Success, they say, is mostly about managing chance. And the key to being successful is being prepared for chance when it occurs.
When Angels consultant Fransisca Elisabet boarded a plane from Jakarta to her hometown Balikpapan in East Kalimantan in March 2024, chance was about to find her. The former general practitioner had only been an Angels consultant for a couple of weeks, and after attending an Angels event in Jakarta, she was going home with a lot to think about.
One thought that may have occurred to her was how lovely it was to be going home. Before joining Angels, Sisca and her husband Wilsen had been kept apart by their professional lives for three years. The new job allowed her to move with their small son from Bandung back to Balikpapan where Wilsen was working as a geologist.
Among the passengers boarding the 7 pm flight from Jakarta was one that strongly resembled the Argentinian soccer legend Lionel Messi – a resemblance so striking that Sisca couldn’t help pointing it out to the elderly gentleman in the seat next to her. She realized too late that she had broken the seal on the invisible boundary between passengers that makes flying economy bearable. Instead of catching up on sleep she would now be fielding questions from a complete stranger about what she did, and why she was going to Balikpapan.
By the time the seatbelt signs went off, Sisca had turned on her laptop and was giving a presentation on stroke care improvement to her neighbour, and showing him all the materials that were available on the Angels website. Dr Hendra Gunawan took in every word. He was surprised to hear of such a program being available outside the major cities. It was, he said, exactly what Balikpapan needed.
Chance had arranged for Sisca to be seated next to a neurologist from Dr Kanujoso Djatiwibowo General Hospital, one of four hospitals in East Kalimantan where she hoped to make an impact. Partly retired, Dr Hendra was no longer working full time at Kanujoso, but his son Dr Athony Gunawan was the hospital’s general neurologist and neurointerventionist. “My son will be very interested,” he told Sisca. “He is smart, the two of you can work together.”
Two hours sped past and as soon as they were in the airport terminal waiting to collect their luggage, Dr Hendra made a video call to his son and handed Sisca the phone.
Love your work
“The video call from my father and Dr Sisca was something unexpected,” Dr Anthony Gunawan (34) says. He had in fact been looking for ways to develop stroke services at Kanujoso since joining the hospital in March 2023, after his neurology residency at Hasanuddin University in Makassar and an interventional neurology fellowship at the same university. He had reached out to Angels about training for his hospital, but no date had been set. Now a newly fledged Angel from his own city was talking to him on his father’s phone.
Balikpapan was where his father left the footprints that Dr Anthony would later follow. He says, “For as long as I can remember my father has been a neurologist. When I was little, I lived in a house that also served as my father’s practice. Every day I watched my father practice as a neurologist with great enthusiasm. Even on holidays we'd often accompany my father to the hospital after going to church or taking a walk.
“On my father’s desk at home there is a poem titled ‘love your work’. He taught us to always love our work, so that we would always work happily.”
East Kalimantan has the highest stroke incidence in all of Indonesia, and most stroke patients only receive antithrombotic therapy and other supportive therapies, resulting in a very high rate of disability, Dr Anthony says.
“When serving stroke patients in an outpatient clinic, I encountered many patients who suffered from severe disabilities post-stroke. Many of them had been fired from their jobs and had fallen into poverty, or were being shunned by their families because they had become a burden, and faced many other social problems. Seeing this, we neurologists in East Kalimantan are motivated to improve stroke care services.”
Dr Anthony’s hospital is a government-run facility with quite adequate resources, he says. They have a CT scan, MRI, a cath lab, and a modern stroke unit his father had helped build. But as he would tell Sisca the following day, the stroke code hadn’t been implemented, there were knowledge gaps to fill, and to rise to the moment created by stroke prevalence in their province, they needed help.
The right place at the right time
Chance can present opportunities one wouldn’t have otherwise encountered, such as being in the right place at the right time and meeting the right person. But seizing those opportunities and turning them into success takes discipline and action. Sisca reported to Kanujoso Hospital less than 12 hours after she arrived back in Balikpapan. She and Dr Anthony shared a laugh about her chance meeting with his dad, and then they got to work.
Training and simulation were at the top of the agenda but because it would take time for hospital bureaucracy to greenlight such an intervention, Sisca arranged for a team lead by Dr Anthony to attend a two-day Angels Day event in June – “so they’d have a picture in their heads of what to expect”.
The workshop and simulation at Kanujoso Hospital took place a month later on 27 July and was received with enthusiasm, plenty of questions and willing volunteers. It included a nurses’ workshop on post-acute care and the FeSS protocol by Ns. Elis Nurhayati Agustina of the National Brain Center in Jakarta whose presentation at Angels Day had caught Dr Anthony’s interest.
Three days later Sisca visited Kanujoso again, this time to talk about quality monitoring. She showed them how to use the stroke care quality improvement registry RES-Q, and staff members were identified who would be responsible for entering their patient data.
The next time she followed up, on 16 August, there were already 38 patients in the registry some of whom had been treated with thrombolysis. By 4 September there were 84, but the percentage of thrombolysed patients treated in under 60 minutes still fell short of the criteria for a WSO Angels gold award. The team at Kanujoso dug deep and by 30 September they had recorded 116 cases. Confirming their award status would be a mere formality.
More than a coincidence
In the nine months that followed Sisca and his father’s chance meeting on a flight from Jakarta, a lot has changed at his hospital, Dr Anthony says. “We have been trying to rebuild a comprehensive stroke service, starting from improving the system and the flow of stroke care from the acute phase to the post-acute phase. We have finally built a more efficient stroke code system.
“We have also started building an interventional neurology service system to support mechanical thrombectomy procedures, starting with forming an interventional neurology team, sending four nurses for neurointervention training, equipping tools and devices for thrombectomy, and drafting standard operating procedures for neurointerventional procedures.
“Our hope for the future is to build a more integrated stroke care system that involves other hospitals around us.”
Balikpapan should be proud of having a stroke unit like the one at Kanujoso, Sisca says, noting the absence of ward stratification (based on national insurance membership and the ability to pay) that plagues some sectors of the Indonesian healthcare system. “There’s no discrimination based on status.”
They should be proud of Dr Anthony, too. “He is still very young, super humble, and everyone talks about how smart he is,” Sisca says.
As for his father, chance was not quite done with Sisca and Dr Hendra. On 1 June Sisca was in Surabaya in East Java to attend a national neurology conference. She was having breakfast in her hotel when she noticed a familiar face among the guests. When he recognized her, Dr Hendra sat down at her table and the two of them enjoyed breakfast together.
“He even got me an omelette and said I had to eat more protein, and I fetched him more vegetables and salad,” she laughs, recalling these small courtesies between two strangers on a plane whose chance meeting may have been something more than a coincidence.
