Address by SPS at the Opening Ceremony of the 10th Singapore Stroke Conference

01 Nov 2008

By Hawazi Daipi

Dr Lee Sze Haur, Dr Sherry Young

Co-Chairpersons,

10th Singapore Stroke Conference Organising Committee

Ladies and Gentlemen, Distinguished Guests

1. I am delighted to be here this afternoon for the opening of the 10th Singapore Stroke Conference, co-organised by the National Neuroscience Institute and Changi General Hospital. 

Stroke - a major cause of morbidity and mortality

2. Singapore has developed rapidly over the past 40 years. In tandem with economic development, the patterns of disease have changed from predominantly communicable diseases to non-infectious diseases. We see much less infectious diarrhoea and malnutrition, but more of the diseases that are prevalent in developed nations. Among these diseases is stroke.

3. Stroke is a major cause of death and disability in Singapore and other parts of the world. In Singapore, it is the fourth most common cause of death and the third leading cause of burden of disease, accounting for 7% of all Disability Adjusted Life Years (DALYs) lost nationally.   Our population is ageing rapidly due to an increase in life expectancy combined with a declining birth-rate.  With the aging of our population, the number of Singaporeans suffering a stroke is projected to rise.

4. The cost of stroke is tremendous.  Major strokes require long hospital stay for treatment of the disease and its complications, as well as rehabilitation. Costs will continue after hospital discharge.  Patients may need medication and rehabilitation, nursing care, and home assist devices such as wheelchairs.  About 10 to 15% die in the first year after stroke. Only a minority of stroke survivors are able to recover fully and return to their previous level of independent functioning. And even that may take many months.

Preventing stroke

5. It has always been said that “an ounce of prevention is worth more than a pound of cure”. We can spend vast amounts of money managing a disease, with expensive investigations, medications and surgical procedures. For stroke, these treatments do not always produce a cure, but can reduce complications, delay a second stroke or heart attack, and improve quality of life and independence. The brain, however, is almost never the same after a stroke.

6. Therefore, we need to look at ways of preventing stroke.  The many factors that can increase the risks of a stroke are well studied. Many of these are preventable. Stroke risk can be reduced by early detection and good management of high blood pressure, diabetes and high cholesterol, which are all major risk factors.  Combined with lifestyle changes including maintaining healthy weight, regular exercise and stopping smoking, stroke risk can be significantly reduced. I would urge all Singaporeans to visit your doctor regularly for screening for these well-known risk factors for stroke, and to take personal responsibility for your own health by leading a healthy lifestyle.

Managing stroke, rehabilitation and reducing risk of complications

7. Despite the best efforts at prevention, some people will still develop a stroke. Once a stroke has occurred, 1 in 10 stroke patients will develop another stroke within the first year. After that, the risk is 4% to 5% yearly.  Fortunately, there are ways to reduce the risk of subsequent strokes.

8. The Chronic Disease Management Programme, which was started in Oct 2006, covers stroke, as well as its major risk factors: diabetes, high blood pressure and high cholesterol.  Through this initiative, stroke patients are encouraged to work with their doctors to actively manage their disease through regular monitoring and appropriate medical treatment. The programme also aims to help patients and their families better understand stroke and what they can do to manage their condition; empowering and motivating them to make relevant changes to their lifestyles. With a proactive approach to the management of stroke, complications and a second stroke can be avoided or delayed for many years.

9. In addition to this, under the Medisave for CDMP (or the Chronic Disease Management Programme), patients have the option to draw on their Medisave to help reduce out-of-pocket payments for outpatient treatment, thus reducing barriers to seeking treatment for stroke.

10. There are also a number of effective interventions, such as surgery or interventional neuroradiology procedures, which have been proven to reduce the risk of subsequent strokes in suitable patients.

11. As knowledge evolves and technology improves, we will be able to offer better treatments to our patients. Singapore will thus continue to give the most up-to-date care to all patients, local and foreign, as we strive to become the medical hub in the region. I see that such evidence-based acute interventions will be discussed later this afternoon. 

12. I am pleased to note that this year’s meeting has dedicated time to address Nursing Care and Rehabilitation after Stroke.  The role of rehabilitation is critical in post-stroke care.  Survivors of stroke experience many changes resulting from their illness, for example weakness on one side of the body, or difficulty with speech and understanding language. 

13. Early rehabilitation after stroke is important for stroke survivors to recover their functional capacity. It provides a targeted and organised plan that aims at helping patients regain as much independence as possible in the shortest period of time possible, by re-learning skills they have lost, learning new skills and finding ways to manage any permanent disabilities. It requires a multidisciplinary and holistic approach; Nurses, occupational therapists, physiotherapists, speech therapists and doctors all play a part in rehabilitation of stroke survivors.

14. But I want to add that there is one additional group that is important for recovery of stroke survivors, and that is the caregivers. Social support both for survivors and their caregivers is essential. Caregivers need to be trained to look after the stroke patient.

15. The social and emotional needs of the stroke patient must also be met, whether in the form of placements in appropriate jobs or financial assistance. Apart from that, counselling and emotional support from counsellors, other stroke survivors, or psychologists is also critical. Together with nursing and specialised medical care, they play a crucial role in the recovery of stroke survivors.

16. Thus, I am certainly glad to see that these issues in stroke rehabilitation will be discussed in tomorrow’s symposia. 

World Stroke Day and official opening of the conference

17. I congratulate the Organising Committee for putting together such a comprehensive programme.  This conference has come a long way since its first meeting.  It has certainly achieved its aim of bringing the experts and those who manage stroke, together in a unique occasion to update their knowledge on the wide range of topics.  It has become THE scientific and educational forum for stroke in Singapore. 

18. Before I declare the Conference open, I am pleased to inform you that the World Stroke Organisation, which is affiliated to the World Health Organisation (WHO), has declared 29 October 2008 as World Stroke Day.  I take this opportunity to acknowledge the dedication and achievements of all professionals involved in the management of stroke and to encourage them to continue with their contributions and efforts to bring awareness and improved care in the management of stroke. 

19. So, my thanks for the kind invitation and I am pleased to declare the “10th Singapore Stroke Conference” officially open.