A model for neurosurgical humanitarian aid based on 12 years of medical trips to South and Central America

Abstract

<jats:p>The pediatric neurosurgical mission trips led by physicians at Virginia Commonwealth University (VCU) Health Systems began in 1996 with the formation of Medical Outreach to Children, founded by 1 of the authors (J.D.W.) after a visit to Guatemala. Since then, 19 surgical trips to 4 different countries in Central and South America have been coordinated from 1996 to 2008.</jats:p> <jats:p>This humanitarian work serves a number of purposes. First and foremost, it provides children with access to surgical care that they would otherwise not receive, thereby significantly improving their quality of life. Second, the visiting surgical team participates in the education of local physicians, parents, and caregivers to help improve the healthcare provided to the children. Last, the team works to promote sustainable global health solutions in the countries it travels to by generating a forum for clinical and public health research discourse.</jats:p> <jats:p>Thus far, a total of 414 children have undergone 463 operations, including 154 initial shunt surgeries, 110 myelomeningocele repairs, 39 lipoma resections, 33 tethered cord releases, 18 shunt revisions, 16 encephalocele repairs, 9 lipomyelomeningocele repairs, and 7 diastematomyelia repairs. The complication rate has been 5–8%, and the team has obtained reliable follow-up in ~ 77% of patients. A correlation was found between an increase in the number of trained neurosurgeons in the host countries and a decrease in the average age of patients treated by the visiting surgical team over time. It is also hypothesized that a decrease in the percentage of myelomeningocele repairs performed by the surgical team (as a fraction of total cases between 1996 and 2006) correlates to an increase in the number of local neurosurgeons able to treat common neural tube defects in patients of younger ages. Such analysis can be used by visiting surgical teams to assess the changing healthcare needs in a particular host country.</jats:p>

Costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa

“…4,11,24,40,46 Access to neurosurgical treatment can have a substantial impact on morbidity and mortality and is a key component in reducing the burden of disease and contributing to health system strengthening; however, its development in resource-limited countries has not been a global health priority. As with other surgical treatments, determining whether neurosurgical interventions can be cost-effective in the developing world should be evidence-based rather than relying on the conventional assumption that neurosurgery is impractical in resource-limited settings.…”

Neurosurgical capacity building in the developing world through focused training

“…While these training methods have proved effective, they require the pairing of training with the importation of heavy and/or expensive neurosurgical equipment and tend to be carried out in major cities of developing countries with the infrastructural capacity for the desirable type of growth. 12,13,16 Thus, the Madaktari Africa train-forward neurosurgery method is distinctive in that it fulfills a niche for need in extreme resource-poor settings, and its requirements are time, patience, and a focus on training rather than direct patient care. Note that our experience demonstrates that continuous (minimum of 6 months at a time) intensive one-to-one experiential training is needed rather than shorter-term training episodes or didactic classroom teaching alone.…”

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

“…76 In many impoverished countries of Central and South America, CSF-diverting procedures account for nearly 40% of total neurosurgical procedures. 37 This high burden of disease is coupled with the reality that most families do not have ready access to specialized neurosurgical care, and many cultural and economic factors lead to delayed presentation to medical care, often weeks to months after the symptomatic onset of hydrocephalus. 27,29 Some factors include shame for carrying a sick child, unawareness of treatment, poverty, initial attempt with traditional healing methods, poor understanding of early signs and symptoms, social taboos, or lack of physical access to health care.…”

“…47 Similarly, in Guatemala, a mere $256 per capita is spent on health care, whereas the United States spends $6096 per capita. 37 Therefore, the majority of hydrocephalus care is financially supported by funding agencies and donations of surgical materials by manufacturers in developed nations and the surgeon's personal expense.…”

“…27,29 Some factors include shame for carrying a sick child, unawareness of treatment, poverty, initial attempt with traditional healing methods, poor understanding of early signs and symptoms, social taboos, or lack of physical access to health care. 34,37,53,57 Limited access to already limited health resources, greater burden of pediatric hydrocephalus, and complex social and geographical barriers pose significant challenges for international global surgery efforts.…”