The elderly man, walking through a park, suddenly drops one of his grocery bags. He stops and sits on a bench.
A younger man passing by asks whether he is OK. The elderly man answers — with slurred speech — that he just needs to rest. The younger man moves on.
In this powerful, touching 10-minute movie, the scene eventually changes to a hospital room. The elderly man is unresponsive, his tearful daughter at his side. He has suffered a major stroke.
Penn Medicine anesthesiology physician Renyu Liu plotted the film, which won the Humanitarian Award and the best short film at this year’s NYC International Film Festival.
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The film, part of a broader stroke awareness campaign, is in Chinese, with English subtitles.
A Chinese news report called the film “the perfect mingle of medicine and art.” Robert Rizzo, the founder of the festival, said the film “brought tears to my eyes because my brother died of stroke. He was 51 years old.”
We recently spoke with Liu, also a professor of anesthesiology and critical care at the University of Pennsylvania, about the film and his continuing efforts to improve stroke awareness using novel tools.
When and why did you start spreading stroke awareness?
It started in 2016. As anesthesiologists, we also take care of stroke patients. We provide anesthesia and critical care for thrombectomy procedures that treat stroke. The Hospital of the University of Pennsylvania was the first comprehensive stroke center in Philadelphia, and our stoke system now spans seven hospitals in our health system.
One day, when I was on call in the hospital waiting for a stroke patient in transit, I noticed a brochure about the FAST (Facial drooping, Arm weakness, Speech difficulty, and Time to call 911) stroke awareness campaign on the table in our cafeteria.
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I took a picture and sent it to Dr. Jing Zhao, a neurologist in Minhang Hospital, Fudan University in Shanghai, China, and asked if they had this kind of campaign there. She told me that it had been introduced into China more than a decade ago, but it did not work well due to language barriers. I proposed working out an acronym that would be easier to be used in China.
Stroke is the No. 1 cause of death in China. One study has shown that, on average, stroke patients do not make it to a hospital for 15 or 16 hours, even in cities. That’s a huge problem. Most of the people think, “Oh, I’m just tired.” But if you don’t get to the hospital in time, you may have a lifelong disability or even die.
Dr. Zhao and I started a program called Stroke 120. Similar to 911 in the U.S., 120 is the dedicated medical emergency number in China. In this program, we linked stroke signs and symptoms to the emergency number. “One, look for an uneven face. Two, examine two arms for arm weakness. And zero, absence of clear speech. If any of the signs is observed, dial 120.”
We started a Stroke 120 task force with support from the Chinese Stroke Association in 2017. More than 20,000 volunteers have joined it.
What was the impetus for the film?
It’s very important to have an effective way to convey the message. We believe that short videos and films are powerful tools to attract audiences in the modern society for educational purposes. By now, we have produced a series of seven short videos and two short movies. Our first was a one-minute video to introduce Stroke 120. It was on China national and local TV, and it has been translated into 33 local dialects in China.
The short movies are based on personal stories, each with a different focus. One was about a young person who has had a stroke. The one that won the award was about an elderly person who lives alone with no children around. At the end of each movie, we introduce information about strokes and, hopefully, draw more people into understanding how important stroke awareness is.
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We are trying to improve stroke awareness by removing the barrier of languages across the world. In Europe, 112 is the emergency phone number in most countries, so we engineered a “Stroke 112” program. It can be easily translated into other languages with no loss of its core message.
We recently produced a video using the Stroke 112 strategy for Nigeria.
What were some of the most important things you were trying to convey in this film?
One is basically that everyone in society has to master the stroke recognition method. In the movie, the poor man could have been rescued if the young passerby had recognized the symptoms and called the medical emergency number.
Another message we wanted to convey is that as society is aging, the number of elderly people living alone is increasing. In previous times, parents and children lived together. Now, many elderly people want to live alone in their homes. But what if they have a stroke? We need a strategy in society to recognize it. That’s what the campaigns and videos are all about.
You also have a Stroke Hero program.
In the campaign, we set up programs for two kinds of heroes. One is a Stroke 120 Hero. We gave awards to people who used the strategy or promoted stroke awareness vigorously. We also give awards for Stroke Hero — basically, for people who have had a stroke and survived, then used his or her story to promote stroke awareness.
One example is Lotje Sodderland, a woman in England who had a stroke when she was 34. She survived, but initially, she could no longer read, write or speak coherently. As she gradually recovered, she started taking cellphone videos to record important events. Later, she contacted David Lynch, a Hollywood director. They produced an outstanding documentary related to stroke recovery, My Beautiful Broken Brain. It is available on Netflix.
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We also hold annual stroke awareness events and scientific symposiums.
You’ve said stroke awareness is even more important during the pandemic. How so?
The pandemic made stroke recognition more difficult. We can’t recognize an uneven facial expression if it is hidden by a mask. Because of social distancing, a weak arm is not easy to recognize. Speech disturbance, another symptom, is also difficult to recognize because a mask often muffles speech.
However, speech disturbance also is becoming a unique tool for stroke recognition during the pandemic. An example was a wonderful story published last year. A first-grade teacher in Michigan was teaching an online class when she got a call from a child’s grandmother who needed help with her granddaughter’s school tablet. The teacher noticed the woman’s speech was jumbled and had someone call 911. “I would have died,” the grandmother later said.
The stroke awareness effort in the United States is much better than in many other countries. However, according to a recent report from the Centers for Disease Control and Prevention, it still remains suboptimal. The researchers found that only two-thirds of adults in the U.S. knew the symptoms of a stroke and recognized the need to call 911 immediately.
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