Practical Challenges and Perspectives for the Development of Neurosurgery in a Peripheral East African Hospital During a One-Volunteer Midterm Mission

Spanu, Fabio; Piquer, José; Panciani, Pier Paolo; Qureshi, Mahmood

doi:10.1016/j.wneu.2017.12.146

Cited by 8 publications

(13 citation statements)

References 13 publications

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“…29,30 Also studies were reported in collaboration with European universities such as Norwegian universities in Ethiopia 19 and Italian and/or Spanish universities in East Africa. 31 Moreover, China also has African collaborations, such as in Ghana. 32 These are only a few examples of the work performed in Africa by many institutions.…”

Section: Reports From Lics and Lmicsmentioning

confidence: 99%

Footprint of Reports From Low- and Low- to Middle-Income Countries in the Neurosurgical Data: A Study From 2015 to 2017

et al. 2019

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In 2015, the Lancet Commission on Global Surgery highlighted the disparities in surgical care worldwide. The aim of the present study was to investigate the research productivity of low-income countries (LICs) and low-to middle-income countries (LMICs) in selected journals representing the worldwide neurosurgical data and their ability to report and communicate globally the existing differences between high-income countries (HICs) and LMICs.-METHODS: We performed a retrospective bibliometric analysis using PubMed and Scopus databases to record all the reports from 2015 to 2017 by investigators affiliated with neurosurgical departments in LICs and LMICs.-RESULTS: A total of 8459 reports by investigators selfidentified as members of neurosurgery departments worldwide were identified. Of these, 6708 reports were included in accordance with our method in the final analysis. The systematic search resulted in 459 studies reported by LICs and LMICs. Of these, 334 reports were included for the full text evaluation. Of the 6708 reports, 303 (4.52%) had been reported with an LMIC affiliation and only 31 (0.46%) with an LIC. The leading countries were India with 182 (54.5% among LMICs and LICs; 2.71% overall), followed by Egypt at 66 (19.76% among the LMICs and LICs; 0.98% overall), with a large difference compared with other countries such as Uganda at 9 (2.69% among the LMICs and LICs) and Tunisia and Pakistan at 8 each (2.4% among the LMICs and LICs). A few reports studies had been generated by collaboration with HIC neurosurgeons.-CONCLUSIONS: Our results have shown that research studies from LMICs are underrepresented. Understanding and discussing the reasons for this underrepresentation are necessary to start addressing the disparities in neurosurgical research and care capacity. Future engagements from international journals, more partnership collaboration from HICs, and tailored funding to support investigators, collaborations, and networks could be of help.

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Section: Reports From Lics and Lmicsmentioning

confidence: 99%

Footprint of Reports From Low- and Low- to Middle-Income Countries in the Neurosurgical Data: A Study From 2015 to 2017

et al. 2019

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“…14 Ideally, long-term collaborations should serve as the foundation to achieve improvement not only in neurosurgery but also in anesthesia, critical care, rehabilitation, and oncology. 32,36 The NED Foundation conducted multiple missions over the last decade that have led to a long-term educational collaboration, focused not only on neurosurgical care but also on neurosurgery-related disciplines. Among other initiatives, they have developed an intensive care unit for critical patient care that allows the local hospital to increase the complexity of neurosurgical cases.…”

Section: Difficulties and Limitations Of The Different Modelsmentioning

confidence: 99%

“…Among other initiatives, they have developed an intensive care unit for critical patient care that allows the local hospital to increase the complexity of neurosurgical cases. 36 Another example is the collaboration between Duke University and New Mulago Hospital in Uganda, where not only academic but also infrastructure improvement has occurred as a result of this partnership. 15 The possibilities of long-distance education via the Internet offer opportunities for continued education, especially during the periods between missions.…”

Section: Difficulties and Limitations Of The Different Modelsmentioning

confidence: 99%

Global neurosurgery: models for international surgical education and collaboration at one university

Almeida

Velásquez

Karekezi

et al. 2018

Neurosurgical Focus

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OBJECTIVEInternational collaborations between high-income (HICs) and low- and middle-income countries (LMICs) have been developed as an attempt to reduce the inequalities in surgical care around the world. In this paper the authors review different models for international surgical education and describe projects developed by the Division of Neurosurgery at the University of Toronto in this field.METHODSThe authors conducted a review of models of international surgical education reported in the literature in the last 15 years. Previous publications on global neurosurgery reported by the Division of Neurosurgery at the University of Toronto were reviewed to exemplify the applications and challenges of international surgical collaborations.RESULTSThe most common models for international surgical education and collaboration include international surgical missions, long-term international partnerships, fellowship training models, and online surgical education. Development of such collaborations involves different challenges, including limited time availability, scarce funding/resources, sociocultural barriers, ethical challenges, and lack of organizational support. Of note, evaluation of outcomes of international surgical projects remains limited, and the development and application of assessment tools, such as the recently proposed Framework for the Assessment of International Surgical Success (FAIRNeSS), is encouraged.CONCLUSIONSActions to reduce inequality in surgical care should be implemented around the world. Different models can be used for bilateral exchange of knowledge and improvement of surgical care delivery in regions where there is poor access to surgical care. Implementation of global neurosurgery initiatives faces multiple limitations that can be ameliorated if systematic changes occur, such as the development of academic positions in global surgery, careful selection of participant centers, governmental and nongovernmental financial support, and routine application of outcome evaluation for international surgical collaborations.

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“…Moreover, the ICP methodology needs to keep realistic expectations about the degree to which local practitioners are willing to change their practice. 22 Intervention by the foreign team needs to be conducted with caution and respect, aiming to guide local physicians toward safer practices, while avoiding dominance, condescension, or the perpetration of deleterious cycles of dependence. Introducing smaller, progressive changes over time has true potential to improve the local situation, instead of major policy changes that threaten the status quo.…”

Section: Considerations When Designing An Icp: the Integrative Modelmentioning

confidence: 99%

“…Since the establishment of the NED Institute (NEDI) in Zanzibar in 2014, 10 the NEDF has focused on consolidating an autonomous neurosurgical center. 20,22 The NEDI hosts monthly surgical camps, organizes international academic activities, and is a potential center for training African residents.…”

mentioning

confidence: 99%

The challenges and opportunities of global neurosurgery in East Africa: the Neurosurgery Education and Development model

Leidinger¹,

Extremera

Kim³

et al. 2018

Neurosurgical Focus

Self Cite

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OBJECTIVEThe objective of this study was to describe the experience of a volunteering neurosurgeon during an 18-week stay at the Neurosurgery Education and Development (NED) Institute and to report the general situation regarding the development of neurosurgery in Zanzibar, identifying the challenges and opportunities and explaining the NED Foundation’s model for safe practice and sustainability.METHODSThe NED Foundation deployed the volunteer neurosurgeon coordinator (NC) for an 18-week stay at the NED Institute at the Mnazi Mmoja Hospital, Stonetown, Zanzibar. The main roles of the NC were as follows: management of patients, reinforcement of weekly academic activities, coordination of international surgical camps, and identification of opportunities for improvement. The improvement opportunities were categorized as clinical, administrative, and sociocultural and were based on observations made by the NC as well as on interviews with local doctors, administrators, and government officials.RESULTSDuring the 18-week period, the NC visited 460 patients and performed 85 surgical procedures. Four surgical camps were coordinated on-site. Academic activities were conducted weekly. The most significant challenges encountered were an intense workload, deficient infrastructure, lack of self-confidence among local physicians, deficiencies in technical support and repairs of broken equipment, and lack of guidelines. Through a series of interviews, the sociocultural factors influencing the NED Foundation’s intervention were determined. Factors identified for success were the activity of neurosurgical societies in East Africa; structured pan-African neurosurgical training; the support of the Foundation for International Education in Neurological Surgery (FIENS) and the College of Surgeons of East, Central and Southern Africa (COSECSA); motivated personnel; and the Revolutionary Government of Zanzibar’s willingness to collaborate with the NED Foundation.CONCLUSIONSInternational collaboration programs should balance local challenges and opportunities in order to effectively promote the development of neurosurgery in East Africa. Support and endorsement should be sought to harness shared resources and experience. Determining the caregiving and educational objectives within the logistic, administrative, social, and cultural framework of the target hospital is paramount to success.

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Practical Challenges and Perspectives for the Development of Neurosurgery in a Peripheral East African Hospital During a One-Volunteer Midterm Mission

Cited by 8 publications

References 13 publications

Footprint of Reports From Low- and Low- to Middle-Income Countries in the Neurosurgical Data: A Study From 2015 to 2017

Footprint of Reports From Low- and Low- to Middle-Income Countries in the Neurosurgical Data: A Study From 2015 to 2017

Global neurosurgery: models for international surgical education and collaboration at one university

The challenges and opportunities of global neurosurgery in East Africa: the Neurosurgery Education and Development model

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