Presentation Slides

No size,wt . restrictions!
! !A. Leland Albright, MD!
[email protected]!
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No size,wt . restrictions!
! ! ! ! ! ! ! ! ! !But,
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There are 29 countries in SSA with no NS!
If you have no NS, how can you talk about safer NS?!
No size,wt . restrictions!
! ! ! ! ! ! ! ! ! !But,
!
!
There are 29 countries in SSA with no NS!
If you have no NS, how can you talk about safer NS?!
I would like to speak about!
No size,wt . restrictions!
I would like to speak about!
No size,wt . restrictions!
From the micro level: Pediatric Neurosurgery in Kijabe, Kenya!
!
To a larger level: Pediatric Neurosurgery in Africa!
!
To the macro level: Neurosurgery in Africa!
I would like to speak about!
No size,wt . restrictions!
From the micro level: Pediatric Neurosurgery in Kijabe, Kenya!
!
To a larger level: Pediatric Neurosurgery in Africa!
!
To the macro level: Neurosurgery in Africa!
I would like to speak about!
No size,wt . restrictions!
From the micro level: Pediatric Neurosurgery in Kijabe, Kenya!
!
To a larger level: Pediatric Neurosurgery in Africa!
!
To the macro level: Neurosurgery in Africa!
1. Developing PNS in Kijabe, Kenya
Email 2001: “Neurosurgeon needed”
Hydrocephalus
Spina Bifida
HC, SB Cases
HC, SB Cases
September, 2010, we moved to Kijabe
Why did we go?
Need?
Neurosurgery in Africa
Population: One billion
Neurosurgeons: 1160
North Africa: 857
South Africa: 160
Subsaharan Africa: 142 (for 723M)
~ 1/5,000,000 people
Neurosurgery in Africa
Population: One billion
Neurosurgeons: 1160
North Africa: 857
South Africa: 160
Subsaharan Africa: 142 (for 723M)
~ 1/5,000,000 people
Pediatric Neurosurgeons: 10-12
Why did we go?
A call to teach and to do PNS
To Teach…Kenyan NS Residents
How to evaluate patients
How to identify the therapeutic options
How to read scans
How to operate
How to evaluate the literature
How to do research*
(How to be a neurosurgeon)
To Teach…Kenyan NS Residents
How to do research
To Teach…Kenyan NS Residents
184. Albright AL, Okechi H. Use of the NICO Myriad Device for Tumor and Cyst Removals in a Developing Country. Child’s Nerv Syst, 28:
185. Okechi H, Albright AL. Intraventricular meningioma. Case report and literature review. Pediatr Neurosurg, 48:30-34,
2012
186. Okechi H, Albright AL, Nzioka A. Tethered cord syndrome secondary to the unusual constallation of a split cord
malformation, lumbar myelomeningocele and coexisting neurenteric cyst. Cast reports in Neurological Medicine, Article
ID 635029, 2012
187. Albright AL, Ferson SS. Developing pediatric neurosurgery in a developing country. Journal of Child Neurology 27:
1559-1564, 2012.
188. Albright AL. The Non-Attending. JAMA Surgery, 148(8):702, 2013.
189. Albright AL, Okechi H. Distal Cordectomies as Treatment for Lumbosacral Myelomeningoceles. J Neurosurg Pediatrics,
13:192-195, 2014.
190. Albright AL, Ferson SS, Okechi H. CSF WBC counts in infants with myelomeningoceles
J Neurosurg Pediatrics, 13:189-191, 2014
191. Shitsama S, Wittayanakorn N, Okechi H, Albright AL. Choroid plexus coagulation in infants with severe hydrocephalus or
hydranencephaly. J Neurosurg Pediatrics, in press 2014.
192. Mansouri A, Okechi H, Albright L, Bernstein M. Reconnaisssance mission to the neurosurgery department in Kijabe
Hospital, Kenya: A call for the submission of ideas and strategies. World Neurosurgery. in press, 2014
193. Githuku JN, Azofeifa A, Valencia D, Trong A, Hamner H, Amwayi S, Guru Z, Omolo J, Albright L, Guo J. Assessing the
prevalence of spina bifida and encephalocele in a Kenyan hospital from 2005-2010; Implications for a neural tube defects
surveillance system. Pan Africal Medical Journal, 18:60, 2014
194. Veronovich Z, Albright AL. Enterocutaneous Fistula in the setting of ventriculoperitoneal shunt extrusion through the skin
and perforation through the small bowel: case report. J Neurosurg Pediatrics, in press 2014
195. Ochieng N, Okechi H, Ferson S, Albright AL. Bacteria causing ventriculoperitoneal shunt infections in a Kenyan
To Teach…PNS Fellows*
First fellow, Ugandan Humphrey Okechi, Fellowship paid for by
grant from Medtronic. (Not) validated by UoN. ~ 750 cases. Exams
every 4 months. Now KH NS consultant.
To Teach…PNS Fellows
Fellow applicants from:
Ghana-current
Ethiopia-Sept. 2014
Nigeria
Kenya
To Teach…and To Do PNS
To Teach…and To Do PNS
~ 4500 operations
Hydrocephalus
Spina bifida
Encephaloceles
Tethered cords
Craniosynostosis
Tumors
Theatre Room 2
Equipment & Supplies
Donated equipment:
New-- MDT grant: Storz
endoscope & monitor, WiFi;
NICO Myriad
Used--Microscope 3, operating
table, Midas Rex, Selector,
micro instruments, CT scanner,
EEG. Used equipment breaks
Donated supplies: Ioban,
cottonoids, plates, screws,
dermabond, tape,
Leica microscope drapes
I live on donated supplies
brought by visiting NSs.
Needs for PNS in Kenya
Now
Continued donated supplies
Rotating U.S. neurosurgery residents
PNSs to cover when we are away
Future
Visiting PNSs to help Dr. Okechi when we leave
Kenyan PNSs (Ochiengs) in January ’18 or ’19
Clinical Officer or NP when Susan leaves
Fund for supplies and equipment
Is PNS Sustainable in Kijabe?
Probably (60/40), because
1. PNSs
Dr. Okechi will continue a few years
Dr.s Ochieng returning in 2018-19
2. Supplies and equipment
Visiting PNSs from the US/Canada
3. Commitment from supporting organisation
BethanyKids.org
2. Developing PNS in Africa
2. Developing PNS in Africa
Huge need for paediatric neurosurgery in Africa
> 50% of the population of most Africa countries is < 16 yrs
Estimated 180,000 new cases of HC in SSA each year
2. Developing PNS in Africa
Huge need
10-12 PNSs in Africa
Why is the situation so bad?
(5 reasons)
2. Developing PNS in Africa
1. Almost no academic PNSs in Africa to teach it.
2. To become a PNS takes an additional year of training.
3. No funding for a fellowship year of training.
4. PNS pays much less than “adult” neurosurgery.
5. Doctors in general do not like to treat disabled people.
PNS Conferences in Africa
Before March, 2014, how many PNS conferences
had there been in the continent of Africa?
0
3
5
PNS Conferences in Africa
Before March, 2014, how many PNS conferences
had there been in the continent of Africa?
0
PNS Conferences in Africa
March 9-14, the first PNS conference. Pretoria, South Africa
Supported by the ESPN and ISPN
First year of a three-year cycle covering all PNS topics
15 faculty: 7 African, 8 abroad
37 African NSs & residents
PNS Fellowships in Africa
How many PNS fellowships are there in Africa?
0
2
5
7
PNS Fellowships in Africa
How many PNS fellowships are there in Africa?
0
2
PNS Fellowships in Africa
1. Red Cross Children’s Hospital,
Funded by University of Cape Town or the fellows
Accredited by University of Cape Town
2. Kijabe Hospital, Kijabe Kenya
Funded by grants from Medtronic, Inc.
Currently not university-accredited
2. Developing PNS in Africa
Huge need
Minimal resources
Outside help needed:
1. Almost no academic PNSs in Africa to teach it.
Visiting academic PNSs coming continually
2. To become a PNS takes an additional year of training.
No way around that
3. No funding for a fellowship year of training.
ASPN or ESPN or ISPN offer fellowships
4. PNS pays much less than “adult” neurosurgery.
No way around that
5. Doctors in general do not like to treat disabled people.
No way around that
2. Developing PNS in Africa
Huge need
Minimal resources
Outside help needed:
1. Almost no academic PNSs in Africa to teach it.
Visiting academic PNSs coming continually
2. To become a PNS takes an additional year of training.
No way around that
3. No funding for a fellowship year of training.
ASPN or ESPN or ISPN offer fellowships
4. PNS pays much less than “adult” neurosurgery.
No way around that
5. Doctors in general do not like to treat disabled people.
Huge need
Minimal resources
Outside help needed:
3. Developing Neurosurgery in Africa
3. Developing Neurosurgery in Africa
Priorities of African NSs 15 years ago for providing NS care:
1. “the training of general surgeons to perform some
basic life-saving neurosurgical procedures (including
treatment of intracranial hematomas, treatment of compound
depressed skull fractures, placement of shunts, treatment of
brain abscesses)
This was modified by Dr. El-Fiki in 2013 to, “It is not
quantity, it is quality that counts. I would recommend that
local surgeons could be enabled to safely perform emergency
life-saving or function-saving procedures..rather than basic
cranial and spinal neurosurgical procedures.”
3. Developing Neurosurgery in Africa
To train the general surgeons, non-Africans proposed:
a “certificate of completion of training in neurosurgery”—based on
2 year apprenticeship in a NS teaching program
Passing the AANS Board exam after year 1
Performing a designated number of certain cases required
by those practicing in the United Kingdom
Obtaining a certificate from the program director testifying
as to the candidate’s competence.
The number of surgeons who have completed the training? 0
3. Developing Neurosurgery in Africa
Is it appropriate to train general or paediatric surgeons to do NS?
Academic NS programs are not interested in this; they have no
interest in training surgeons or in treating their complications.
There is minimal evidence that African surgeons want this
Training a surgeon to do emergency NS operations would
take12+ months because those cases are infrequent.
There is no funding to pay for that training
Is it appropriate? Occasionally, but it is very difficult to do
3. Developing Neurosurgery in Africa
Is it appropriate to train general or paediatric surgeons to do NS?
Academic NS programs are not interested in this; they have no
interest in training surgeons or in treating their complications.
There is minimal evidence that African surgeons want this
Training a surgeon to do emergency NS operations would
take12+ months. Those cases are infrequent.
There is no funding to pay for that training
Is it appropriate? Occasionally, but it is very difficult to do
Is it appropriate? Occasionally, but it is very difficult to
3. Developing Neurosurgery in Africa
Is it appropriate to try to develop NS in SSA?
1. Medical budgets in SSA countries are meagre; those
funds will help far more people with malaria, AIDS and Tb
2. NS relies on equipment e.g. CT scanners that is
expensive to purchase and expensive to maintain
3. NS patients are often disabled and not valued
IT IS PROBABLY NOT APPROPRIATE TO DEVELOP NS IN SSA
3. Developing Neurosurgery in Africa
Is it appropriate to try to develop NS in SSA?
1. Medical budgets in SSA countries are meagre; those
funds will help far more people with malaria, AIDS and Tb
2. NS relies on equipment e.g. CT scanners that is
expensive to purchase and expensive to maintain
3. NS patients are often disabled and not valued
Is it appropriate? Probably not, at this time
3. Developing Neurosurgery in Africa
Priorities of African NSs 15 years ago for providing NS care:
1. “the training of general surgeons to perform some basic lifesaving neurosurgical procedures (including treatment of
intracranial hematomas, treatment of compound depressed skull
fractures)
2. The complete training of neurosurgeons
3. Developing Neurosurgery in Africa
International Neurosurgeons Can Help That:
1. By coming to teach, to operate, and to bring
supplies & equipment
2. By offering NS teaching conferences via the internet,
as the University of Toronto does now
3. By paying for NS faculty to attend international
conferences about topics that are directly
applicable in their countries
The bottom line about
Developing Neurosurgery in Africa:
The bottom line about
Developing Neurosurgery in Africa:
“The future of neurosurgery in Africa will depend
mainly on the efforts of African neurosurgeons to
improve neurosurgery in their respective countries.”
El Khamlichi A
(It will not primarily depend on the efforts of NSs from developing countries)
Asante Sana
Mmemaswali?
BethanyKids.org
susanandlelandinkijabe.blogspot.com

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