PARTNER SPOTLIGHT: Tanzania Neurosurgery Project

The World Health Organization recommends that all countries have one neurosurgeon for each 100,000 residents. In Tanzania the ratio is 1:13,000,000. Many Tanzanians, including thousands of children, die each year from hydrocephalus, encepheloceles, head and spinal trauma and other correctable conditions. There are only five neurosurgeons in Tanzania, which leaves millions of Tanzanian citizens with no access to basic neurosurgical care (Härtl and Ellegala 2010).

The Cornell Neurosurgery program focuses on Bugando Hospital in northern Tanzania, a regional center which serves a population of 14 million people. In addition, we work closely with the neurosurgery department at the Muhimbili Orthopedic Institute (MOI) in Dar Es Salaam. The program consists of several components:

1. Our multidisciplinary teams of surgeons, anesthesiologists, nurses and biomedical engineers train local health care providers to deliver basic neurosurgical care using locally available equipment and resources. We are doing “hands-on” training of doctors in Tanzania, empowering them with a high level of expertise in the management of neurosurgical disorders and neurosurgical procedures (Wait and Härtl 2010; Mitchell 2013). Providing the highest level of surgical training to these eager, talented surgeons impacts every other level of care-- nursing, anesthesia, intensive care treatment, general ward care. Setting the bar high encourages a positive response and team effort involving all areas.

2. Promising surgeons are selected for a short term observational fellowship at Weill Cornell Medical College in New York. The purpose of this fellowship is to provide motivated surgeons the opportunity to experience first-hand high level surgical care. This also greatly facilitates the communication between the Cornell team and the Bugando surgeons, once the surgeon has returned home.

3. Every year a neurosurgery meeting is organized with international faculty in East Africa that combines lectures, practical workshops and even live surgeries (Kahamba 2011). Surgeons and nurses from many African countries participate.

4. Weekly conference calls and “skype” conferences are held between the Cornell team and their colleagues at Bugando and MOI to discuss challenging cases, patient management and ongoing research.

5. An IRB approved database for traumatic brain and spinal injury has been implemented at Bugando and MOI that monitors patient care and ensures quality. This and previous projects have led to several publications in peer-reviewed journals (Winkler 2010; Maier 2014).

It is hoped that these efforts will over time show that the program improves patient outcome and can serve as a model for other hospitals and programs (Coburger et al. 1012).

References:

1. Hartl R, Ellegala DB. Neurosurgery and global health: going far and fast, together. World Neurosurg. Apr 2010;73(4):259-260.

2. Wait SD, Hartl R. Multi-institutional American team teaches neurosurgery in underserved Tanzania. World Neurosurg. Jun 2010;73(6):610-611.

3. Kahamba JF, Assey AB, Dempsey R, Qureshi MM, Hartl R. The Second African Federation of Neurological Surgeons Course in the East, Central, and Southern Africa Region Held in Dar es Salaam, Tanzania, January 2011. World Neurosurg. Nov 7 2011.

4. Winkler AS, Tluway A, Slottje D, Schmutzhard E, Hartl R. The pattern of neurosurgical disorders in rural northern Tanzania: a prospective hospital-based study. World Neurosurg. Apr 2010;73(4):264-269.

5. Coburger J, Leng LZ, Rubin DR, Mayaya G, Medel R, Ngayomela I, Ellegala D, Durieux ME, Nicholas J, Härtl R. Multi-Institutional Neurosurgical Training Initiative at a Tertiary Referral Center in Mwanza, Tanzania: Where We Are After 2 Years. World Neurosurg. 2012 Sep 27

6. Maier D, Njoku I Jr, Schmutzhard E, Dharsee J, Doppler M, Härtl R, Winkler AS. Traumatic brain injury in a rural and an urban Tanzanian hospital--a comparative, retrospective analysis based on computed tomography. World Neurosurg. 2014 Mar-Apr;81(3-4):478-82

7. Mitchell KB, Giiti G, Kotecha V, Chandika A, Pryor KO, Härtl R, Gilyoma J. Surgical education at Weill Bugando Medical Centre: supplementing surgical training and investing in local health care providers. Can J Surg. 2013 Jun;56(3):199-203

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