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.
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.
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.”