Neurosurgery in East Africa: Innovations

Budohoski, Karol P.; Ngerageza, Japhet G.; Austard, Benedict; Fuller, Anthony T.; Galler, Robert; Haglund, Michael M.; Lett, Ronald; Lieberman, Isador H.; Mangat, Halinder S.; March, Karen; Olouch-Olunya, David; Piquer, José; Qureshi, Mahmood; Santos, Marcela de Souza; Schöller, Karsten; Shabani, Hamisi K.; Trivedi, Rikin; Young, Paul H.; Zubkov, Micaella; Härtl, Roger; Stieg, Philip E.

doi:10.1016/j.wneu.2018.01.085

Cited by 47 publications

(24 citation statements)

References 63 publications

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“…4,5 The global initiative Africa 100 was pioneered by Professor Majid Samii and was designed to increase the number of permanent practicing surgeons on the continent. 3 There has also been an increase in the number of South-South partnerships promoting the exchange of resources, technology, and knowledge between developing countries, exemplified by a large number of neurosurgeons practicing in Nepal after being trained in India. Under the aegis of the World Federation of Neurosurgical Societies (WFNS), many neurosurgeons in South Asia have undergone longand short-term training and fellowships in various subspecialties of neurosurgery in other countries, including Tur-key, India, and China.…”

Section: Discussionmentioning

confidence: 99%

Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education

Deora

Garg

Tripathi

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe evolution of the neurosurgical specialty in lower-middle-income countries is uniformly a narrative of continuous struggle for recognition and resource allocation. Therefore, it is not surprising that neurosurgical education and residency training in these countries is relatively nascent. Dr. Harvey Cushing in 1901 declared that he would specialize in neurosurgery and gave his greatest contribution to the advancement of neurosurgical education by laying the foundations of a structured residency training program. Similar efforts in lower-middle-income countries have been impeded by economic instability and the lack of well-established medical education paradigms. The authors sought to evaluate the residency programs in these nations by conducting a survey among the biggest stakeholders in these educational programs: the neurosurgical residents.METHODSA questionnaire addressing various aspects of the residency program from a resident’s perspective was prepared with Google Forms and circulated among neurosurgery residents through social media and email groups. Where applicable, a 5-point Likert scale was used to grade the responses to the questions. Responses were collected from May to October 2019 and analyzed using descriptive statistics. Complete anonymity of the respondents was ensured to keep the responses unbiased.RESULTSA total of 195 responses were received, with 189 of them from lower-middle-income countries (LMICs). The majority of these were from India (75%), followed by Brazil and Pakistan. An abiding concern among residents was lack of work hour regulations, inadequate exposure to emerging subspecialties, and the need for better hands-on training (> 60% each). Of the training institutions represented, 89% were offering more than 500 major neurosurgical surgeries per year, and 40% of the respondents never got exposure to any subspecialty. The popularity of electronic learning resources was discernible and most residents seemed to be satisfied with the existent system of evaluation. Significant differences (p < 0.05) among responses from India compared with those from other countries were found in terms of work hour regulations and subspecialty exposure.CONCLUSIONSIt is prudent that concerned authorities in LMICs recognize and address the deficiencies perceived by neurosurgery residents in their training programs. A determined effort in this direction would be endorsed and assisted by a host of international neurosurgical societies when it is felt that domestic resources may not be adequate. Quality control and close scrutiny of training programs should ensure that the interests of neurosurgical trainees are best served.

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Section: Discussionmentioning

confidence: 99%

Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education

Deora

Garg

Tripathi

et al. 2020

Neurosurgical Focus

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“…The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. .303 21 24 .591 7 (6-12) 8 (7)(8)(9)(10)(11)(12)(13)(14) .193 33 40 .277…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

“…[6][7][8] Although neurosurgery has been developing in East Africa since the 1940s, it remains tertiary and expensive. 9 Both stabilization techniques and time to surgery for spinal trauma are largely unreported. Such information would not only allow for improvement in operative decision making but also provide direction for future policy, government collaboration, and research initiatives critical to mitigating the burden of spinal trauma.…”

Section: Introductionmentioning

confidence: 99%

Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Magogo

Lazaro

Mango

et al. 2020

Global Spine Journal

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Study Design: Retrospective case series. Objective: Little is known about operative management of traumatic spinal injuries (TSI) in low- and middle-income countries (LMIC). In patients undergoing surgery for TSI in Tanzania, we sought to (1) determine factors involved in the operative decision-making process, specifically implant availability and surgical judgment; (2) report neurologic outcomes; and (3) evaluate time to surgery. Methods: All patients from October 2016 to June 2019 who presented with TSI and underwent surgical stabilization. Fracture type, operation, neurologic status, and time-to-care was collected. Results: Ninety-seven patients underwent operative stabilization, 23 (24%) cervical and 74 (77%) thoracic/lumbar. Cervical operations included 4 (17%) anterior cervical discectomy and fusion with plate, 7 (30%) anterior cervical corpectomy with tricortical iliac crest graft and plate, and 12 (52%) posterior cervical laminectomy and fusion with lateral mass screws. All 74 (100%) of thoracic/lumbar fractures were treated with posterolateral pedicle screws. Short-segment fixation was used in 86%, and constructs often ended at an injured (61%) or junctional (62%) level. Sixteen (17%) patients improved at least 1 ASIA grade. The sole predictor of neurologic improvement was faster time from admission to surgery (odds ratio = 1.04, P = .011, 95%CI = 1.01-1.07). Median (range) time in days included: injury to admission 2 (0-29), admission to operating room 23 (0-81), and operating room to discharge 8 (2-31). Conclusions: In a cohort of LMIC patients with TSI undergoing stabilization, the principle driver of operative decision making was cost of implants. Faster time from admission to surgery was associated with neurologic improvement, yet significant delays to surgery were seen due to patients’ inability to pay for implants. Several themes for improvement emerged: early surgery, implant availability, prehospital transfer, and long-term follow-up.

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“…The Neurosurgical Training Program of East Africa led by Moody Qureshi from Kenya and approved through the College of Surgeons of East, Central, and Southern Africa (COSECSA) has developed neurosurgery training programs in Ethiopia, Kenya, Tanzania, and Uganda. 6 Our group, Duke Global Neurosurgery and Neurology (DGNN), helps support the Uganda program, which started in 2009, and to date we have been able to train 5 Ugandans to become neurosurgeons, graduated the first woman neurosurgeon this past year, and have 6 more residents in the program. 27 In Ethiopia, the neurosurgery training program has been incredibly successful at increasing the number of neurosurgeons and the number of neurosurgery cases performed and has been supported since 2004 through a partnership between the University of Bergen, Haukeland University Hospital, the Black Lion Specialized Hospital, and a private hospital in Addis Ababa.…”

Section: Training (Increase the Number Of Neurosurgeons)mentioning

confidence: 99%

Global neurosurgery: innovators, strategies, and the way forward

Haglund

Fuller

2019

Journal of Neurosurgery

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Around the world today, low- and middle-income countries (LMICs) have not benefited from advancements in neurosurgery; most have minimal or even no neurosurgical capacity in their entire country. In this paper, the authors examine in broad strokes the different ways in which individuals, organizations, and universities engage in global neurosurgery to address the global challenges faced in many LMICs. Key strategies include surgical camps, educational programs, training programs, health system strengthening projects, health policy changes/development, and advocacy. Global neurosurgery has begun coalescing with large strides taken to develop a coherent voice for this work. This large-scale collaboration via multilateral, multinational engagement is the only true solution to the issues we face in global neurosurgery. Key players have begun to come together toward this ultimate solution, and the future of global neurosurgery is bright.

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Neurosurgery in East Africa: Innovations

Cited by 47 publications

References 63 publications

Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education

Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education

Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Global neurosurgery: innovators, strategies, and the way forward

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