A Glance at Neurosurgery in Nigeria Following the 3rd CAANS Congress
The Continental Association of African Neurosurgical Societies (CAANS) held its 3rd Congress in Abuja, Nigeria in July 2018. The congress took place at the Transcorp Hilton Hotel in the capital city and welcomed neurosurgeons from 22 different African countries and 13 other countries outside the continent.
AANS International Programs Committee Chair Kenan Arnautovic, MD, PhD, FAANS, and eight other faculty members from the United States represented the American Association of Neurological Surgeons (AANS) at the meeting.
Congress President Bello B. Shehu, MD, IFAANS, and Local Organizing Committee Chair Samuel Ohaegbulam, MD, organized the congress. Abderrahmane Sidi Said, MD, celebrated the end of his term as CAANS president and welcomed 2018-2020 CAANS President Mahmood M. Qureshi, MD.
The field of neurosurgery in Nigeria has made great strides since the turn of the century in terms of building programs and developing residents. In this article, authors Muhammad Raji Mahmud, MD, and Muhammad Mansur Idris, MBBS, share how Nigerian neurosurgery has advanced.
Looking back at the records, the history of neurosurgery in Nigeria can be best divided into pre-colonial, colonial and post-colonial eras. The pre-colonial period includes the years before 1861, the colonial period transpired 1861-1960 and the post-colonial continues after 1960.1,2 Available data concerning various neurological diseases and neurosurgical practices occurring in Nigeria are still appallingly scant, especially during the pre-colonial and colonial eras.
However, the period after 1960, starting precisely in October 1962, saw the commencement of a formal neurosurgical practice at the premier University College Hospital in Ibadan by the late distinguished scholar E. Latunde Odeku, MD.3
The Origins of Neurosurgery in Nigeria
Before 1861, Nigeria was not yet colonized by Britain. At this time, political systems known as empires and kingdoms occupied the Sub-Saharan area now called Nigeria. By the Atlantic coast were powerful kingdoms, including Ife and the Yoruba Kingdom of Oyo as well, and further north was the Kanem-Bornu Empire, with a known history of more than a thousand years. There was also a powerful kingdom west of Kanem-Bornu called the Sokoto Caliphate, which was the dominant political force in the savannah for more than a hundred years. South of the Sokoto Caliphate were the small, but powerful, kingdoms of Tiv, Jukum and many others, which occupied the region now known as the Middle Belt.4,5 Each kingdom had a powerful political leader as well as a booming economy based on agriculture and commerce. Famous trading centers, such as Kano and Ibadan, remain active to this day.
In this economy, there were a variety of productive relationships and individuals had rights to land in the community through family inheritance. According to author and professor Tola Pearce, PhD, the stable agricultural economy provided enough food to feed all and reserve some for periods of bad weather or other calamities, such as invasion by pests that were common at the time.6 Since there was surplus food production, other members of the society were fed, even if they did not work in agriculture. These members pursued other specialist trades, such as woodcarving, leatherworking, pottery and healing. In other words, the nature of the economy facilitated specialization and development. Some healers concentrated on the development of an integrated body of knowledge for a more efficient explanation and treatment of illness. A variety of health specialists emerged, such as medicine men, diviners, midwives and magicians.2
The First Neurosurgeons in Nigeria
Professor Samuel C. Ohaegbulam, MD, MB, BCh, FRCS, FRCS, FWACS, FMCS, FICS – Dr. Ohaegbulam is currently chief neurosurgeon at Memfys Hospital for Neurosurgery in Enugu, a city in southeast Nigeria. He graduated from Cairo University Medical School in 1967 with honors and received his neurosurgical training in the United Kingdom at the Atkinson Hospital of St. George’s Medical School, London.
Dr. Ohaegbulam received microneurosurgery training at the Henry Ford Hospital in Detroit and pioneered the neurosurgical service of the University of Nigeria Teaching Hospital in 1974. He was promoted to full professor in 1980 and was chief of neurosurgery at the North West Armed Forces Hospital in Tabuk, Saudi Arabia 1989-2001.
He has held many positions at the University of Nigeria, including head of anatomy, associate dean of medicine and dean of medicine as well as deputy vice chancellor and head of Enugu campus of University of Nigeria Nsukka (UNN).
He is the author of Geographical Neurosurgery, the first online book of the Congress of Neurological Surgeons (CNS), in addition to his numerous chapters in books, scientific journals and speeches during conference proceedings. He is the pioneer president of the African Federation of Neurosurgical Societies, which was founded in 2007.
Professor M. Temitayo Shokunbi, MBBS, MSC, FRCSC, FWACS, FAS – Dr. Shokunbi, a consultant neurosurgeon at the University College Hospital, studied medicine at the University of Ibadan from 1973-1978. He later went to the University of Western Ontario to study neurosurgery and neuroanatomy 1981- 1986 and he obtained his MSc with a specialist certificate in neurosurgery from the Royal College of Physicians and Surgeons of Canada.
Professor Bello Bala Shehu, MD, IFAANS – Dr. Shehu graduated from Ahmadu Bello University in Zaria, Nigeria. He received his neurosurgical training at the Royal Victoria Hospital, Belfast in Northern Ireland and Cork University Hospital in Cork, Ireland, as well as Oldchurch Hospital in Romford, England. He returned to the Ahmadu Bello University and immediately started training young doctors in neurosurgery, given the total lack of the discipline in the all of northern Nigeria. Dr. Shehu is a fellow of the Royal College of Surgeons in Ireland, the West African College of Surgeons, the American College of Surgeons and the Nigerian National Medical College.
He moved to Usmanu Danfodiyo University and established a full-fledged regional center for neurosurgery, which over time has produced many young neurosurgeons. Today, these neurosurgeons contribute in various teaching hospitals throughout northern Nigeria, including Ahmadu University Zaria, Aminu Kano Teaching Hospital in Kano, the University of Maiduguri, Jos University Teaching Hospital, the University of Abuja Teaching Hospital and the National Hospital in Abuja, Nigeria. He envisioned, commissioned and constructed the first Level 1 trauma center in West Africa at the National Hospital in Abuja in 2014, serving as the chief medical director. He is currently vice chancellor of the federal university in his home state.
The First Neurosurgical Programs
The Rockefeller Foundation of New York sponsored the first formal neurosurgical program in Nigeria. The foundation established an academic facility for neurosurgeons at the University of Ibadan in October 1962. The late E. Latunde Odeku, MD, spearheaded th unit.7
Similarly, neurosurgical departments were established in Lagos by the late Colin da Silva in 1968, followed by Dr. Ohaegbulam in Enugu in 1974.8 Professor Shehu, a British-trained Nigerian neurosurgeon, came back to establish neurosurgical centers in northern Nigeria in the late 1990s. Adelola Adeloye, MD, later joined Dr. Odeku in Ibadan.
The Growth of Neurosurgery in Nigeria
Neurosurgery has had a stunted growth in the first half century of its existence in post-colonial Nigeria. Significant progress was made over the last two decades, in terms of equipment and development of local talent. Yet, more can be done so that Nigerian neurosurgeons can favorably compete with their counterparts in other countries in North and South Africa.
Neurosurgery has made substantial innovations in Nigeria. Over 50 neurosurgeons trained locally in the last 10 years and Nigeria produced the first female neurosurgeon in West Africa. Nigerians are also taking their rightful place in the global neurosurgical community. In 2009, the Chair of the Young Neurosurgeon Committee of the World Federation of Neurosurgical Societies (WFNS) Muhammad Raji Mahmud, MD, hailed from Nigeria.
Neurosurgical residency programs were established over 30 years ago to address the acute shortage of neurosurgical manpower in the country. There are two post-graduate training bodies, the West African College of Surgeons and the National Postgraduate Medical College of Nigeria. Fellowships to either of the two bodies are awarded at the end of the residency program.9,10
After completing medical school, a candidate spends one year on a preregistration house job. In the second year, the doctor performs his mandatory service in the National Youth Service Corp (NYSC). The postgraduate training formally begins after passing the primary examination that is organized and conducted by the two postgraduate bodies previously mentioned.
The first 24 months of the residency period is devoted to rotation in general surgery, trauma/accident and Emergency, anesthesiology, urology, orthopedics and a rural posting. Success in Part I of the examination will lead to a candidate starting 48 months of clinical neurosurgery. The period is usually devoted to neuroradiology, neuropathology, neurology and other aspects of clinical neurosurgery. There is a six-month to one-year overseas training for candidates to fill gaps in training. The exiting examination, Part II, will lead to the designation of Fellow of the West African College of Surgeon (FWACS) in neurosurgery or Fellow of the Medical College of Nigeria (FMCN) in neurosurgery.3
Neurosurgical residency training is experiencing considerable growth in Nigeria. Each year, a minimum of five to ten neurosurgeons are added to the pool in the country. Starting from two training centers 15 years ago, there are now about ten accredited training centers in various parts of the country.
Recently, Nigerian neurosurgeons successfully hosted the Continental Association of African Neurosurgical Societies (CAANS) 3rd Congress in Abuja. This is a breakthrough feat in the history of neurosurgery in Nigeria.
Challenges to Neurosurgery in Nigeria
Neurosurgery in Nigeria, like in all other emerging and developing countries, is faced with huge funding gaps. All the centers in Nigeria are mainly practicing general neurosurgery with trauma dominating the list. There is urgent need for sub-specialization in areas of Neurovascular, Neuro-oncology, Pediatric Neurosurgery and Minimal Invasive Neurosurgery. There are very few state-owned centers and only one privately owned and accredited training center that offer resident training locally. Therefore, there is need for more training centers to be accredited in order to increase the talent needed in the country.
The authors wish to thank and appreciate all the input given by the members of the Neurosurgery Division of the Department of Surgery at the National Hospital in Abuja, Nigeria. We are indebted to Bello Bala Shehu, MD, IFAANS, and Ayodeji Salman Yusuf, MD, for proofreading the article.
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2. Ityavyar, D. A. (1987). Background to the development of health services in Nigeria. Social Science & Medicine, 24(6), 487-499.
3. Adeloye, A. (1982). Neurosurgical Education in Africa. Neurosurgery, 10(1), 130-132.
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5. Crowder, M. (1962). The Story of Nigeria. London: Faber.
6. Pearce, T. O. (1980). Political and economic changes in Nigeria and the organisation of medical care. Social Science & Medicine. Part B: Medical Anthropology, 14(2), 91-98.
7. Odeku, E. (2011). Beginnings of Neurosurgery at the University of Ibadan, Nigeria. Annals of Ibadan Postgraduate Medicine, 5(2).
8. Adeloye, A. (1985). The World of African Neurosurgery. The tenth E Latunde Odeku Memorial Lecture. Ibadan, Nigeria.
9. Emejulu, J.K. (2008). Neurosurgery in Nigeria–an evaluation of the perception of health personnel in a new centre and a comparison of the Nigerian situation with that of other African states. Nigerian Journal of Clinical Practice, 11(4):291–5. https://www.ncbi.nlm.nih.gov/pubmed/19320396
10. El Khamlichi A. (1998). African Neurosurgery Part II: Current state and future prospects. Surgical Neurology, 49(Special Editorial):342–7.
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