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How Direct Relief and Boehringer Ingelheim Brought Advanced Stroke Treatment to 30 Low-Income Countries Around the Globe
Working with the World Stroke Organization and Angel’s Initiative, Direct Relief builds network of hospital partners reducing death and disability from strokes
Mick Dhom Mayenga, pictured here at a hospital in Brazzaville, Republic of Congo, was paralyzed on his left side. He received a donated treatment from Direct Relief and Boehringe Ingelheim and has regained range of movement. (Image courtesy of Centre Hospitalier Universitaire de Brazzaville)
Mick Dhom Mayenga lay on the hospital stretcher, unable to move his left arm or leg. He was only 33 years old and had two small children to provide for, yet a stroke had left him completely paralyzed on his left side and struggling to speak clearly.
He feared the worst. “Here in Africa, when you have a stroke, it’s over for you. You are never standing again,” he said. “My family, my little family, depends on me.”
Until recently, his fate would have been grim. But doctors at Centre Hospitalier Universitaire de Brazzaville in the Republic of Congo had just received their first donation from Direct Relief and Boehringer Ingelheim of alteplase, an effective medicine that can dissolve blood clots blocking blood flow to the brain (the main cause of most strokes), reducing the risk of long-term impairment.
In a video taken two months after his stroke, Mayenga moves his left arm and leg freely, lifts a jug with more than 20 lbs. of water up and down, and carries it in his left hand as he walks past his children. “Really, it saved my life, and my family too,” he said. “It was something magnificent.”
“Direct Relief’s donation of alteplase has revolutionized stroke management in the Congo,” the Brazzaville hospital reported in a survey. “We are so grateful.” The first four patients to be treated were all evaluated post-treatment as either completely symptom-free or remaining functionally independent despite having minimal symptoms, the hospital reported.
In one of the more complex programs in its 77-year history, Direct Relief partnered with Boehringer Ingelheim to donate more than 37,000 vials of alteplase to 38 healthcare partners in 30 countries, including Bangladesh, Cambodia, Chad, Republic of the Congo, Democratic Republic of the Congo, Ethiopia, The Gambia, Ghana, India, Jordan, Mongolia, Papua New Guinea, St. Vincent & the Grenadines, Sudan, Syria, Ukraine, Zambia and others.
Before and after video: Mick Dhom Mayenga paralyzed on his left side after his stroke in Brazzaville, Republic of Congo, and two months later after treatment with alteplase. (Video credit: Centre Hospitalier Universitaire de Brazzaville)
Among non-communicable disorders, stroke is the second leading cause of death and the third leading cause of death and disability combined. The overwhelming majority of the global stroke burden – 87% of deaths and 89% of disability-adjusted life-years (DALYs) lost – occurs in low-income and low-middle-income countries, the World Stroke Organization (WSO) says in its Global Stroke Fact Sheet 2025. Between 1990 and 2021, stroke incidence rose by 70%, stroke deaths by 44%, and DALYs lost by 32%.
Direct Relief hadn’t previously donated stroke medicine, so it had to build a mostly new network of partners capable of providing the treatment. Administering alteplase requires a high level of medical capabilities. The medicine must be administered within 4.5 hours of a stroke, according to the approved label. The hospital must have brain imaging (MRI or CT scan) equipment to confirm and evaluate the nature of the stroke. In many countries where Direct Relief sought to bring the medicine, only top academic or referral hospitals met the clinical requirements.
Direct Relief worked with the WSO to identify many of these facilities, establishing new relationships across Africa, Asia, and the Caribbean with top hospitals, and with national ministries of health that managed or helped arrange distribution in 10 nations. Among 13 institutions that responded to an initial survey of recipients, six said Direct Relief’s donation was the first time they had received a supply of the medicine.
“With initiatives like this and our Rare Diseases Program, Direct Relief is building the systems needed to deliver advanced medicines to people who otherwise would have no access to them,” said Direct Relief CEO Amy Weaver. “Each of these efforts moves us closer to a world where geography no longer determines access to care — where the best medical innovations reach everyone who can benefit from them.”
The program began in 2024 when Boehringer Ingelheim informed Direct Relief that, due to changing regulatory circumstances in the countries where it offers the drug, it had tens of thousands of vials of the medicine available for donation, and wanted to know whether Direct Relief was able to meet the complex requirements to distribute it.
“While this donation presented an immense opportunity to expand our support of stroke care globally, we also recognized the complexity and scope of the work ahead,” said Neesha Rao, Associate Director, Access to More Health, Boehringer. “We are deeply grateful for the expertise and unwavering commitment that Direct Relief brought to meet these challenges. Every story we receive about how this endeavor has made a difference—for patients, their families, and healthcare providers—is a cause for celebration.”
Direct Relief doesn’t simply take donated medicines and ship them out, hoping that recipients will find a use for them. It only donates medicines to partners who have specifically requested them and have a proven ability to manage and administer the drugs properly. Recipients must comply with standards for tracking the storage, distribution, and disposal of each batch of medicine. Direct Relief only ships medicine with enough remaining shelf-life to comply with standards in recipient countries.
Building Capacity
Another key participant in the effort was Angel’s Initiative, a Boehringer Ingelheim nonprofit initiative dedicated to improving stroke patients’ chances of survival and living a disability-free life. Angel’s Initiative creates “stroke-ready hospitals,” helping hospitals adopt and drill staff in proven stroke treatment protocols, emphasizing rapid and standardized response. The organization helped Direct Relief identify hospitals capable of administering the medicine and provided online stroke training courses to recipients.
“We’ve demonstrated that donating this type of medicine is completely possible, and on the way we’ve built relationships with the WSO and Angel’s Initiative, we’ve broadened our own partner network quite significantly, and we’re offering stroke care training to every partner that receives this donation,” said Direct Relief’s Eleni Brauner, who arranged the donation from Boehringer Ingelheim and led the global distribution effort. “This is a long-term healthcare systems strengthening exercise catalyzed by a donation.”
For Direct Relief’s Regional Director for Africa, Jeffrey Samuel, the relationships with ministries of health and top academic hospitals that he helped establish over the past year for the alteplase donation created a pipeline for the increasing volume of highly specialized medicine donations Direct Relief receives.
Ministries of health offer geographic reach that individual hospitals often lack, as well as the ability to align with evolving regulatory systems that safeguard the quality of medicines entering their countries. “As health systems strengthen across Africa, it’s vital that our partnerships evolve with them,” Samuel said. “By working more closely with governments, we can help ensure that patients everywhere — regardless of where they live — have access to the advanced treatments they need.”
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