Infrastructural Limitations in Establishing Neurosurgical Specialty Services in Liberia

Abstract

IntroductionLiberia recently employed the first neurosurgeon in the country's history. In a country with a population of 4.7 million people and staggering rates of cranial and spine trauma, as well as hydrocephalus and neural tube defects, neurosurgery is considered a luxury. Our study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, we aim to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty practice in Liberia. MethodsOur institutions, in collaboration with the Korle-Bu Neuroscience Foundation, spent 10 days in Liberia, based in Tappita, and performed 18 surgeries in addition to seeing several hundred clinic patients. This is a retrospective review of the cases performed along with outcomes to investigate obstacles in providing neurosurgical services in the country. ResultsBefore arriving in Liberia, we evaluated, planned, and supplied staff and materials for treating complex neurosurgical patients. Sixteen patients underwent 18 surgeries at a hospital in Tappita, Liberia, in November 2018. Their ages ranged from 1 month to 72 years (average 20 years). Five patients (28%) were female. Ten patients (56%) were under the age of 18. Surgeries included ventriculoperitoneal shunting (VPshunt), lumbar myelomeningocele repair, encephalocele repair, laminectomy, and a craniotomy for tumor resection. Ten patients (55%) underwent VP-shunting. Two patients (11%) had a craniotomy for tumor resection. Three patients (17%) had laminectomy for lumbar stenosis. Two patients (11%) had repair of lumbar myelomeningocele. ConclusionAfter an aggressive and in-depth approach to planning, conducting, and supplying complex neurosurgical procedures in Liberia, the greatest limiting factor to successful outcomes lie in real-time is access to health care, which is largely limited by overall infrastructure. Our study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, we aim to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty procedural practice in the country of Liberia. Most notably, we focus on infrastructure factors, including power, roads, water, education, and overall health care.

Current trends and challenges: The landscape of perioperative mortality in intracranial surgeries in low‐ and middle‐income settings: A narrative review

“…Policymakers should devise fiscal strategies to alleviate neurosurgical healthcare costs, ensuring equitable access across socioeconomic lines. Investing in improved transportation infrastructure can expedite patient journeys to neurosurgical centers, reducing surgical delays, and alleviating financial burdens 11 . Socioeconomic factors significantly impact health outcomes, such as perioperative intracranial mortality, and can impede early abnormality detection and prompt neurosurgical intervention.…”

“…Strengthening healthcare systems in LMICs necessitates ensuring adequate resources for vital infrastructure, including operating rooms, imaging facilities, and essential neurological instruments 11,32 . Enhancing surgical skills and safety through the adoption of standardized protocols and guidelines is paramount.…”

“…Such limitations restrict the timely and appropriate execution of surgical interventions, thereby exacerbating POM associated with intracranial surgeries. 4,6,9,11,12 Furthermore, limited follow-up care and substandard preoperative preparation contribute to the management gaps of intracranial surgeries in LMICs. Inadequate postoperative monitoring and access to rehabilitation services often lead to suboptimal recovery and an increased risk of complications.…”

“…For instance, HICs boast a significantly higher per capita ratio of computed tomography (CT) scanners, contributing to diagnostic delays in intracranial hemorrhage identification and subsequent treatment in LMICs 10 . Additionally, the scarcity of trained neurosurgeons is strikingly apparent in LMICs, with the deficit most pronounced in Africa 9,11 . The notably fewer neurosurgeons per capita in LMICs result in delays and compromised delivery of neurosurgical care.…”

“…The notably fewer neurosurgeons per capita in LMICs result in delays and compromised delivery of neurosurgical care. Compounding these issues, the late presentation of neurosurgical pathologies complicates intracranial disease management, subsequently increasing morbidity and mortality rates 4,6,11,12 . These challenges in LMICs are amplified by limited resources, underdeveloped infrastructure, and the lack of educational materials and training programs.…”