Quixeramobim is a small city and municipality located in the Sertão Central region in the semi-arid northeast of Brazil. It is the second largest urban centre in the state of Ceará, and located at its geographical heart, as the 10-meter high granite and steel obeslik on Dias Ferreira Square reminds you.
Despite the great economic progress of the last two decades, Quixeramobim remains for the time being a relatively low income income region, with bands of lower purchasing power in its diverse population.
But about 4 km from the city center, towards the neighboring city of Quixadá, you will find an imposing building that has expanded health opportunities in the hinterland of Ceará, won international praise for patient care and changed the outlook for stroke patients in the region.
Affectionately known as the Giant of the Backlands, the Regional Hospital of the Central Backlands (HRSC) is an expressive example of the regionalization of health to guarantee that complex services are available not only in the capitals, but in the places where the patients live. Its long list of achievements includes twenty-one consecutive WSO Angels Awards – more than any other hospital in Brazil – making it a guiding light for the mission to make more and better stroke care available to populations around the world, and make the world safe for stroke.
Giant strides
Team engagement emerges as the magic ingredient for delivering one of the best stroke services in the world to one of the poorest communities in Brazil. Yes, the hospital has well-established protocols to enable fast and efficient service, and ongoing professional training ensures everyone knows exactly what to do. But, says HRSC general director Dr Cristiano Rabelo, “one of the great forces is the engagement of the team, because the flows of care are not simply imposed – they are built by the professionals themselves. This makes everyone feel part of the process and have a real commitment to the quality of care.”
Before the creation of the stroke unit at HRSC two years after the hospital opened in September 2016, stroke patients in the Sertão Central region faced a challenging reality, Dr Rabelo says. “There was no CT scan or MRI available for quick and accurate diagnosis and the nearest stroke-ready centre was 200 km away in the state capital Fortaleza.”
But starting in 2018 the Giant of the Backlands brought about a fundamental shift in the assistance given to stroke patients, Dr Rabelo says. “The hospital, which is strategically located in the centre of the state of Ceará, started to offer rapid diagnosis, specialized treatment and early rehabilitation, facilitating the recovery of many patients and reducing sequelae and disabilities.”
However to ensure that patients arrived at the hospital in time to benefit from these services, it was necessary to reach out beyond the hospital walls.
Partnerships promote performance
Strategic partnerships with the Mobile Emergency Care Service (SAMU) and primary care facilities are the key to the rapid arrival of patients at the hospital, Dr Rabelo says.
“The SAMU is an essential partner in the treatment of stroke, since the time of arrival of the patient to the hospital is one of the most critical factors to guarantee effective treatment. The partnership between the HRSC and the SAMU is an example of how the public health network can function efficiently when there is organization and commitment to the patient.”
It is also an example of how partnerships promote performance.
The launch of the EMS Angels Awards in Brazil in 2023 provided an important building block for the pioneering concept of Angels Cities, as gold status in the EMS Awards became a criterion for Angels City status. And after the concept was expanded to become the global strategy, 100 Angels Regions, there was a surge in the number of EMS organizations around the world being recognized for their stroke care.
SAMU Ceará Base Polo Quixeramobim joined these ranks in 2024 with two consecutive diamond awards, raising the possibility that the city of Quixeramobim could become an Angels Region ahead of candidates in more prosperous parts of the country.
There was just one more box to be ticked.
Something special
In order for a region to gain Angels Region status, population-based targets must be met for the implementation of FAST Heroes, a schools-based campaign that leverages the relationship between children and their grandparents to spread life-saving knowledge about stroke to vulnerable populations.
Dr Victor Abreu, neurologist and head of the HSRC stroke unit, is a champion of the campaign. He says it’s the engagement of children in learning, especially with the playful and fantastic world of superheroes versus villains, that accounts for its success both in and beyond the Sertão Central region.
“The family relationship is very important for the growth and formation of dignified citizens willing to do good,” Dr Abreu says. “Between grandparents and grandchildren, however, it is something special that involves care, zeal and attention – and that certainly facilitates learning.”
Recognizing that education and health needed to work together, HSRC stepped in to present the Angels Regions concept to the Quixeramobim City Hall, explaining how it would benefit the entire population.
Dr Rabelo says, “The mayor immediately supported the initiative and mobilized his health and education staff to make the project feasible.”
As a result Quixeramobim did not meet its FAST Heroes targets – it overshot them by almost 300 percent.
It’s not only about targets
Alessandro Rômulo has been an Angels consultant for six years, and has been working in this region for the past year. Chlidren play a crucial role in this scenarion, he says. Therefore, when planning a FAST Heroes activation, they’re not focused on reaching a specific target. Instead, their goal is to reach as many children as possible, as this creates a significant impact on the community.
“We didn’t say, we need this many children,” his colleague Andrea Giordano says. “We knew the more children trained the better, so we didn’t make a calculation, we just made a plan to reach the maximum number of children, and the maximum number of schools.”
At the same time they keep the focus on public schools, which over 80 percent of students attend in the north of the country. “Our priority is the public,” Andrea says. “We only convert regions if we are succesful in public schools.”
But this is not the only way in which Brazil has moved the goalposts for Angels Region status, thereby multiplying the impact of the program.
For them the goal of public awareness education is only met when FAST Heroes has officially been made a mandatory part of the curriculum for public school learners aged six to 10. This requires close cooperation with municipal education departments, but the rewards are enormous, Andrea explains.
“This ensures the project stays active in schools year after year and continues to benefit families in the region. For us as Team Angels, if a city embraces FAST Heroes in this way, we can have even more and continuous impact on the population’s knowledge about stroke and help even more people prevent the disease.”
They can also increase the likelihood that these patients will receive rapid diagnosis and treatment, leading to better outcomes – and that’s what it means to make the world safe for stroke.
