Thirty-five stroke-ready hospitals and a gradually filling trophy cupboard spell progress in a small country with a long coastline and a capital city situated directly on the equator.
Stroke care in Ecuador has been on an upward trajectory ever since the formidable partnership of Paulina López and Manuel Jaramillo, two emergency physicians at Ambato General Hospital, was rewarded with a WSO Angels Platinum Award in 2021. The international recognition led to an agreement with the Ecuador’s Vice-President to grow the number of stroke-ready hospitals in the country.
The initial agreement targeted 30 stroke-ready hospitals that would include a roughly equal number of public hospitals that offer free medical care, and those managed by the Social Security Institute (IESS) for its members. Three years on, Ecuador’s 35 stroke-ready hospitals include 16 public health and 12 IESS hospitals, with the balance in the private healthcare sector.
With the original mission all but accomplished, it was time for a new accord, which came into being in June 2024 when the Ministry of Public Health and the Angels Initiative signed the Inter-Agency Cooperation Agreement with a commitment to strengthen the national health system in respect to stroke care.
The custodian of the agreement is Dr Verónica Pacheco, who in 2024 led the development of the first national protocol for prehospital stroke care in Latin America, formulating guidelines that are now being implemented throughout the country. As a result, two prehospital care teams had already won EMS Angels Awards – gold for the prehospital service in Tungurahua, Cotopaxi, Chimborazo and Pastaza, and diamond status for coordination zones 2 and 9 in Pinchincha Province.
In Q3 of 2024, Eugenio Espejo Specialty Hospital also reclaimed its award status. This was a particularly satisfying result, Erika Bermeo of the Angels team in Ecuador says, as this hospital is the most emblematic hospital of the public health system and one that has distinguished itself by the quality of its services. A third-level institution, Eugenio Espejo Specialty Hospital, represents the referral hospital of Ecuador for the reception of patients who depend on public health.
Four new stroke-ready centres have been developed, including in remote cities in Ecuador. One of these is the Isidro Ayora General Hospital, located in the province of Loja in the south of the country. It serves the oldest and therefore the most vulnerable population in the country, but also extends coverage to other provinces such as El Oro, Zamora Chinchipe and even the northern part of Peru.
The Enrique Garcés General Hospital, located in the south of Quito, is the tenth certified hospital in the capital, while Latacunga General Hospital becomes the first stroke-ready centre in Cotopaxi province.
Another great success story is the General Hospital of Macas, a reference health facility in the province of Morona Santiago, located in the south center of the Amazon region. Its conversion to a certified stroke centre makes treatment accessible to a significant number of patients from indigenous communities such as Shuar and Achuar who previously had to travel well over four hours to receive care.
Training has had a direct impact on performance, with more than 3,000 health professionals, including doctors, nurses and pre-hospital staff, benefiting from more than 20 training sessions, both in-person and virtual. These included workshops at seven hospitals in the public health network, and 12 face-to-face sessions on “The implementation of guidelines for prehospital care”.
Prehospital staff have also completed the ASLS course on the Angels e-learning platform, and almost 1,000 nurses completed the Stroke Basics for Nurses course in the Angels Academy during 2024. This brings the total number of stroke-certified nurses to 12,264.
In May, Angels participated in the Nurse Training Congress with a presentation on “The role of nursing hyperacute phase of stroke”, and in September presented the workshop “Body Interact: Initiative Angels” at the Congress of Emergency and Disaster Medicine in Quito, which allowed participating health professionals to develop their knowledge of diagnosis and treatment with simulation exercises.
Delegates of the main health entities of Ecuador such as the Red Cross, Firefighters, IESS, and the Ministry of Public Health, attended workshops in Quito and Ambato that were designed to improve early and timely stroke care in the prehospital and hospital phase.
But the educational programme was not confined to healthcare staff. In the provinces Guayas, Pichincha, Manabí, Chimborazo and Tungurahua, leaders of hospital neurology and emergency services joined Angels for several large-scale public awareness campaigns on the recognition of stroke symptoms.
“The achievements resulting from this new agreement with the Ministry of Public Health fill us with pride and satisfaction, and drives us to continue working to save and improve the quality of life of millions of stroke patients,” Angels consultant Erika Bermeo says.
“We are fortunate to have strategic allies who invest their Angels spirit in everything they do. We have the active participation of Dr Paulina Lopez and Dr Manuel Jaramillo who are leading doctors in our country, contributing their scientific knowledge in training directed to hospitals that are in the process of being recognized as stroke-ready centres.
“More doctors have joined, including Dr Verónica Pacheco, the team of delegates from the Ministry of Public Health who are very supportive of the Angels Initiative, and a large number of health professionals.
“We are on the right track, looking for new opportunities with agreements that extend to other institutions, working with passion for a purpose that will always be to beneit more patients, providing them with a second chance at life.”
