Editor’s Note: The opinions expressed in this piece are those exclusively of the author and do not represent a position statement of the AANS.
Although I am only a third-year medical student, I recognize that global neurosurgery is a niche to which I hope to contribute. As a Nigerian and American, I have always been interested in global health. I have family members in Nigeria who have suffered needlessly due to a dysfunctional healthcare system. High upfront costs and poor coordination of care within the system lead to delays in access to specialty services. Unsurprisingly, neurosurgical conditions have the most devastating impact on quality of life back home in Nigeria; this fact has driven my interest in neurosurgery and has made me interested in exploring novel ways of delivering quality healthcare to populations lacking access.
In Nigeria, Africa’s most populous country, well-established neurosurgical training programs exist, actively working to address the shortage of surgeons serving the continent.1 Upon completing residency, many go on to complete fellowships in other countries like the U.S. or U.K. There are two main neurosurgical societies within Nigeria: the Nigerian Society of Neurological Sciences (NSNS) and the Nigerian Academy of Neurological Surgeons (NANS).1 Both societies have approximately 100 active surgeons. Through these societies, neurosurgeons work together to try and provide all aspects of modern subspecialized neurosurgery to communities within Nigeria.
Critical Cultural Challenges
There are six geopolitical regions within Nigeria, all of which have their own unique customs and traditions. Culture often defines how individuals approach health care, which in turn influences how neurosurgery can be practiced. Public opinion regarding neurosurgeons’ ability to provide quality care within the country is generally mixed, with distrust that has been perpetuated through sub-adequate leadership.4,5
Dr. Douglas Emeka Okor, a U.K. trained neurosurgeon and NANS member, is working to address the cultural and social barriers to providing care throughout these six diverse regions. Complex neurosurgical procedures are performed regularly by privately run hospitals that are able to maintain equipment and train staff. These private hospitals are not funded by the federal government, instead they are managed by private stakeholders within the industry so they are self-sustainable and profitable. Unfortunately, the resulting high cost prohibits many from receiving this medical care.6,7
Strain on the Federal System
In contrast, neurosurgical capacity within public institutions or federal medical centers (FMCs) has been stunted due to chronic underfunding from the Nigerian federal and state governments. This has reduced provider morale with negative impact on patient care.7 As a result, many Nigerians have a deep-seated distrust of the federal healthcare system leading many to seek specialized care abroad in countries like India.6,7 This has contributed significantly to fragmented neurosurgical care across Nigeria. Efforts should focus on bridging the gap in neurosurgical care between the public and private practice healthcare systems.3
Toward Progress and Solutions
One way to help bridge the gap in care is through effective policy and regulatory reform within host nations.4,5 Duke University, Harvard University and the World Federation of Neurological Societies are all engaged at this level.3 For example, their efforts in collecting data on the burden of neurosurgical disease in Uganda is being used to direct policy change and bring about holistic and stepwise improvements in neurosurgical care and funding across all of Africa.3,9-10
There are many challenges to providing optimal neurosurgical care around the world.3 Global partners willing to participate should collaborate within the recognized professional organizations in the host country for the advancement of neurological services. This year, I plan to attend the annual NANS conference in Abuja, Nigeria. I hope to connect directly with neurosurgeons from Nigeria to continue learning about the challenges currently facing the country so that I can, one day, join them as a colleague working toward progress in my country.
References
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1. Mahmud, M. R., & Idris, M. M. (2018). A Glance at Neurosurgery in Nigeria Following the 3rd CAANS Congress. AANS Neurosurgeon, 27(3). Retrieved from https://aansneurosurgeon.org/inside-neurosurgeon/a-glance-at-neurosurgery-in-nigeria-following-the-3rd-caans-congress/
2. Johnson, W. (2019, December 3). Bogota Declaration on Global Neurosurgery. Retrieved from https://globalneurosurgery.org/bogota-declaration/
3. Budohoski, K. P., Ngerageza, J. G., Austard, B., Fuller, A., Galler, R., Haglund, M., … Stieg, P. E. (2018). Neurosurgery in East Africa: Innovations. World Neurosurgery, 113, 436–452. doi: 10.1016/j.wneu.2018.01.085
4. Frenk, J. (2010). The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress. PLoS Medicine, 7(1). doi: 10.1371/journal.pmed.1000089
5. Meara, J. G., & Greenberg, S. L. (2015). The Lancet Commission on Global Surgery Global surgery 2030: Evidence and solutions for achieving health, welfare and economic development. Surgery, 157(5), 834–835. doi: 10.1016/j.surg.2015.02.009
6. [Nigeria Health Watch]. (2019, January 19). The Nigerian Patient is Worth It! | Douglas Emeka Okor | #BrainGain4Naija Conference [YouTube]. Retrieved from https://www.youtube.com/watch?v=UEyWQF4elTo
7. Urowayino, J. (2019, October 15). Furore over Buhari’s 2020 health budget proposal. Retrieved from https://www.vanguardngr.com/2019/10/furore-over-buharis-2020-health-budget-proposal/
8. World Federation of Neurosurgical Societies WFNS. (n.d.). World Federation of Neurosurgical Societies. Retrieved from https://www.wfns.org/
9. Tran, T. M., Fuller, A. T., Butler, E. K., Makumbi, F., Luboga, S., Muhumuza, C., … Haglund, M. M. (2017). Burden of Surgical Conditions in Uganda. Annals of Surgery, 266(2), 389–399. doi: 10.1097/sla.0000000000001970
10. Farber, S. H., Vissoci, J. R. N., Tran, T. M., Fuller, A. T., Butler, E. K., Andrade, L., … Haglund, M. M. (2016). Geospatial Analysis of Unmet Surgical Need in Uganda: An Analysis of SOSAS Survey Data. World Journal of Surgery, 41(2), 353–363. doi: 10.1007/s00268-016-3689-5
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