Modern Lithuania is in some ways a tale of two cities as the relationship between Vilnius and Kaunas is often characterized by rivalry. The not-so-friendly competition about which city exemplifies the true Lithuanian identity plays out in multiple spheres – from culture, economics, education and science, to tight contests on the basketball court.
In one important area however it is conspicuously absent. A robust alliance between four neurologists – two from each city – has transformed stroke training in Lithuania and become a catalyst for stroke care quality improvement in several East and South European and Central Asian countries.
On the stage in Basel, Switzerland, to receive an ESO Spirit of Excellence Award during ESOC 2024, Team Lithuania line up as follows: On the far right is Prof. Dalius Jatuzis from the Clinic of Neurology and Neurosurgery at Vilnius University. Next to him, Dr Prof. Aleksandras Vilionskis from Republican Vilnius University Hospital. Representing Kaunas are Prof. Antanas Vaitkus and Dr Prof. Vaidas Matijosaitis (far left), both from the Department of Neurology at the Hospital of Lithuanian University of Health Sciences (LSMU).
It is easy to guess which of the four is a force to reckon with on the basketball court as Prof Vaidas Matijosaitis towers above his colleagues. “Not professionally,” he explains. His primary reason for indulging in Lithuania’s national obsession is “to make joy and fun for myself”, but it does allow him to make a point about teamwork. In lectures about stroke care he makes reference to basketball to drive home the idea that “to play well you have to understand each other”.
A stellar team
The Kaunas-Vilnius stroke transformation team is one that plays well together. They have a crucial role in the development of stroke care in Lithuania, pooling their expertise to present training workshops for nurses, EMS and young neurologists, and to promote quality monitoring and simulation-based learning.
Prof Matijosaitis became a convert to simulation training while attending a Train the Trainer event hosted by the Angels Initiative in Mainz, Germany, in 2016. It became a dream to establish a simulation centre at LSMU that could serve the region – an ambition that took them to Masaryk University in Brno in the Czech Republic to learn from one of the most esteemed simulation centres in Central Europe.
The simulation centre in Kaunas has now developed into an international project where best practices are shared with future stroke leaders from Greece, Bulgaria, Georgia, Moldova, Romania, Hungary and Ukraine. They have also held simulation workshops in Moldova and Kyrgyzstan, with Kazakhstan next on their itinerary.
They also lead by example. All four doctors are from diamond hospitals and have twenty ESO Angels Awards between them, but impeccable credentials are not the only reason why they’re an exceptional team.
“We are different in many ways, we have different strengths,” Prof Matijosaitis says. “Some know more about stroke trials, some know more about pathway organization, some are experts in the simulation process. But if you join it all together you have a good core of all the necessary knowledge. It’s like a puzzle in which all the key details slot together. We’re a perfect team because we add knowledge to each other.”
Chasing butterflies
Lithuania’s second-largest city, Kaunas is known both for its history and natural beauty. Located at the confluence of the two largest Lithuanian rivers, its surrounding lakes, forests and nature reserves are home to many of the country’s more than 3,500 beetle species and almost 2,500 species of butterflies and moths.
As a boy, Vaidas Matijosaitis’s love for science was nurtured by a neighbour, an entomologist in a museum laborotary in Kaunas, who encouraged him to find and study insects. In the fields where he was collecting butterflies and bugs, his interest in biology grew.
As a young doctor he became fascinated by the secrets locked up in the brain. His neurology residency at Kaunas University of Medicine showed him that behind these secrets there were still more things to be unraveled. “The science of neuroloy is moving forward very fast,” he says. “New methods are being discovered for diagnostics and management of diseases that previously had no cure.”
Ultrasound diagnostics was the focus of his doctoral studies in neuroscience, which he embarked on one year after completing his residenship in 2006. Back then fewer than one percent of ischemic stroke patients in Lithuania underwent recanalization therapy – the result of a lack of government support and limited supplies of the thrombolytic drug.
Finally, in 2014, the Lithuanian parliament approved the Lithauanian Health Programme 2014-2025 (a 10-year plan for improving population health and reducing healthcare inequalities) and gave its support to the development of a stroke cluster system whose goal was to have a stroke-ready hospital within an hour’s reach of every one of Lithaunia’s 2,8 million citizens.
Today there are 11 hospitals in the official stroke network including six thrombectomy-ready stroke centers.
It all starts from your ideas
Prof. Matijosaitis’s power to influence practice at his hospital grew after he became head of the stroke unit at LSMU in 2016. Stroke teams are the building blocks of the stroke cluster, he says. Small teams are easier to steer in a new directions than those that operate in hospitals like LSMU, which with 2,300 beds is the largest and most advanced medical institution in the Baltic countries. Despite this the team at LSMU have played well together, streamlining the pathway to reduce the door-to-needle time from 78 minutes in 2016 to below 30.
What the Angels Initiative’s Rita Rodrigues describes as “a perfect pathway” benefits from the very good proximity of triage to red zone and ICU wards, and having the CT room just on the other side of a door. In addition to an environment optimized for speed, a prenotification system connects an ambulance directly to the neurologist on duty. Since 2018 Lithuania has also had an electronic health system that gives healthcare professionals access to patient history, medication, pre-existing conditions and chronic diseases that in the case of stroke could contraindicate treatment with thrombolysis.
A tour of the LSMU stroke unit and emergency and imaging rooms is a preamble to simulation training, exposing visiting doctors to resources far more extensive than in their own hospitals.
“The people who come are very motivated – to start stroke simulation in their own countries, to develop their own systems, to perform better, to decrease quality parameters,” Prof. Matijosaitis says. “They may not have all the options we do, but it is good to start by changing your way of thinking. It all starts from your ideas. We try to make an impact on the way they think about change.”
The transformative impact of simulation training comes from mirroring real-world scenarios and challenges – but the experience also holds up a mirror to Prof. Matijosaitis and his colleagues. He says, “It’s important to take a good look at oneself and one’s work from the outside. You will also see something to improve.”
Another joint project of the Kaunas-Vilnius team of stroke leaders is the upcoming ESO Stroke Summer School for which they, along with emergency neurologist Rytis Masiliūnas of Vilnius University Hospital, constitute the local organization committee. The programme runs from 15 to 21 September.
