Neurosurgery And Global Health

This book is a combination of ideas and experiences from over 100 dedicated and brilliant neurosurgeons around the world. Their common goal is to provide data for a deeper understanding of the multi-faceted aspects of neurosurgery and, by doing so, to better serve patients across the globe. Scientific curiosity, deep dedication, incredible work ethics, entrepreneurship, and creativity are the common traits among all neurosurgeons, and not the exception. By allowing readers to see the field of neurosurgery from the perspectives of surgeons spanning five continents, this book serves to provide multiple, diverse viewpoints and to build a foundation for future collaborations. The book’s 24 chapters are organized into 3 parts. Part I provides the reader with an overview of the role of neurosurgery in worldwide health care, its evolution over the past decades, the current state and future directions of each neurosurgical subspecialty across the five continents. Over the years, the overarching goal for neurosurgeons has been to develop new, more effective and high-end solutions for complex diseases and to provide access to neurosurgical services for all patients. Part II discusses the differences and similarities of neurosurgery education and training across the globe, providing a snapshot of how new tools, technology, and paradigms reduce inequality and increase access to neurosurgical education. Educational accomplishments and challenges still present for the in different regions of the world are reviewed. Part III focuses on economic aspects influencing neurosurgery globally, including how to make efficient decisions in the face of scarcity, yet demand. The authors provide theories, models, and tools helpful to apply when planning to allocate resources, not just financial, but also human and intellectual. A deeper understanding of economics does not necessarily provide the answer to the problem; rather it provides the tools to find an answer, or, ideally, multiple possible solutions. Neurosurgery and Global Health is the first comprehensive guide to the role of neurosurgery in the global health care sphere, providing an in-depth compendium about the understanding of the neurosurgical role within global health, its efforts in the education of tomorrow’s workforce, and the economic aspects driving the field.

During his training, neurosurgeon Robert J. Dempsey, M.D. was told that global health was something for infectious diseases and not possible in super-specialties. This is the story of questioning that belief, of addressing a massive need by working in the areas of need, going to numerous ministers of health worldwide and showing them that with the training of even a few neurosurgeons, we can complete a trauma system in their country. The result is now we can also provide care for cancer, stroke and congenital defects of newborn children where it was previously impossible. In 2015, the Lancet Commission’s report predicted, over the next few years, 47 million unnecessary deaths worldwide due to the lack of essential surgeries. This book relates the importance of rectifying that ongoing tragedy and, more importantly, the humanizing influences that such a journey has had on a super-specialist working with the people of greatest need. It concludes that in spite of massive need, the present situation is actually very hopeful, as we have shifted the focus of global health from service alone to partnered teaching, leading us now to self-sustaining systems of care delivered for and by the people in the regions of need. Global Neurosurgery covers the thought-provoking and often frightening lessons learned over four decades of neurosurgical involvement in global health, working from a period when little or none existed to the present state of specialized healthcare in the area of need. This process starts in the U.S. and then addresses health disparity on four continents and now on U.S. tribal reservations. It emphasizes the importance of first listening, then partnering with government, medical societies, universities and private foundations, and most importantly, learning from mistakes. The programs developed allow the recipients of the care to take over the training so that it becomes about them and their patients in their home lands. It will appeal to a wide audience because its stories explain actual worldwide health conditions while giving an insight valuable to the professional or lay person into the experiences and operating rooms of a neurosurgeon working under very difficult conditions.

In this issue of Neurosurgery Clinics, guest editors Drs. Robert J. Dempsey and Michael M. Haglund bring their considerable expertise to the topic of Global Neurosurgery. Top experts in the field cover the delivery of neurosurgical care in a variety of settings, discussing topics such as worldwide need and disparities; medical curriculum development for a worldwide curriculum for neurosurgery; continuing medical education for graduates; key partners in global health; bioengineering in global health; and much more. Contains 16 relevant, practice-oriented topics including overview on global neurosurgery; global neurosurgery and international policy; establishing microsurgical skills laboratories in low- and middle-income countries and partnering through WIFI for remote teaching; establishing the trainee in their first program; traumatic brain injury and the early development of a neurosurgical program; and more. Provides in-depth clinical reviews on global neurosurgery, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Surviving Neurosurgery: Vignettes of Resilience is a practical guide to the inner workings of the lives of neurosurgeons, healthcare partners, and patients. To this end, this text serves as a first-hand documentary of the unique challenges faced as one progresses through their career. It is a snapshot in time capturing the experiences of both patients and providers. The text is divided into seven parts that run the gamut of a neurosurgeon’s career symbolic of the seven years of neurosurgical training. These narratives include, but are not limited to, residency challenges, surgical nuances, research and funding, embracing humanity, patient experiences, and overcoming hurdles along the journey. Chapters share the wisdom and experiences of over 100 authors consisting of patients, trainees, advanced practice providers, and attending neurosurgeons.

This book provides coverage of a broad range of topics in the ?eld of neurosurgery, 5 for residents and registrars in training and for recent graduates of training programs. 6 As neurosurgical training incorporates expertise from centers worldwide, there is a 7 need to have input from specialists in neurosurgery from various countries. This text 8 is a compilation by expert authors in the USA and the UK to provide information on 9 the basic knowledge and clinical management required for optimal care of neuro- 2011 surgical patients. 1 The text is an up-to-date synopsis of the ?eld of neurosurgery from American and 2 British perspectives, which covers the most common clinical conditions encountered 3 by neurosurgeons. The chapters are organized under broad topics, including inves- 4 tigative studies, perioperative care, the role of newer techniques and the management 5 of tumors, vascular and traumatic lesions. Additional topics are then covered, includ- 6 ing pediatrics, spine and peripheral nerve lesions, as well as functional neurosurgery 7 and infections. We anticipate that trainees will ?nd this information useful for certi?- 8 cation examinations and recent graduates of neurosurgical training programs can 9 utilize this text as an update of the most important neurosurgical topics.

The concept of this project is based on the premise that neurosurgeons are vital agents in the application of the American health care apparatus. They remain the true advocates for patients undergoing surgery for a neurological condition. Yet, the tenets of health care economics, health care policy, and the business of medicine remain largely debated within the context of politicians, policy experts, and administrators. This textbook will ease that gap. It will bring material generally absent from medical curricula into discussion. It will make potent features of health care economics, policy, and the business of practice digestible to clinical neurosurgeons in order to help them better treat their patients. The information provided in this text will also provide an excellent foundation for understanding the mechanics of running a neurosurgical practice. It simultaneously addresses career progression and opportunity evaluation.

An inspiring story of doctors who changed the health care of an African nation Dr. Dilan Ellegala arrives in Tanzania, shocked to find the entire country has just three brain surgeons for its population of forty-two million. Haydom Lutheran Hospital lacks even the most basic surgical tools, not even a saw to open a patient’s skull. Here, people with head injuries or brain tumors heal on their own or die. When confronted with a villager suffering from a severe head trauma, Dilan buys a tree saw from a farmer, sterilizes it, and then uses it to save the man’s life. Yet Dilan realizes that there are far too many neurosurgery patients for one person to save, and of course he will soon be leaving Tanzania. He needs to teach someone his skills. He identifies a potential student in Emmanuel Mayegga, a stubborn assistant medical officer who grew up in a mud hut. Though Mayegga has no medical degree, Dilan sees that Mayegga has the dexterity, intelligence, and determination to do brain surgery. Over six months, he teaches Mayegga how to remove tumors and treat hydrocephalus. And then, perhaps more important, Dilan teaches Mayegga how to pass on his newfound skills. Mayegga teaches a second Tanzanian, who teaches a third. It’s a case of teach-a-man-to-fish meets brain surgery. As he guides these Tanzanians to do things they never thought possible, Dilan challenges the Western medical establishment to do more than send vacationing doctors on short-term medical missions. He discovers solutions that could transform health care for two billion people across the world. A Surgeon in the Village is the incredible and riveting account of one man’s push to “train-forward”—to change our approach to aid and medical training before more lives are needlessly lost. His story is a testament to the transformational power of teaching and the ever-present potential for change. As many as seventeen million people die every year because of a shortage of surgeons, more than die from AIDS, malaria, and tuberculosis combined. Dilan Ellegala and other visionaries are boldly proposing ways of saving lives.