Neurosurgery in Tanzania: A Discussion of Culture, Socioeconomics, and Humanitarians

Kinasha, Abednego; Kucia, Elisa J.; Vargas, Jan; Kavolus, Joseph J.; Magarik, Jordan A.; Ellegala, Dilantha B.; Nicholas, Joyce S.

doi:10.1016/j.wneu.2011.06.008

Cited by 14 publications

(7 citation statements)

References 2 publications

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“…The nation's gross domestic product in 2011 was estimated to be $64.71 billion, with a reported per capita income of $1500. [1027] According to the WHO estimates, Tanzania spends $57 per person per year on health as compared with US expenditure $7,960 per person per year. There are very few neurosurgeons; according to our information, five neurosurgeons for a population of 44 million; and according to a published report, 1 neurosurgeon per 12.8 million inhabitants,[41] and almost all are practicing in the city of Dar es Salam.…”

Section: Discussionmentioning

confidence: 99%

Craniocerebral injury by penetration of a T-shaped metallic spanner: A rare presentation

Kazim

Bhatti²,

Godil³

2013

Surg Neurol Int

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Background:Craniocerebral injuries caused by penetration of metallic foreign bodies present a significant challenge to neurosurgeons as an extensive surgery may be required, leading to high morbidity and mortality.Case Description:We describe a unique case of penetrating brain injury (PBI) caused by a T-shaped metallic spanner in an assault victim. The patient presented with profuse bleeding from the scalp and necrotic brain tissue evident at the point of entry of the retained short arm of the spanner. Skull X-ray and head computerized tomography (CT) revealed the short arm of spanner penetrating the left parieto-occipital lobe of the brain, extending up to the contralateral occipital lobe. Safe removal of the retained spanner was achieved with a craniectomy and durotomy. Postoperative CT revealed no residual metallic foreign body, and patient had a good functional and neurological outcome at six months’ follow up.Conclusion:To the best of our knowledge, the successful surgical treatment of a PBI caused by a similar metallic object has not been reported in scientific literature previously. The case is also unique considering the fact that it was managed within the medical and diagnostic constraints of an East African country.

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Section: Discussionmentioning

confidence: 99%

Craniocerebral injury by penetration of a T-shaped metallic spanner: A rare presentation

Kazim

Bhatti²,

Godil³

2013

Surg Neurol Int

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“…4,44 In many developing countries, the expansion of subspecialty neurosurgical care is assisted by a combination of nonprofit organizations, the sustained presence of visiting teams, and both in-and out-of-country training. 1,10,17,26,35,46 Providing a neurosurgeon with the technical training to perform a procedure is insufficient. To successfully establish an epilepsy surgery program, epileptologists, EEG technologists, nurses, and biomedical support team members must all receive additional training.…”

Section: Multidisciplinary Program Development and Training Modelmentioning

confidence: 99%

Surgical treatment of epilepsy in Vietnam: program development and international collaboration

Rocque¹,

Davis²,

McClugage³

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe purpose of this report was to describe an international collaboration model to facilitate the surgical treatment of children with epilepsy in Vietnam.METHODSThis model uses three complementary methods to achieve a meaningful expansion in epilepsy surgery capacity: US-based providers visiting Hanoi, Vietnam; Vietnamese providers visiting the US; and ongoing telecollaboration, including case review and real-time mentorship using internet-based communication platforms.RESULTSIntroductions took place during a US neurosurgeon’s visit to Vietnam in 2014. Given the Vietnamese surgeon’s expertise in intraventricular tumor surgery, the focus of the initial visit was corpus callosotomy. After two operations performed jointly, the Vietnamese surgeon went on to perform 10 more callosotomy procedures in the ensuing 6 months with excellent results. The collaborative work grew and matured in 2016–2017, with 40 pediatric epilepsy surgeries performed from 2015 through 2017. Because pediatric epilepsy care requires far more than neurosurgery, teams traveling to Vietnam included a pediatric neurologist and an electroencephalography (EEG) technologist. Also, in 2016–2017, a neurosurgeon, two neurologists, and an EEG nurse from Vietnam completed 2- to 3-month fellowships at Children’s of Alabama (COA) in the US. These experiences improved EEG capabilities and facilitated the development of intraoperative electrocorticography (ECoG), making nonlesional epilepsy treatment more feasible. The final component has been ongoing, i.e., regular communication. The Vietnamese team regularly sends case summaries for discussion to the COA epilepsy conference. Three patients in Vietnam have undergone resection guided by ECoG without the US team present, although there was communication via internet-based telecollaboration tools between Vietnamese and US EEG technologists. To date, two of these three patients remain seizure free. The Vietnamese team has presented the results of their epilepsy experience at two international functional and epilepsy surgery scientific meetings.CONCLUSIONSOngoing international collaboration has improved the surgical care of epilepsy in Vietnam. Experience suggests that the combination of in-country and US-based training, augmented by long-distance telecollaboration, is an effective paradigm for increasing the capacity for highly subspecialized, multidisciplinary neurosurgical care.

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“…Advancement toward specialized care in Tanzania began in 1971, when orthopedic and trauma services were established at the Muhimbili Hospital. 12 Spine and head trauma services were originally carried out by expatriate orthopedic surgeons from Cuba, China, and the Union of Soviet Socialist Republics. However, even as the incidence of nontraumatic neurosurgical case referrals to Muhimbili increased, a number of obstacles prevented advancement of the complexity of neurosurgical care.…”

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confidence: 99%

“…These included the lack of operative and diagnostic facilities, subspecialty training, and continuity of service due to the lack of a permanent neurosurgeon. 12 The 1980s brought change when the first Tanzanian citizens specialized in neurosurgery (trained abroad) returned to Tanzania to practice. This included pioneers such as Drs.…”

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confidence: 99%

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Overcoming barriers to neurosurgical training in Tanzania: international exchange, curriculum development, and novel methods of resource utilization and subspecialty development

Ormond

Kahamba

Lillehei

et al. 2018

Neurosurgical Focus

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Tanzania sits on the Indian Ocean in East Africa and has a population of over 53 million people. While the gross domestic product has been increasing in recent years, distribution of wealth remains a problem, and challenges in the distribution of health services abound. Neurosurgery is a unique case study of this problem. The challenges facing the development of neurosurgery in Tanzania are many and varied, built largely out of the special needs of modern neurosurgery. Task shifting (training nonphysician surgical providers) and 2-tiered systems (fast-track certification of general surgeons to perform basic neurosurgical procedures) may serve some of the immediate need, but these options will not sustain the development of a comprehensive neurosurgical footprint. Ultimately, long-term solutions to the need for neurosurgical care in Tanzania can only be fulfilled by local government investment in capacity building (infrastructure and neurosurgical training), and the commitment of Tanzanians trained in neurosurgery. With this task in mind, Tanzania developed an independent neurosurgery training program in Dar es Salaam. While significant progress has been made, a number of training deficiencies remain. To address these deficiencies, the Muhimbili Orthopedic Institute (MOI) Division of Neurosurgery and the University of Colorado School of Medicine Department of Neurosurgery set up a Memorandum of Understanding in 2016. This relationship was developed with the perspective of a “collaboration of equals.” Through this collaboration, faculty members and trainees from both institutions have the opportunity to participate in international exchange, join in collaborative research, experience the culture and friendship of a new country, and share scholarship through presentations and teaching. Ultimately, through this international partnership, mutual improvement in the care of the neurosurgical patient will develop, bringing programs like MOI out of isolation and obscurity. From Dar es Salaam, a center of excellence is developing to train neurosurgeons who can go well equipped throughout Tanzania to improve the care of the neurosurgical patient everywhere. The authors encourage further such exchanges to be developed between partnership training programs throughout the world, improving the scholarship, subspecialization, and teaching expertise of partner programs throughout the world.

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Neurosurgery in Tanzania: A Discussion of Culture, Socioeconomics, and Humanitarians

Cited by 14 publications

References 2 publications

Craniocerebral injury by penetration of a T-shaped metallic spanner: A rare presentation

Craniocerebral injury by penetration of a T-shaped metallic spanner: A rare presentation

Surgical treatment of epilepsy in Vietnam: program development and international collaboration

Overcoming barriers to neurosurgical training in Tanzania: international exchange, curriculum development, and novel methods of resource utilization and subspecialty development

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