1
|
Mukumbya B, Kitya D, Trillo-Ordonez Y, Sun K, Obiga O, Deng DD, Stewart KA, Ukachukwu AEK, Haglund MM, Fuller AT. The feasibility, appropriateness, and usability of mobile neuro clinics in addressing the neurosurgical and neurological demand in Uganda. PLoS One 2024; 19:e0305382. [PMID: 38913633 PMCID: PMC11195962 DOI: 10.1371/journal.pone.0305382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Uganda has a high demand for neurosurgical and neurological care. 78% of the over 50 million population reside in rural and remote communities where access to neurosurgical and neurological services is lacking. This study aimed to determine the feasibility, appropriateness, and usability of mobile neuro clinics (MNCs) in providing neurological care to rural and remote Ugandan populations. METHODS Neurosurgery, neurology, and mobile health clinic providers participated in an education and interview session to assess the feasibility, appropriateness, and usability of the MNC intervention. A qualitative analysis of the interview responses using the constructs in the updated Consolidated Framework for Implementation Research was performed. Providers' opinions were weighted using average sentiment scores on a novel sentiment-weighted scale adapted from the CFIR. A stakeholder analysis was also performed to assess the power and interest of the actors described by the participants. RESULTS Twenty-one healthcare providers completed the study. Participants discussed the potential benefits and concerns of MNCs as well as potential barriers and critical incidents that could jeopardize the intervention. Of the five CFIR domains evaluated, variables in the implementation process domain showed the highest average sentiment scores, followed by the implementation climate constructs, inner setting, innovation, and outer setting domains. Furthermore, many interested stakeholders were identified with diverse roles and responsibilities for implementing MNCs. These findings demonstrate that MNC innovation is feasible, appropriate, and usable. CONCLUSION The findings of this study support the feasibility, appropriateness, and usability of MNCs in Uganda. However, integration of this innovation requires careful planning and stakeholder engagement at all levels to ensure the best possible outcomes.
Collapse
Affiliation(s)
- Benjamin Mukumbya
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - David Kitya
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yesel Trillo-Ordonez
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Keying Sun
- Duke Global Health Institute, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Oscar Obiga
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Di D. Deng
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
| | | | - Alvan-Emeka K. Ukachukwu
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Health System, Durham, NC, United States of America
| | - Michael M. Haglund
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Health System, Durham, NC, United States of America
| | - Anthony T. Fuller
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
| |
Collapse
|
2
|
Corell A, Jabang JN, Manneh J, Manneh EK, Tisell M, Brandt C, Majing T, Smedberg C, Förars C, Rebucas S, Goswell P, Ronold T, Landén C, Engström A, Sorto P, Uche E, Wague D, Sakho Y, Sundblom J. Successful adaptation of twinning concept for global neurosurgery collaborations-a validation study. Acta Neurochir (Wien) 2024; 166:174. [PMID: 38600222 PMCID: PMC11006720 DOI: 10.1007/s00701-024-06060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/06/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Globally, many regions have an urgent, unmet need of neurosurgical care. A multi-step neurosurgical twinning technique, International Neurosurgical Twinning Modeled for Africa (INTIMA), was proved to be successful during a previous mission to Neurosurgical Unit, Enugu, Nigeria. The Swedish African Neurosurgical Collaboration (SANC) performed a developmental mission together with the local neurosurgical unit in The Gambia, adopting the INTIMA model. METHODS A multidisciplinary team visited for a 2-week collaborative mission at the Neurosurgical Department of the Edward Francis Small Teaching Hospital in Banjul, The Gambia. The mission followed the data of neurosurgical operations during and after the mission as well as about the operations 3 months prior to and after the mission was collected. RESULTS During the mission, a total of 22 operations was carried out, the most common being degenerative spinal conditions (n = 9). In the 3 months following the mission, 43 operations were performed compared to 24 during the 3 months leading up to the mission. The complexity of the performed procedures increased after the mission. An operating microscope (Möller-Wedel) was donated and installed and the neurosurgeons on site underwent training in microneurosurgery. The surgical nurses, nurses at the postoperative ward, and the physiotherapists underwent training. A biomedical engineer serviced multiple appliances and devices improving the patient care on site while training local technicians. CONCLUSION This study validated the use of the INTIMA model previously described in a mission by Swedish African Neurosurgical Collaboration (SANC). The model is sustainable and produces notable results. The core strength of the model is in the multidisciplinary team securing all the aspects and steps of the neurosurgical care. Installation of an operating microscope opened for further microsurgical possibilities, improving the neurosurgical care in The Gambia.
Collapse
Affiliation(s)
- Alba Corell
- Department of Neurosurgery, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden.
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
| | - John N Jabang
- Neurosurgical Unit, Department of Surgery, EFSTH Teaching Hospital, Banjul, The Gambia
| | - Job Manneh
- Neurosurgical Unit, Department of Surgery, EFSTH Teaching Hospital, Banjul, The Gambia
| | - Ebrima K Manneh
- Neurosurgical Unit, Department of Surgery, EFSTH Teaching Hospital, Banjul, The Gambia
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Christian Brandt
- Neurosurgical Department, Lund University Hospital, Lund, Sweden
| | - Tomas Majing
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla Smedberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Förars
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Sarinah Rebucas
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Pascal Goswell
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Tove Ronold
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - Caroline Landén
- Department of Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Engström
- Department of Strategic Planning, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pia Sorto
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Enoch Uche
- Department of Neurosurgery, The University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Daouda Wague
- Department of Neurosurgery, Fann University Teaching Hospital, Dakar, Senegal
| | - Youssoupha Sakho
- Department of Neurosurgery, Grand Yoff General Hospital, Dakar, Senegal
| | - Jimmy Sundblom
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
3
|
Lawson McLean A, Vetrano IG, Lawson McLean AC, Conti A, Mertens P, Müther M, Nemir J, Peschillo S, Santacroce A, Sarica C, Tuleasca C, Zoia C, Régis J. Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework. BRAIN & SPINE 2024; 4:102794. [PMID: 38601776 PMCID: PMC11004717 DOI: 10.1016/j.bas.2024.102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
Introduction The field of neurosurgery faces challenges with the increasing involvement of other medical specialties in areas traditionally led by neurosurgeons. This paper examines the implications of this development for neurosurgical practice and patient care, with a focus on specialized areas like pain management, peripheral nerve surgery, and stereotactic radiosurgery. Research question To assess the implications of the expanded scope of other specialties for neurosurgical practice and to consider the response of the EANS Frontiers in Neurosurgery Committee to these challenges. Materials and methods Analysis of recent trends in neurosurgery, including the shift in various procedures to other specialties, demographic challenges, and the emergence of minimally invasive techniques. This analysis draws on relevant literature and the initiatives of the Frontiers in Neurosurgery Committee. Results We explore a possible decrease in neurosurgical involvement in certain areas, which may have implications for patient care and access to specialized neurosurgical interventions. The Frontiers in Neurosurgery Committee's role in addressing these concerns is highlighted, particularly in terms of training, education, research, and networking for neurosurgeons, especially those early in their careers. Discussion and conclusion The potential decrease in neurosurgical involvement in certain specialties warrants attention. This paper emphasizes the importance of carefully considered responses by neurosurgical societies, such as the EANS, to ensure neurosurgeons continue to play a vital role in managing neurological diseases. Emphasis on ongoing education, integration of minimally invasive techniques, and multidisciplinary collaboration is essential for maintaining the field's competence and quality in patient care.
Collapse
Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
| | - Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna C. Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
| | - Alfredo Conti
- UOC Neurochirurgia, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Patrick Mertens
- Department of Neurosurgery, University Hospital of Neurology and Neurosurgery, Hospices Civils de Lyon, University Lyon 1, Lyon, France
| | - Michael Müther
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Jakob Nemir
- Department of Neurosurgery, University Hospital Center Zagreb, School of Medicine, Zagreb, Croatia
| | - Simone Peschillo
- Endovascular Neurosurgery, Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Antonio Santacroce
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- European Radiosurgery Center Munich, Munich, Germany
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontatio, Canada
| | - Constantin Tuleasca
- Lausanne University Hospital (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Lausanne, Switzerland
| | - Cesare Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - Jean Régis
- Aix Marseille University, Department of Functional Neurosurgery, CHU Timone, Marseille, France
| | - EANS Frontiers in Neurosurgery Committee
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- UOC Neurochirurgia, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Department of Neurosurgery, University Hospital of Neurology and Neurosurgery, Hospices Civils de Lyon, University Lyon 1, Lyon, France
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, University Hospital Center Zagreb, School of Medicine, Zagreb, Croatia
- Endovascular Neurosurgery, Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- European Radiosurgery Center Munich, Munich, Germany
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontatio, Canada
- Lausanne University Hospital (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Lausanne, Switzerland
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
- Aix Marseille University, Department of Functional Neurosurgery, CHU Timone, Marseille, France
| |
Collapse
|
4
|
Ferreira T, Awuah WA, Tan JK, Adebusoye FT, Ali SH, Bharadwaj HR, Aderinto N, Fernandes C, Zahid MJ, Abdul-Rahman T. The current landscape of intracranial aneurysms in Africa: management outcomes, challenges, and strategies-a narrative review. Neurosurg Rev 2023; 46:194. [PMID: 37548805 DOI: 10.1007/s10143-023-02102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
Intracranial aneurysms (IAs) pose complex and potentially life-threatening challenges in Africa, where limited resources, restricted access to specialised healthcare facilities, and disparities in healthcare provision amplify the difficulties of management. Timely diagnosis and treatment are pivotal in preventing complications, including subarachnoid haemorrhage. Treatment options encompass observation, surgical clipping, endovascular coiling, and flow diversion. Positive outcomes observed in IA management in Africa include high survival rates, favourable functional outcomes, successful treatment techniques, and the absence of complications in some cases. However, negative outcomes such as postoperative complications, reduced quality of life, perioperative mortality, and the risk of recurrence persist. Challenges in IA management encompass limited access to diagnostic tools, a scarcity of specialised healthcare professionals, and an unequal distribution of services. Addressing these challenges requires interventions focused on improving access to diagnostic tools, expanding the number of trained professionals, and establishing specialised IA treatment centres. Collaboration, research, and capacity-building efforts hold significant importance in improving patient outcomes and reducing disparities in IA management across Africa.
Collapse
Affiliation(s)
- Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Wireko Andrew Awuah
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine
| | | | - Favour Tope Adebusoye
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine.
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Oyo, Nigeria
| | | | | | - Toufik Abdul-Rahman
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine
| |
Collapse
|
5
|
Buh FC, Hutchinson PJA, Anwar F. Early neuro-rehabilitation in traumatic brain injury: the need for an African perspective. BMC Med 2023; 21:290. [PMID: 37542228 PMCID: PMC10403949 DOI: 10.1186/s12916-023-03009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a global public health challenge, affecting about 69 million individuals annually and being one of the leading causes of mortality. It has adverse consequences in terms of cognitive and physical functioning, which makes rehabilitation interventions an integral part of its management. Early neuro-rehabilitation guidelines for traumatic brain injury have not yet been developed and implemented in most of Africa especially Sub-Saharan Africa. BODY: We aimed with this Opinion to propose a collective reflection on the development and implementation of early neuro-rehabilitation guidelines as an integral part of the care in traumatic brain injury. The different aspects to be considered for reflection have been highlighted: Traumatic brain injury severity to be considered in early neuro-rehabilitation; who should be assessed and receive early neurorehabilitation, barriers to be considered for early neurorehabilitation; what early neurorehabilitation to be considered; the different phases involved in rehabilitation after mild, moderate, and severe TBI; and lastly, what perspective for the creation of neurorehabilitation teams. In conclusion, neuro-rehabilitation should start at the time of admission and should continue from the intensive care unit through the community for the moderate-to-severe traumatic brain injury population. However, mild TBI should also be considered for long-term follow-up in the community due to the fact that some mild traumatic brain injury patients might develop chronic cognitive problems or fatigue with time. CONCLUSION Neurorehabilitation should start at the time of admission and continue from the intensive care unit through the community for the moderate-to-severe traumatic brain injury population. There is a need to develop, agree on, and implement guidelines on early neuro-rehabilitation interventions for patients with moderate to severe traumatic brain injury in the African region, where disparities in care are common reality.
Collapse
Affiliation(s)
- Franklin Chu Buh
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, P.O. BOX 63, Buea, S.W. Region, Cameroon.
- NIHR Global Health Research Group On Acquired Brain and Spine Injury, Cambridge University, Cambridge, UK.
- Department of Physiotherapy and Physical Medicine, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
- Department of Physiotherapy, St. Louis University Institute, Douala, Cameroon.
- Panafrican Hospital Center, LT Region, P.O. BOX 13152, Douala, Cameroon.
| | | | - Fahim Anwar
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
6
|
Takoutsing BD, Wunde UN, Zolo Y, Endalle G, Djaowé DAM, Tatsadjieu LSN, Zourmba IM, Dadda A, Nchufor RN, Nkouonlack CD, Bikono ERA, Magadji JPO, Fankem C, Jibia ABT, Esene I. Assessing the impact of neurosurgery and neuroanatomy simulation using 3D non-cadaveric models amongst selected African medical students. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1190096. [PMID: 37215067 PMCID: PMC10192731 DOI: 10.3389/fmedt.2023.1190096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Background Laboratory dissections are essential to acquire practical skills to perform neurosurgical procedures. Despite being traditionally done on cadavers, they are often unavailable and suffer from cultural barriers in the African context. Non-cadaveric UpSurgeOn neurosurgery models have been developed to bridge this barrier, providing an almost similar experience with the human body. This study aimed to assess the impact of the UpSurgeOn hands-on-touch non-cadaver model training amongst selected Cameroon medical students. Methods An anonymous 35-item questionnaire was distributed online using Google drive systems to medical students who attended UpSurgeOn's hands-on-touch non-cadaver model training course. These questions aimed to capture data on previous experience with neuroanatomy and neurosurgery practicals and the perception, attitudes, and impact of the UpSurgeOn neurosurgery tool. Results Eighty-six students completed the survey. The mean age was 21.2 ± 1.868 years, 61.6% were males with 62.8% of respondents being medical students in preclinical years. Before the training, 29.4% had a fair knowledge of neuroanatomy. Textbooks and Youtube videos were the main sources of neuroanatomy and neurosurgery knowledge for more than half of the respondents. Up to 91.5% had no prior exposure to a neuroanatomy/neurosurgery cadaver laboratory dissection, and 22.6% and 17.6% had witnessed and performed at least one craniotomy before, respectively. There were 11.1%, 15.5%, and 31.3% of our respondents who had used a surgical microscope, a neurosurgical instrument, and the UpSurgeOn Neurosurgery tool before, respectively. The majority perceived the UpSurgeOn tool easy to use and felt they needed to learn just a few things before getting going with the box. Most thought of increasing the use of the UpSurgeOn Box and saw the need to be part of the training curriculum. Finally, the majority felt this tool helped to increase familiarity and acquire neurosurgical skills, and to develop the orientation skills needed during neurosurgical approaches. Conclusion Undergraduate exposure to traditional neurosurgery/neuroanatomy labs is limited in Cameroon. Neurosurgery/neuroanatomy practical skills are gained essentially using non-practical means. Most students found the UpSurgeOn tool user-friendly, saw the need to incorporate it as part of their training, and perceived it to be essential in getting acquainted with neurosurgical skills.
Collapse
Affiliation(s)
- Berjo Dongmo Takoutsing
- Research Division, Winners Foundation, Yaounde, Cameroon
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Ubraine Njineck Wunde
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Global Surgery Division, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Geneviève Endalle
- Research Division, Winners Foundation, Yaounde, Cameroon
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Dieunedort Arnold Menga Djaowé
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Garoua, Garoua, Cameroon
| | | | - Ines Miste Zourmba
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Garoua, Garoua, Cameroon
| | - Aminatou Dadda
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Garoua, Garoua, Cameroon
| | | | | | | | | | | | | | - Ignatius Esene
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| |
Collapse
|
7
|
Rodríguez-Mena R, Piquer-Martínez J, Llácer-Ortega JL, Haji MA, Idrissa-Ahmadsa S, Nahoda H, Young PH, Qureshi MM, García-Rubio MJ, Piquer-Belloch J. The NED foundation experience: A model of global neurosurgery. BRAIN & SPINE 2023; 3:101741. [PMID: 37383428 PMCID: PMC10293322 DOI: 10.1016/j.bas.2023.101741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/17/2023] [Accepted: 04/11/2023] [Indexed: 06/30/2023]
Abstract
Introduction The Neurosurgery Education and Development (NED) Foundation (NEDF) started the development of local neurosurgical practice in Zanzibar (Tanzania) in 2008. More than a decade later, multiple actions with humanitarian purposes have significantly improved neurosurgical practice and education for physicians and nurses. Research question To what extent could comprehensive interventions (beyond treating patients) be effective in developing global neurosurgery from the outset in low and middle-income countries? Material and method A retrospective review of a 14- year period (2008-2022) of NEDF activities highlighting landmarks, projects, and evolving collaborations in Zanzibar was carried out. We propose a particular model, the NEDF model, with interventions in the field of health cooperation that have simultaneously aimed to equip, treat, and educate in a stepwise manner. Results 138 neurosurgical missions with 248 NED volunteers have been reported. In the NED Institute, between Nov 2014-Nov 2022, 29635 patients were seen in the outpatient clinics and 1985 surgical procedures were performed. During the course of NEDF's projects, we have identified three different levels of complexity (1, 2 and 3) that include the areas of equipment ("equip"), healthcare ("treat") and training ("educate"), facilitating an increase of autonomy throughout the process. Discussion and Conclusion In the NEDF's model, the interventions required in each action area (ETE) are coherent for each level of development (1, 2 and 3). When applied simultaneously, they have a greater impact. We believe the model can be equally useful for the development of other medical and/or surgical specialties in other low-resource healthcare settings.
Collapse
Affiliation(s)
- Ruben Rodríguez-Mena
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
- Neurosurgery Department, Hospital Universitario de La Ribera.Ctra, Corbera, Km 1, 46600, Alzira, Valencia, Spain
| | - Jose Piquer-Martínez
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - José L. Llácer-Ortega
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
- Neurosurgery Department, Hospital Universitario de La Ribera.Ctra, Corbera, Km 1, 46600, Alzira, Valencia, Spain
| | - Mohammed A. Haji
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Said Idrissa-Ahmadsa
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Hadia Nahoda
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Paul H. Young
- Section of Neurosurgery, Department of Surgery, St. Louis University, St. Louis, Missouri, USA
| | - Mahmood M. Qureshi
- Section of Neurosurgery, Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - María J. García-Rubio
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - José Piquer-Belloch
- Cátedra de Neurociencia Global y Cambio Social NED VIU, Calle Pintor Sorolla 21, 46002, Valencia, Spain
- Neurosurgery Department, Hospital Universitario de La Ribera.Ctra, Corbera, Km 1, 46600, Alzira, Valencia, Spain
| |
Collapse
|
8
|
Abu-Bonsrah N, Totimeh T, Kanmounye US, Banson M, Bandoh D, Sarpong K, Dadey D, Adam A, Nketiah-Boakye F, Dakurah T, Boakye M, Haizel-Cobbina J, Ametefe M, Bankah P, Groves ML. Assessment of the Neurosurgical Capacity in Ghana: Challenges and Opportunities. World Neurosurg 2022; 167:e953-e961. [PMID: 36064120 DOI: 10.1016/j.wneu.2022.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low- and middle-income countries experience numerous challenges in the provision of neurosurgical care. However, limited information exists on the neurosurgical workforce and the constraints under which care is delivered in Ghana, West Africa. METHODS A 19-item survey assessing neurosurgical workforce, infrastructure, and education was administered to Ghanaian consultant neurosurgeons and neurosurgeon trainees between November 8, 2021, and January 20, 2022. The data were analyzed using summary descriptions, and qualitative data were categorized into themes. RESULTS There were 25 consultant neurosurgeons and 8 neurosurgical trainees (from 2 training centers) identified at 11 hospitals in Ghana totaling a workforce density of 1 neurosurgeon per 1,240,000. Most neurosurgical centers were located in Accra, the capital city. Almost half of the population did not have access to a hospital with a neurosurgeon in their region. Of hospitals, 82% had in-house computed tomography and/or magnetic resonance imaging scanners. In the operating room, most neurosurgeons had access to a high-speed drill (91%) but lacked microscopes and endoscopic sets (only 64% and 36% had these tools, respectively). There were no neurointensivists or neurological intensive care units in the entire country, and there was a paucity of neurovascular surgeries and functional neurosurgical procedures. CONCLUSIONS The provision of neurosurgical care in Ghana has come a long way since the 1960s. However, the neurosurgical community continues to face significant challenges. Alleviating these barriers to care will call for systems-level changes that allow for the prioritization of neurosurgical care within the Ghanaian health care system.
Collapse
Affiliation(s)
- Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
| | - Teddy Totimeh
- Department of Neurosurgery, University of Ghana Medical Centre, Accra, Ghana
| | | | - Mabel Banson
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Dickson Bandoh
- Department of Neurosurgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwadwo Sarpong
- Georgetown University School of Medicine, Washington, DC, USA
| | - David Dadey
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Abass Adam
- Department of Neurosurgery, Tamale Teaching Hospital, Tamale, Ghana
| | | | - Thomas Dakurah
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Joseline Haizel-Cobbina
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mawuli Ametefe
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Patrick Bankah
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|