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Haji FA, Lepard JR, Davis MC, Lien ND, Can DDT, Hung CV, Thang LN, Rocque BG, Johnston JM. A model for global surgical training and capacity development: the Children's of Alabama-Viet Nam pediatric neurosurgery partnership. Childs Nerv Syst 2021; 37:627-636. [PMID: 32720077 DOI: 10.1007/s00381-020-04802-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Training capable and competent neurosurgeons to work in underserved regions of the world is an essential component of building global neurosurgical capacity. One strategy for achieving this goal is establishing longitudinal partnerships between institutions in low- and middle-income countries (LMICs) and their counterparts in high-income countries (HICs) utilizing a multi-component model. We describe the initial experience of the Children's of Alabama (COA) Global Surgery Program partnership with multiple Vietnamese neurosurgical centers. METHODS The training model developed by the COA Global Surgery Program utilizes three complementary and interdependent methods to expand neurosurgical capacity: in-country training, out-of-country training, and ongoing support and mentorship. Multiple Vietnamese hospital systems have participated in the partnership, including three hospitals in Hanoi and one hospital in Ho Chi Minh City. RESULTS During the 7 years of the partnership, the COA and Viet Nam teams have collaborated on expanding pediatric neurosurgical care in numerous areas of clinical need including five subspecialized areas of pediatric neurosurgery: cerebrovascular, epilepsy, neuroendoscopy for hydrocephalus management, craniofacial, and neuro-oncology. CONCLUSION Long-term partnerships between academic departments in LMICs and HICs focused on education and training are playing an increasingly important role in scaling up global surgical capacity. We believe that our multi-faceted approach consisting of in-country targeted hands-on training, out-of-country fellowship training at the mentor institution, and ongoing mentorship using telecollaboration and Internet-based tools is a viable and generalizable model for enhancing surgical capacity globally.
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Affiliation(s)
- Faizal A Haji
- Division of Neurosurgery, Kingston Health Sciences Centre, Kingston, Ontario, Canada. .,Department of Surgery, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Jacob R Lepard
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neurosurgery, Children's of Alabama Hospital, Birmingham, AL, USA
| | - Matthew C Davis
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neurosurgery, Children's of Alabama Hospital, Birmingham, AL, USA
| | - Nguyen Duc Lien
- Department of Neurosurgery, Viet Nam National Cancer Hospital, Hanoi, Vietnam
| | - Dang Do Thanh Can
- Department of Neurosurgery, Children's Hospital #2, Ho Chi Minh City, Vietnam
| | - Cao Vu Hung
- Department of Neurology, Viet Nam National Chrildren's Hospital, Hanoi, Vietnam
| | - Le Nam Thang
- Department of Neurosurgery, Viet Nam National Children's Hospital, Hanoi, Vietnam
| | - Brandon G Rocque
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neurosurgery, Children's of Alabama Hospital, Birmingham, AL, USA
| | - James M Johnston
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neurosurgery, Children's of Alabama Hospital, Birmingham, AL, USA
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Can DDT, Lepard JR, Tri TT, Van Duong T, Thuy NT, Thach PN, Johnston JM, Oakes WJ, Dong A T. The growth of pediatric neurosurgery in southern Vietnam and the first separation of pygopagus twins: case report. J Neurosurg Pediatr 2020; 25:445-451. [PMID: 31952040 DOI: 10.3171/2019.11.peds19291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/14/2019] [Indexed: 11/06/2022]
Abstract
Conjoined twins are a rare congenital abnormality with an estimated incidence of 1:50,000 pregnancies and 1:200,000 live births. Pygopagus twins are characterized by sacrococcygeal fusion that is commonly associated with perineal and spinal abnormalities. Management of this complex disease requires a well-developed surgical system with multidisciplinary capacity and expertise.A decade ago there were no dedicated pediatric neurosurgeons in southern Vietnam. This has changed within a few short years; there are now 10 dedicated pediatric neurosurgeons with continually expanding technical capacity. In August 2017 a multidisciplinary surgical and anesthetic team successfully separated female pygopagus twins with fused sacrum and spinal cord with associated myelomeningocele defect.The authors present here the first successful separation of pygopagus twins in Vietnam as a representative case of gradual and sustainable pediatric neurosurgical scale-up.
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Affiliation(s)
- Dang D T Can
- 1Neurosurgical Department, Children's Hospital 2, and
- 9University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Jacob R Lepard
- 1Neurosurgical Department, Children's Hospital 2, and
- 2Department of Neurological Surgery, University of Alabama at Birmingham
- 8Harvard Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Tran T Tri
- 4Pediatric Surgery Department, Children's Hospital 2, Ho Chi Minh City
| | - Tran Van Duong
- 5Plastic Surgery Department, Cho Ray Hospital, Ho Chi Minh City
| | | | - Pham N Thach
- 7Urology Department, Children's Hospital 2, Ho Chi Minh City, Vietnam; and
| | - James M Johnston
- 2Department of Neurological Surgery, University of Alabama at Birmingham
- 3Section of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama
| | - W Jerry Oakes
- 2Department of Neurological Surgery, University of Alabama at Birmingham
- 3Section of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama
| | - Tran Dong A
- 4Pediatric Surgery Department, Children's Hospital 2, Ho Chi Minh City
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Jean WC, Huynh T, Pham TA, Ngo HM, Syed HR, Felbaum DR. A system divided: the state of neurosurgical training in modern-day Vietnam. Neurosurg Focus 2020; 48:E2. [PMID: 32114556 DOI: 10.3171/2019.12.focus19800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
The current report is the first of its kind in describing the neurosurgical training in modern-day Vietnam. Starting with in-depth face-to-face interviews, followed by electronically distributed questionnaires, a detailed picture of the training systems emerged.Neurosurgical training in Vietnam is multifaceted and dichotomous. The country of nearly 100 million people currently has only one neurosurgery-specific residency program, at the University of Medicine and Pharmacy at Ho Chi Minh City (UMPHCMC). This program lasts for 3 years, and Westerners might recognize many similarities to programs native to their countries. A similar training program exists in the north, at the Hanoi Medical University, but at this institution, trainees focus on neurosurgery only in the final year of their 3-year training. Neurosurgical training that resembles the program in Hanoi permeates the rest of the country, and the goal for all of the programs is to rapidly produce surgeons who can be dispersed throughout the country to treat patients requiring urgent neurosurgical procedures who are medically unsuitable for transfer to large urban centers and multispecialty hospitals. For the privilege of practicing elective neurosurgery, trainees around the country are required to acquire further training in Ho Chi Minh City or Hanoi or during fellowships abroad.A clear description of the neurosurgical training systems in Vietnam is hard to achieve, as there exist many diverse pathways and no standard definition of the endpoint for training. Unification and a clearer certification standard will likely help to elevate the standards of training and the state of neurosurgical practice in Vietnam.
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Affiliation(s)
- Walter C Jean
- 1Department of Neurosurgery, George Washington University, Washington, DC.,7Global Brainsurgery Initiative, Washington, DC
| | - Trong Huynh
- 2Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey.,3Department of Neurosurgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Tuan A Pham
- 4Department of Neurosurgery, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hung M Ngo
- 3Department of Neurosurgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Hasan R Syed
- 5Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.,7Global Brainsurgery Initiative, Washington, DC
| | - Daniel R Felbaum
- 6Department of Neurosurgery, Georgetown University Hospital, Washington, DC; and.,7Global Brainsurgery Initiative, Washington, DC
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Neurosurgical Oncology in Vietnam. World Neurosurg 2019; 127:541-548. [PMID: 30902769 DOI: 10.1016/j.wneu.2019.03.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In conjunction with Vietnam's unparalleled economic growth over the past 20 years, our scope of neurosurgical interventions has considerably diversified throughout this time period. METHODS Although still appreciably limited, healthcare resources and infrastructure have expanded and shifted the focus within neurosurgery at Ho Chi Minh City's Cho Ray Hospital from head trauma (which remains highly prevalent) to an equal proportion of elective cases for vascular lesions, tumors, and degenerative spine disease. Arguably the most significant progress throughout the new millennium has been achieved in the realm of neurosurgical oncology. RESULTS About 1000 craniotomies are performed annually for brain tumors at our institution, most of which are for lower-grade lesions that result in excellent surgical outcomes. We continue to strive to improve the standard of care for patients with malignant brain tumors, as the first multidisciplinary neuro-oncology care team was founded recently in 2016. CONCLUSIONS This article is the first in the English neurosurgical literature to report on the current state and outcomes of neuro-oncology in Vietnam, as we highlight our experiences in caring for patients with brain tumors at Cho Ray Hospital.
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Rocque BG, Davis MC, McClugage SG, Tuan DA, King DT, Huong NT, Thi Bich Van N, Kankirawatana P, Vu Hung C, Nam Thang L, Johnston JM, Duc Lien N. Surgical treatment of epilepsy in Vietnam: program development and international collaboration. Neurosurg Focus 2018; 45:E3. [DOI: 10.3171/2018.7.focus18254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
| | | | | | - Dang Anh Tuan
- 2Department of Neurology, Vietnam National Children’s Hospital
| | - Donald T. King
- 3Division of Neurology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Pongkiat Kankirawatana
- 3Division of Neurology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cao Vu Hung
- 2Department of Neurology, Vietnam National Children’s Hospital
| | - Le Nam Thang
- 4Department of Neurosurgery, Vietnam National Children’s Hospital, Dong Da District; and
| | | | - Nguyen Duc Lien
- 5Department of Neurosurgery, Vietnam National Cancer Hospital, Thanh Tri District, Hanoi, Vietnam
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Carr C, Kahn L, Mathkour M, Biro E, Bui CJ, Dumont AS. The shifting burden of neurosurgical disease: Vietnam and the middle-income nations. Neurosurg Focus 2018; 45:E12. [DOI: 10.3171/2018.7.focus18297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Global Burden of Disease (GBD) is an international collaboration and the largest comprehensive investigation of global health disease burden ever conducted. It has been particularly insightful for understanding disease demographics in middle-income nations undergoing rapid development, such as Vietnam, where 6 of the top 10 causes of death are relevant to the neurosurgeon. The burden of stroke—the number one cause of death in Vietnam—is particularly impressive. Likewise, road injuries, with a disproportionate rate of traumatic brain injury, continue to increase in Vietnam following economic development. Low-back and neck pain is the number one cause of disability. Simultaneously, more patients have access to care, and healthcare spending is increased.METHODSIt is imperative that neurosurgical capital and infrastructure keep pace with Vietnam’s growth. The authors searched the existing literature for assessments of neurosurgical infrastructure or initiatives to address neurosurgical disease burden. Using GBD data, the authors also abstracted data for death by cause and prevalence of years of life lost due to disability (YLD) for common neurosurgical pathologies for Vietnam and comparison nations.RESULTSInterventions aimed at primary prevention of risk factors for neurosurgical disease and focused on the transference of self-sustainable technical skills were found to be analogous to those that have been successful in other regions. Efforts toward stroke prevention have been focused on causal risk factors. Multiple investigators have found that interventions aimed at increasing helmet use were successful in preventing traumatic brain injury. Government-led reforms and equipment donation programs have improved technical capacity. Nevertheless, Vietnam lags behind other nations in neurosurgeons per capita; cause-attributable death and YLD attributable to neurosurgical disease are considerably higher in Vietnam and middle-income nations compared to both lower-income nations and upper-income nations.CONCLUSIONSMore than two-thirds of deaths attributable to neurosurgical pathologies in Vietnam and other middle-income nations were due to stroke, and one-fifth of both cause-attributable death and YLD was associated with neurosurgical pathologies. Vietnam and other middle-income nations continue to assume a global burden of disease profile that ever more closely resembles that of developed nations, with particular cerebrovascular, neurotrauma, and spinal disease burdens, leading to exponentially increased demand for neurosurgeons that threatens to outpace the training of neurosurgeons.
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Affiliation(s)
- Christopher Carr
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Lora Kahn
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Mansour Mathkour
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Erin Biro
- 2Department of Neurosurgery, Ochsner Health System; and
| | - Cuong J. Bui
- 2Department of Neurosurgery, Ochsner Health System; and
| | - Aaron S. Dumont
- 3Department of Neurosurgery, Tulane University Medical Center, New Orleans, Louisiana
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Karras CL, Tran HM, Dornbos D, Nguyen P, Nimjee SM, Prevedello DM, Powers CJ. Inside Vietnam's Largest Neurosurgery Department. World Neurosurg 2017; 105:122-125. [DOI: 10.1016/j.wneu.2017.05.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
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Maria Auxiliadora Hospital in Lima, Peru as a model for neurosurgical outreach to international charity hospitals. Childs Nerv Syst 2011; 27:145-8. [PMID: 20490509 PMCID: PMC3015176 DOI: 10.1007/s00381-010-1170-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 04/29/2010] [Indexed: 10/25/2022]
Abstract
INTRODUCTION A myriad of geopolitical and financial obstacles have kept modern neurosurgery from effectively reaching the citizens of the developing world. Targeted neurosurgical outreach by academic neurosurgeons to equip neurosurgical operating theaters and train local neurosurgeons is one method to efficiently and cost effectively improve sustainable care provided by international charity hospitals. The International Neurosurgical Children's Association (INCA) effectively improved the available neurosurgical care in the Maria Auxiliadora Hospital of Lima, Peru through the advancement of local specialist education and training. METHODS Neurosurgical equipment and training were provided for the local neurosurgeons by a mission team from the University of California at San Diego. RESULTS At the end of 3 years, with one intensive week trip per year, the host neurosurgeons were proficiently and independently applying microsurgical techniques to previously performed operations, and performing newly learned operations such as neuroendoscopy and minimally invasive neurosurgery. CONCLUSION Our experiences may serve as a successful template for the execution of other small scale, sustainable neurosurgery missions worldwide.
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