Brain Surgery in the Bush: Adapting Techniques and Technology to Fit the Developing World

Vargas, Jan; Mayegga, Emanuel; Nuwas, Emmanuel; Ellegala, Dilantha B.; Kucia, Elisa J.; Nicholas, Joyce S.

doi:10.1016/j.wneu.2012.01.033

Cited by 22 publications

(17 citation statements)

References 8 publications

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“…The problem of African neurosurgery has been the focus of several recent publications. [56789] The outlook in Nigeria is even worse with about 27 neurosurgeons serving an estimated population of 170 million (ratio of 1:6.3 million). The African neurosurgeons are, almost exclusively, in urban centers.…”

Section: Introductionmentioning

confidence: 99%

Neurosurgery in rural Nigeria: A prospective study

Rabiu

Komolafe

2016

Journal of Neurosciences in Rural Practice

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Background:Africa has very few neurosurgeons. These are almost exclusively in urban centers. Consequently, people in rural areas, most of the African population, have poor or no access to neurosurgical care. We have recently pioneered rural neurosurgery in Nigeria.Objectives:This report details our initial experiences and the profile of neurosurgical admissions in our center.Methods:A prospective observational study of all neurosurgical patients managed at a rural tertiary health institution in Nigeria from December 2010 to May 2012 was done. Simple descriptive data analysis was performed.Results:A total of 249 males (75.2%) and 82 females (24.8%) were managed. The median age was 37 years (range: Day of birth – 94 years). Trauma was the leading cause of presentation with 225 (68.0%) and 35 (10.6%) having sustained head and spinal injuries, respectively. Operative intervention was performed in 54 (16.3%). Twenty-four (7.2%) patients discharged against medical advice, mostly for economic reasons. Most patients (208, 63.4%) had satisfactory outcome while 30 (9.1%) died.Conclusion:Trauma is the leading cause of rural neurosurgical presentations. There is an urgent need to improve access to adequate neurosurgical care in the rural communities.

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Section: Introductionmentioning

confidence: 99%

Neurosurgery in rural Nigeria: A prospective study

Rabiu

Komolafe

2016

Journal of Neurosciences in Rural Practice

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“…Managing hydrocephalus peri-and postoperatively is challenged by limits in neurosurgical manpower, supportive consultations, ICU capabilities, imaging technology, operative tools, and medications. 20,38,47,58,76 Government remuneration models also contribute unique challenges to conducting pediatric neurosurgery in the developing world. In Kenya for instance, the government's health care budget is $15/year per person, resulting in a large discrepancy between the capacity to treat and the ability to afford treatment.…”

Section: Major Challenges Limitations In Health Care Infrastructurementioning

confidence: 99%

“…Criticisms exist for medical missions that periodically provide care, as they can promote increased dependency on foreign aid and the disenfranchisement of local health care providers. 16,58,76 Another important issue is that of surgical follow-up, 76 as many surgical missions perform needed surgery, but continuity of care is compromised when a medical team leaves a country. Many of the international surgical initiatives for hydrocephalus to date have attempted to address the aforementioned issues by improving the longevity and continuity of local initiatives, providing training for local health professionals and fellowship programs for the next generation of local neurosurgeons, following up with patients, and crafting innovative interventions, such as ETV/CPC, that are ultimately more suitable to a developing nation's scarce resources.…”

Section: Ethics Of International Aidmentioning

confidence: 99%

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

Muir

Wang

Warf

2016

FOC

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OBJECTIVE Pediatric hydrocephalus is one of the most common neurosurgical conditions and is a major contributor to the global burden of surgically treatable diseases. Significant health disparities exist for the treatment of hydrocephalus in developing nations due to a combination of medical, environmental, and socioeconomic factors. This review aims to provide the international neurosurgery community with an overview of the current challenges and future directions of neurosurgical care for children with hydrocephalus in low-income countries. METHODS The authors conducted a literature review around the topic of pediatric hydrocephalus in the context of global surgery, the unique challenges to creating access to care in low-income countries, and current international efforts to address the problem. RESULTS Developing countries face the greatest burden of pediatric hydrocephalus due to high birth rates and greater risk of neonatal infections. This burden is related to more general global health challenges, including malnutrition, infectious diseases, maternal and perinatal risk factors, and education gaps. Unique challenges pertaining to the treatment of hydrocephalus in the developing world include a preponderance of postinfectious hydrocephalus, limited resources, and restricted access to neurosurgical care. In the 21st century, several organizations have established programs that provide hydrocephalus treatment and neurosurgical training in Africa, Central and South America, Haiti, and Southeast Asia. These international efforts have employed various models to achieve the goals of providing safe, sustainable, and cost-effective treatment. CONCLUSIONS Broader commitment from the pediatric neurosurgery community, increased funding, public education, surgeon training, and ongoing surgical innovation will be needed to meaningfully address the global burden of untreated hydrocephalus.

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“…Although this change in the practice of neurosurgery is likely better for patients, such technologically advanced tools in neurosurgery are expensive and not readily available to much of the world. Potentially, the symbiotic development of computers and neurosurgery in industrialized nations may inadvertently decrease the ability of future neurosurgeons to train neurosurgeons in low-technology environments and widen the "neurosurgical gap" between rich and poor countries (26,28). However, it is also possible that computational technologies will hold answers that help bridge gaps in neurosurgical knowledge around the world.…”

Section: Conclusion: Modern Neurosurgery In the Developing Worldmentioning

confidence: 99%