to move forward to see what's happening in contemporary streets. This disease will hit us, it will hit our family members, it is not a rare thing, it happens every day and it does not spare anyone. We must have a public health system that knows how to cope with this situation and offers these services to every Albanian citizen" - continued Ilir Alimehmeti, Deputy. Dean of the Faculty of Medicine.

For his part, journalist Carlo Bollino says that the public health sector needs reform and a clear model.

"The public health system needs reform and a clear model. It will be a system based on private insurance or like the one that some European countries have, including Italy, where the intervention of the state is strong. Albania is in the middle, officially it has a system like Italy, free healthcare, but concretely people are forced to pay out of pocket, because the private insurance system is not widespread. The main responsibility rests with the state, which must make clear what it offers and what it doesn't" - continued Carlo Bollino, Report TV.

According to experts, the missing services, and those that are not provided in time, in the public hospital service have caused the private hospital structures in the capital to increase significantly in an abnormal way in the last decade, from one to about 10 such.

Despite the improvements, the public health system in these 30 years has walked a difficult path, accompanied by many diseases, which according to experts in the field are related to insufficient investments, with the lack of appropriate strategies that go hand in hand with science and treatments contemporary, with the incompetence of its leading elites, corruption or, in many cases, with clientelistic ties between politics and non-public health services./ VOA