Building neurosurgical capacity in low and middle income countries

Abstract

Neurosurgery capacity in low- and middle-income countries is far from adequate; yet burden of neurological diseases, especially neuro-trauma, is projected to increase exponentially. Previous efforts to build neurosurgical capacity have typically been individual projects and short-term missions. Recognizing the dual needs of addressing disease burden and building sustainable, long-term neurosurgical care capacity, we describe in this paper an ongoing collaboration between the Mulago Hospital Department of Neurosurgery (Kampala, Uganda) and Duke University Medical Center (Durham, NC, USA) as a replicable model to meet the dual needs. The collaboration employs a threefold approach to building capacity: technology, twinning, and training performed together in a top-down approach. Also described are lessons learned to date by Duke Global Neurosurgery and Neurosciences (DGNN) and applicability beyond Kampala.

Keywords: Capacity building; Developing country; Global surgery; Neurosurgery/education; Uganda.

Fig. 1

Global distribution of physicians. [Sourced from World Mapper] Note the significant deficiency in central and eastern Africa, which is reflected in the lack of neurosurgeons in Africa compared to North America.

Fig. 2

Number of neurosurgery cases performed at Mulago Hospital (2006–2009). Number of cases performed by the Ugandan neurosurgeons before and after the Duke Neurosurgery Program was initiated. There was a 313% increase.

Fig. 3

A. Projected distribution of fellowship-trained neurosurgeons. B. Projected distribution of NSU-capable general surgeons and fellowship-trained neurosurgeons.