Global Neurosurgery Committee

Visiting Moroccan Neurosurgeon in the Democratic Republic of Congo

Author: Ulrick S. Kanmounye

Three of the seven Congolese Neurosurgeons have been trained in Morocco and currently there are four Congolese residents in Moroccan neurosurgery programmes.

Since their return, the three Morocco-trained neurosurgeons have been working in the western neurosurgical zone. This zone has a population of 26,644,000 people and a surface area of 359,543 square meters. The western zone is the third largest and second most populated neurosurgical zone in the DRC, it is home to the capital city and to two of the biggest neurosurgical centres in the country – the Ngaliema Clinic of Dr Jeff Ntalaja and the Kinshasa University Clinic of Pr Glennie Ntsambi. Dr Ntalaja and Pr Ntsambi, together with the visiting neurosurgeon, Pr Adyl Melhaoui, operated on an aneurysm of the anterior communicating artery and a voluminous 6 cm temporal meningioma.

These are surgeries for which Congolese patients have had to travel abroad in order to be operated. Unfortunately, very few patients can afford these operations abroad and the lack of appropriate care has led to the death of most patients. The main reason these procedures have not been available locally has been the lack of equipment. Fortunately, with the help of various partners this has gradually changed since 2013.

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The operations took place on Saturday, 18th August, 2018 at the Ngaliema Clinic’s surgery centre. A few weeks before the interventions, Pr Melhaoui (radiosurgery specialist and treasurer of the Moroccan Neurosurgical Society) and Dr Ntalaja chose the cases and decided on the operating plan.

The first operation was the anterior communicating artery aneurysm with Pr Melhaoui as lead surgeon, Pr Ntsambi and Dr Ntalaja as assistants. Then the second surgery (meningioma of the convexity) had Pr Melhaoui as lead surgeon, Dr Ntalaja and Dr Ngamasata as assistants. After both surgeries, Pr Melhaoui expressed his satisfaction with the surgical team, anaesthesia team, circulating nurses and equipment. He then met the acquaintances of the patients and discussed the operative and post-operative phases. The neurosurgeons then went on to discuss conditions for future surgeries and collaborations. Both teams agreed that for a start, the local team needed to
continue operating less complex surgeries so as to minimise the risks and gain experience. As a result, it was decided that the host team would take on similar surgeries only after consulting the visiting professor.

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Exchange of technology and skill is capital to the development of global neurosurgery both for the visiting and the hosting team. By exchanging reciprocally and indiscriminately, both teams learn valuable skills and information from each other. Therefore, it is especially important that surgeons from more advanced countries understand the cultural, medical, financial and social contexts in host Low and Middle Income Countries. This is made easy if there is a long-standing relationship between both teams.

Also, visiting neurosurgeons should keep in mind that prior to their visit, host neurosurgeons fought hard to improve the lives and health of their patients and themselves. On the other hand, host neurosurgeons of less advanced countries have to put aside apprehensions and ego in order to learn from their colleagues. It is capital that they keep an open mind and that they give honest feedback to the visiting team. Finally, for both teams, the biggest challenge is to perennialise all that was acquired and built during the visit.

In Dr Kee Park’s words, global neurosurgery “is not so much about how to perform surgery better… it is about how to better provide neurosurgical care to those that need it.”

Global Neurosurgery 2019: A Practical Symposium

Please join us at the “Global Neurosurgery 2019: A Practical Symposium,” hosted by Weill Cornell Medical College in New York on the 18th and 19th of January 2019.

This symposium will bring together neurosurgeons and health policy leaders from around the world who are involved in the training and education of neurosurgeons in developing countries. These assembled leaders will review the current status of neurosurgery in developing countries and the neurosurgical support coming from North America and Europe, identify key factors for success in overcoming barriers for the development of sustainable global neurosurgery models, identify key failures, and identify ways for neurosurgery health care providers to get involved in a meaningful way.

There is significant limitation in education, training and access to neurosurgery on a global scale which results in unnecessary morbidity and mortality from neurosurgical conditions. This leads to a critical public health concern in many developing countries. The paucity of neurosurgical care in developing countries leads to significant morbidity and mortality. While most historical global health initiatives have focused on improving primary care outcomes and access, more recent efforts have focused on surgical access. Over the past 5 to 10 years, there has been an increase in multi-institutional collaborations focusing on the prevalence of neurosurgical conditions, current outcomes, and creating educational training programs that lead to sustainable change. The majority of this work is taking place in Haiti and Tanzania, and there is now published data to support the need and potential success of these programs. The rates of neurosurgical disorders in these locations has been found to be as high as 16%, with a mortality rate as high as 33%. Both the Tanzania and Haiti experiences demonstrated significant increase in number and success of neurosurgical cases.

While significant progress has been made, there are still barriers to more widespread access, incomplete assessment of the success of independent, locally-performed surgeries following these programs, and a need to define future directions and methods to broaden the scope of these initiatives. We therefore plan to draw upon the existing data and bring together the groups involved in prior and current initiatives to identify keys to success and strategic plans to collaborate and work through barriers to increase sustainable access to neurosurgery through local training to improve outcomes and global public health.

This symposium will consist of lectures imparting the existing experience and state of global health in neurosurgery, review of barriers, group interaction to develop strategic plans by region, review of funding opportunities and sources, closing with future directions and definition of metrics for success.

For more information on the symposium, please visit the website.

Incision— The Present and Future of Global Surgery

The report published by the Lancet commission on global surgery (LCoGS) in 2015 which revealed that 5 billion people globally lack access to safe surgical and anesthesia care changed the perspective of Global health. Following that, the World Health Organization (WHO) in the 68th World Health Assembly adopted a resolution (WHA68.15) “Strengthening Emergency and Essential Surgical and Anesthesia Care as a component of universal health coverage (UHC)”. The resolution encouraged member states to put more attention in improving surgical and anesthesia care especially in developing countries.

The global surgery movement has been gaining a lot of attention of lately and the community has been growing. Several organizations have been established and important and strategic partnerships have been formed to further improve access to safe surgical care in all possible ways to those who need it the most.

One of such organizations is Incision – The International student surgical network, which is a new organization solely run by highly motivated medical students, residents and doctors around the world. It is a global network of medical students and young doctors advocating for, educating on and performing research in the field of Global Surgery. The Incision team is comprised of 40 members from over 30 countries. Some members of incision were involved in collecting and analyzing the 2016 World Development Index (WDI) surgical indicators for the World Bank with support from institutions such as the WHO, Kings College London and Harvard Medical School Program for Global Surgery and Social Change (PGSSC).

 

In November 2017, Incision in partnership with other organizations successfully organized the first ever Global Neurosurgery conference in Morocco where notable Global surgery leaders like Dr. Walt Johnson (Neurosurgeon & WHO lead on Emergency and Essential Surgical care), Dr. Kee Park (Neurosurgeon & Paul Farmer Global Surgery Scholar) and other prominent individuals around the world gave various enlightening lectures on the field of Global Surgery.

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That not being enough, incision will also partake in several important global surgery events this year.
Three of the events will take place this month (March).

 

The first event Incision will be involved in will be on March 6th/7th in Milan, Italy. The event titled “Surgical Equity: A challenge of our era”, and hosted by Nesta, will bring experts like Amb. Neil Parsan (President of The G4 Alliance), Tom Weiser (Associate Professor of Surgery, Stanford University), Emmanuel Makasa (Global Surgery Advocate and Consultant) and other important stakeholders together.

This event will hold workshops on:
• Postoperative Infections
• Safe Anesthetic Care
• Blood Banking and Transfusions
• Operating Theatre Technologies.

 

For more information on the first event “Surgical Equity: A challenge of our era”, visit the website at https://www.nesta.org.uk/blog/surgical-equity-challenge-our-era

 

The second event will be on the 9th of March 2018. Incision’s National Working Group in the USA, The Global Surgery Student Alliance (GSSA) will be organizing the second annual Global Surgery symposium in Houston. The previous global surgery symposium successfully organized by the GSSA was in Boston in March 2017.
The upcoming global surgery symposium in Houston is part of the Houston Global Health Collaborative (HGHC) conference titled GLOCAL. The event will feature prominent leaders in the field of global surgery like Dr. Ray Price who will be the Keynote speaker. The panel sessions will include:
• Sub-Specialties in Global Surgery
• Capacity-Building
• Pathways to Global Surgery Panel featuring the residents in Baylor College of Medicine (BCM).

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For more Information on the event and prominent speakers visit https://www.globalsurgerystudents.org/houston-symposium

 

The third and final event Incision will be involved with this month will be on March 15th at the Consortium of Universities for Global Health (CUGH) Global Surgery Satellite Session in New York. The CUGH satellite session on Disparities in Global Surgery: Building Systems and Networks through Collaboration will shed more light on several Global Surgery topics like:
• The Surgery Ecosystem in Global Health
• Surgery around the World: The Regional Context
• Transitioning from Trauma/Disaster Response toward Sustainable Surgical Care
• What’s Missing?
• Technology, Innovation and Research in Global Surgery

 

For more information on the CUGH 2018 Satellite Session please visit http://cugh2018.org/surgery

 

And also In May 2018, Incision will be organizing another international Global Surgery Symposium (IGSS) in the beautiful city of Leuven, Belgium. The speakers will be from 5 continents and attendees are expected from over 30 countries. It is going to be big and you can’t afford to miss out.

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Incision is also aiming for equity on all levels so that individuals from developing countries can attend the symposium.
Help Incision with travel scholarships for Low and Middle Income Country (LMIC) applicants by donating here https://www.gofundme.com/bringing-equity-into-surgery/

For more information on IGSS2018 watch this clip:

And also follow the event on twitter @IGSS_2018

 

The Global surgery community is louder than ever and this is just the beginning. Incision is playing an important role in involving the surgeons of the future. Everyone is encouraged to attend any of the conferences and symposiums.
And those who won’t be able to attend, a livestream link will be available and be shared with you all, and you can always keep up to date on various global surgery activities on social media by following these twitter accounts bellow:

@studentsurgnet
@gsurgstudents
@G4alliance
@surgerymatters
@GlobalNeuroSurg
@IGSS_2018
@CUGHnews
@DVervoort94
@ZinebBentounsi
@Keepark

 

Thank you!

Dr. Aliyu Ndajiwo.
Nigeria.
Incision Advocacy Team Member.
Twitter: @AliyuNdajiwo

Global Neurosurgery: The Way Forward

 

At the 2017 World Federation of Neurosurgical societies (WFNS) XVI. World Congress on Neurosurgery, Dr. Kee Park briefed the audience on Global Neurosurgery.

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In the lecture, Dr. Park who has been a leading figure in the global neurosurgery initiative called for more partnership and support from all relevant stakeholders in the field of global surgery in improving access to safe neurosurgical care for all. He also stressed on the importance of engaging surgical residents as well as medical students.

You can watch the video lecture below.

Global Neurosurgery: The Way Forward.

Reflections on developing pediatric neurosurgery in Sub-Saharan Africa

In the article published in the Journal of Neurosurgery, Dr. Leland Albright provides a thoughtful retrospective of the years he committed to developing Pediatric Neurosurgery in Sub-Saharan Africa.

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He wrote in the article, “In 2011, the World Bank estimated the population of Sub-Saharan Africa (SSA) to be 874,841,049, with 44% of the population being 1–14 years old (http://www.tradingeconomics.com/sub-saharan-africa/population-total-wb-data.html). Millions of children in SSA have hydrocephalus, spina bifida, and other common pediatric neurosurgical conditions.

Kijabe, Kenya, is a village of approximately 5000 people located 65 km northwest of Nairobi, at an altitude of 7220 feet within the Rift Valley Escarpment. It is home to Kijabe Hospital and was founded at that site by missionaries in 1915, because its elevation was too high for malaria-bearing mosquitoes. The hospital is a 283-bed general hospital under the auspices of the Africa Inland Church. Its consultant staff consists of approximately 20 Kenyan physicians and 20 expatriate medical missionary physicians.

Dr. Dick Bransford, a career missionary general surgeon, initiated pediatric neurosurgery (PNS) in Kijabe in 1997, when he began treating children with hydrocephalus and spina bifida. The number of those children increased steadily, and in 2001, Dr. Bransford inserted 119 ventriculoperitoneal shunts and closed 61 myelomeningoceles (MMCs). In 2002, he sent an email to me with the subject “Neurosurgeon Needed,” requesting help in the management of such children. I began going to Kijabe for 2–3 weeks most Januaries thereafter to teach and operate. My wife, Susan Ferson, a pediatric nurse practitioner, and I moved to Kijabe on September 1, 2010, to teach and to perform PNS. We ended our work there in January 2015. In this manuscript, I offer my reflections on developing PNS in Kenya and in SSA in general.”

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