Stroke is not a new disease, and the public often hears about it. However, the problem is that understanding and the ability to take effective action is still limited. According to the General Chair of the Indonesian Stroke Foundation (Yastroki), Major General TNI (Ret.) Dr. Dr. Tugas Ratmono, Sp.S. MARS., MH, the public does not fully understand what a stroke is and how to act when someone is affected. Therefore, they feel challenged to continue providing education.

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In situations like this, Yastroki is here with the aim of expanding its role so that people can understand and be more educated. "When people hear the word stroke, perhaps many people are familiar with it, but in-depth knowledge about stroke is still rare. Many people arrive late at the hospital, which shows that the level of awareness about stroke is still low," he said.

In fact, this disease can be treated or cured if the patient has a strong spirit and gets support from the surrounding system. Tugas Ratmono is to explain that there are three classifications of stroke patients. "There are three groups of stroke patients: first, patients who are independent and want to recover quickly. Second, patients who have given up and lost their spirit. And third, patients who are depressed to the point that some end their lives. All of this must be treated. This is what we have been doing so far we are trying and we will continue to do so," he stressed.

The incident that happened to a middle-aged man with the initials YR (52) at a house in Karet Tengsin Village, Tanah Abang District, Central Jakarta, was thought to be the result of frustration due to the stroke and diabetes he suffered from which had not yet healed. The victim chose a shortcut by hanging himself with a rope in his bedroom. This was reported by VOI on November 1.

If only the late YR and his family had been educated about strokes, this tragic incident could have been avoided. Therefore, Yastroki is working with various related parties to continue providing education so that people understand how to deal with family, friends and other people closest to them who have had a stroke. "We always believe that stroke can be prevented, treated, and those affected can recover," he stressed.

What the community can do is immediately take the person closest to them who has had a stroke to the nearest health facility (faskes). Then, the patient will be given treatment by health workers. After that, the community has an important role in supporting post-treatment recovery through physical, mental, spiritual and economic rehabilitation. "Sufferers must undergo rehabilitation in various aspects, and the community needs to participate, because Yastroki cannot do this alone," he said to Edy Suherli, Savic Rabos, and Irfan Medianto from VOI during an interview at the Yastroki office, in the Rasunah Said area, Kuningan Setia Budi, South Jakarta, not long ago. The following is the complete excerpt.

Currently, what is our society's knowledge about stroke, are the signs of this disease familiar?

If people have heard the word stroke often, they still know very little about stroke. If we see that many people are still late going to the hospital, this shows that knowledge of stroke is still low. Let's look at the existing data, in Indonesia the incidence of stroke continues to increase from year to year. So all parties still need to make hard efforts to provide information about stroke, starting from prevention, treatment, and post-stroke. So how to deal with that impact well, that's what we have to work hard on.

Signs of someone having a stroke?

The easiest sign is a sudden change in the face, a slanted mouth. Then paralyzed on one side. Then his speech is slurred, slurred or unable to speak at all. If you find these signs in your family, friends or close people, take them immediately to the hospital so you can get proper treatment.

Is there a correlation between the lifestyle and environmental conditions of people who have had a stroke?

There are two risk factors for stroke, those that can be controlled and those that cannot be controlled. Risk factors that cannot be controlled include age, race (ethnicity), gender and genetics. Then the factors that can be controlled are high blood pressure, heart problems, high cholesterol, blood viscosity and air pollution. Areas with high pollution also have a high incidence of stroke. Then there is also lifestyle, which can influence high blood pressure, heart problems, high cholesterol, blood viscosity. So you must have a healthy lifestyle to avoid stroke. In general, there are two types of stroke, one is blockage and the other is bleeding. This is related to the diseases that I mentioned earlier. There are also psychological factors that influence it.

From that exposure, so this stroke can be prevented?

People who have had a stroke can be treated and recover. The Ministry of Health has a strategy to prevent strokes in a SMART way. Namely C: regular health checks. Then E: get rid of cigarettes and alcohol. Then R: exercising diligently is important, at least 150 minutes a week. Please arrange how many days you will exercise, it can help prevent stroke. Next D: a balanced diet. Exactly how can you consult with a nutrition expert? Next I: getting enough rest is also important, don't work all the time. And finally K: manage stress wisely. So you have to exercise, be happy and don't forget to be happy. Preventive action is better than cure, have an umbrella ready before it rains. So it must be taken care of before it gets hit. The problem is that if you get hit, your life will die. This impact is extraordinary.

What obstacles do Yastroki's friends face in educating the public to understand what a stroke is?

This is a challenge, and this challenge must be an opportunity. We have to handle strokes from upstream to downstream well. During the COVID-19 pandemic, it was very difficult to change the behavior of using masks, but slowly it was finally possible. Likewise with this stroke. How do we inform the public that stroke can be prevented and treated. From religious teachings, I think any religion encourages us to live healthily so we can work and worship well.

Another behavior that is not easy to change is taking strokes lightly. I've had it, but I'm going to the hospital later. However, the sooner the better. We from Yastroki have prepared stroke helpers, they are volunteers who will help and encourage people who have had a stroke to go to hospital. Hopefully they can pass on the culture of caring for society to others. Apart from the public, it is also important for health workers in hospitals to be quick to take action when there are sufferers. Don't let the patient come immediately but the action is too late. Stroke is an emergency or emergency.

What actions do people take to deal with stroke sufferers? What do you see?

It is true that if someone has a stroke, they massage or prick their ear with a needle to ensure smooth blood circulation and there is much more information circulating. Actions that are not recommended are just a waste of time. The most appropriate thing is to immediately take the patient to the nearest health facility (faskes). The standard for taking a patient to the nearest health facility is 15 minutes. I don't know if this is possible in Jakarta, where traffic jams are possible. Then after arriving at the health facility it must be treated within 60 minutes. So there is a code of stroke, work standards that must be applied when treating stroke patients. This must be enforced.

For health workers, they already have a code for stroke, what about ordinary people, what should they do when someone in their family or someone close to them has had a stroke?

We always think that stroke can be prevented, treated, and recovered. For the community, what is needed is readiness to take patients to the nearest health facility. After arriving at the health facility, the action is to be treated and recovered, that is the domain of health workers and hospitals. After being treated by health workers, stroke patients will return to society. This is the role of society to help those who have had a stroke to recover, namely rehabilitation. Sufferers must be rehabilitated physically, mentally, spiritually and economically. The community needs to take part, because Yastroki cannot do it alone.

There are three groups of stroke patients, the first is independent patients who want to recover quickly. The two patients were resigned and had no enthusiasm. And third are patients who are depressed, to the point where someone ends their life. We have to handle all of this. This is what we strive for now and in the future.

What needs to be noted is that the desire to recover must come from the patient, right?

Yes, that's right, I'm also a neurology doctor. I emphasize to patients that 70 percent of the healing role must come from the patient. The patient's enthusiasm for recovery was very high. The doctor and drug factors are not that big.

Not long ago the presidential and vice presidential candidates underwent medical examinations, is stroke included in the items examined?

In the past, when he was still active at RSPAD and was part of the team for medical examinations of presidential and vice-presidential candidates, one of the items examined was stroke. Whether our presidential and vice presidential candidates have had strokes or not. Then, if there is an indication of a stroke, how long has the stroke been? Then what is the function of their organs, because if they are disturbed and can't do their job, that's not allowed. Especially strokes related to cognitive or higher function. The problem is that they will lead this country, so they have to be healthy.

OK, for Yastroki itself, what are you planning to do, either alone or in collaboration with other parties?

We were founded 34 years ago, I as Chairman have only been in office since May 2023. So currently we are still carrying out inventory and preparing work plans with the Yastroki management. The programs that will be carried out include building public awareness about stroke. We do this through the Kamisan Yastroki event, a dialogue that presents various speakers present to convey information about prevention, management and post-stroke. There are also stories from strokers, former stroke sufferers, to inspire many people.

We are collaborating with hospitals to develop various services, such as teleconsultation, telemedicine via applications. In collaboration with a company we developed a smartwatch. We communicated this with the Ministry of Health and the Indonesian neurologist organization. Then we will develop stroke helper so that more people can get involved. There will be training for those who want to get involved.

Yastroki is also holding a jamboree, what is the target?

We want to build collective awareness that stroke can be prevented. Also builds awareness of stroke. We have been supported by the DKI regional government for this event. It's true that we can't change society all at once, yes, it's going to be done slowly and continuously until it's successful. The jamboree is one of our ways of doing socialization. We also distributed 1,000 wheelchairs for stroke sufferers, there were also gymnastics and other activities. This is the second jamboree that we are holding in October 2023. The previous jamboree was held last year in Yogyakarta.

These are Health Tips from Doctor Tugas Ratmono

Since he was still a student, Major General TNI (Ret.) Dr. Dr. Tugas Ratmono, Sp.S. MARS., MH, who currently serves as General Chair of the Indonesian Stroke Foundation (Yastroki), is already fond of exercising. This habit continued until he retired from the TNI and is now more involved in social and health activities.

“When I was at school and then went to college, my hobby was sports. My hobby used to be running, until it became a habit. If I don't run, I'll get a cold. Eventually it became a routine," said Tugas Ratmono, who now also plays tennis and occasionally golf.

“But for  golf, the time is longer. That's why I don't force myself, if someone asks me to. The thing is, golf takes a long time. If I don't have time, I still exercise even if I do it at home on a treadmill," said Tugas, who also likes listening to music.

Making him enjoy music is a way to balance physical and cultural elements. “I also like listening to music. This is necessary for a balance between art and non-physical activities," said an alumnus of the UGM Faculty of Medicine (1990).

When carrying out physical activities such as sports, Doctor continued, the task should not be excessive. Especially at a young age. “The important thing is to sweat and get fit. Don't force it too much, because it will have bad effects if you force it too much," said the man who was born in Kebumen, Central Java, 13 November 1963.

Balanced Diet

In terms of food, Tugas Ratmono is that there are relatively no significant obstacles. “Until now, I have no restrictions regarding food. However, due to age, I have started to reduce my carbohydrate intake. So the portion of rice is not as much as before when I was young. It's true that there's nothing to prohibit, but you shouldn't eat too much. Yes, just know yourself," said Tugas, who completed the ABRI Milsuk Sepa (1989).

He implements a balanced diet. “My body weight has always been relatively stable, around 64 kg. It was difficult for me to go up, but down quickly. For example, when fasting, it goes down quickly. "Now, after fasting, it takes time to rise again to your original position," said the Doctor Tugas whose last position was Head of the TNI Health Center (2020-2021).

In carrying out a balanced diet, he continued, you cannot have excess calorie intake and you cannot also lack calories. "One more thing that must be maintained is drinking sufficient water intake to avoid dehydration or lack of body fluids. For light activity, 30 cc/kg body weight is needed and for moderate activity 40 cc/kg body weight. When I'm active, I drink at least 2.5 liters a day," added Tugas, who runs around his house in the Banteng field area, Central Jakarta.

So that you don't get too burdened with business in the office and organization. Doctor Tugas relieves stress by exercising. “If asked how to deal with stress, I do exercise. But we also have to measure our own abilities and those with whom we work together," he said.

During the COVID-19 pandemic, it was felt by Doctor Tugas that their stress levels had increased. “Everyone involved in handling the COVID-19 pandemic yesterday was stressed. We have to race against time to overcome the virus that is spreading. I just take it all with joy. While carrying out activities with predetermined targets, we remain cheerful, and don't forget to be happy. That's what I did," said the Coordinator of the Wisma Atlet COVID-19 Emergency Hospital, Kemayoran, Central Jakarta.

This feeling of happiness, continued the Doctor Tugas, can increase the body's immunity. "If our immunity increases, we can overcome existing stress," continued the man who once held the position of Head of the Gatot Subroto RSPAD Nerves Department.

For Family

Family for Tugas Ratmono is everything. “When we are in the office we focus on work. Once at home we have to give time to our children and wife. Yes, when you're at home, try to be with your family," he said.

Now that the children are grown up, the situation has changed. “My first child is married and now lives in Surabaya. Meanwhile, his younger brother is still studying at the University of Indonesia. In the past, when everyone still lived in Jakarta, we usually went somewhere at the weekend to eat together. Now there are only three of us," he continued.

Tugas Ratmono is lucky to have a family who understands his current position. "When I first retired in October 2001, I was ready to enjoy my old age at home. Eh, it turns out I'm actually stressing myself. Finally, I kept myself busy again by opening a practice and being active in activities at Yastroki," he said.

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"So even though I'm at retirement age, I'm busy again. With business, the way of thinking and working is used again. You can still work and be useful for many people. Be a useful person to the people around you. It would be even better if it could be a solution for the people around us," said Tugas Ratmono.

"There are three groups of stroke patients: first, patients who are independent and want to recover quickly. Second, patients who have given up and lost their spirit. And third, patients who are depressed to the point that some end their lives. All of this must be treated."