Challenges to the growth of neurosurgery workforce in subsaharan Africa

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(NOTE: We hope to have Dr. Dieu Merci Kabulo of the Congo, a member of our community and a neurosurgeon from the Congo, to give a talk on this topic in the new future on www.Neurosurgical.tv)

A glance at the map of global surgery workforce on the website of the World Federation of Neurosurgical Societies (WFONS) and we notice a dire situation in subsaharan Africa. In the Democratic Republic of Congo for example, there are 0.005 neurosurgeons per 100,000 people a lot less than the recommended objective (1 neurosurgeon per 100,000). There are a myriad of reasons that explain this.

Firstly, neurological sciences have a reputation to be difficult. For instance, medical students apprehend neuroanatomy and neuroradiology lectures; fortunately not as much as they do with pathology ?. In addition, it is counter intuitive but being a successful neurologists or neurosurgeons does not imply good teaching skills. We therefore advise that basic neurological sciences should be made more interactive, practical and student-friendly. For example, YouTube channels (like Osmosis, iMedicalSchool), Drs Chaffanjon and Palombi publish free and comprehensive medical videos that have become popular among students and should be used by lecturers. In addition, lecturers should be trained to improve their pedagogical skills.

Secondly, neurosurgery is associated with mysticism in subsaharan Africa. This is true both within and without the medical community. In a very religious society, it contributes to hinder the development of neurosurgery as patients and potential residents are apprehensive. A solution to this will be to inform and educate people on the practice, pathologies and benefits of neurosurgery. Given that people tend to attribute what they do not understand to mystical phenomena, getting them to understand what neurosurgery is about will help debunk some misconceptions.

Lack of opportunities due to nepotism, tribalism and chauvinism are equally important impediments to the growth of the neurosurgical workforce in subsaharan Africa. It is not uncommon for residents to be chosen based on their sex, ethnicity and/or social backgrounds. Equality and justice should not be exceptions but the rule. We have to advocate for more transparent and fairer residency admissions.

Last but not the least, financial, educational and material penury has been and remains one of the most important obstacles to surgery for all. One reason is that most global health financing is aimed at medical and infectious diseases ( HIV, tuberculosis and malaria) making global surgery an orphan. Worse still, global neurosurgery is neglected with most global surgery initiatives focusing on the Bellwether procedures. We have to be more active outside the operating room as a community, especially on social media and local media to grow larger in order to weigh in on political decisions. Besides the economical barrier, there are very few local neurosurgery programs and fellowships available. The few that exist train a limited number of residents and fellows. A solution would be for aspiring residents to seek intra-continental programs like those of COSECSA.

In conclusion, the growth of the subsaharan Africa’s neurosurgery workforce faces many problems and fortunately there are many potential solutions available. Bringing attention to these issues publically and internationally is the first step to working towards the growth of the workforce in subsaharan Africa.

#GlobalSurgery #GlobalNeurosurgery #EqualSurgery

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