Barriers to Care for Patients With Neurologic Disease in Rural Zambia

Abstract

The awesome burden of treatable yet untreated neurologic disease in the developing world presents a humanitarian crisis to those of us with neurologic expertise from more privileged situations. Although increased economic resources are critically needed, a shortage of personnel to care for these patients is as great a problem. It is neither feasible nor desirable to propose training neurologists to work in these regions. However, COs could be selected to receive additional training and return to their home regions to serve as resources for referrals and as community educators. Such a training program would not require massive financial commitments. A handful of dedicated neurologists could conceivably accomplish this in 6- to 8-week training sessions. Ideally, educational materials, such as posters and pamphlets in both English and the native language of the various regions, would be provided at no cost. Existing textbooks in neurology are written for physicians and often focus on diagnostic evaluations and therapies far beyond the services available in developing countries. A text for practical use by COs and community health workers that discusses the application of available medicines and therapies for common neurologic problems would be invaluable. Similar books exist that address general medical and obstetrical problems (for example, Where There Is No Doctor: A Village Health Care Handbook). Where There Is No Neurologist could be developed as a primary teaching tool and a valuable reference for COs with neurologic expertise. Neuroscience researchers, clinical neurologists, and neurology residents from industrialized countries have much to offer and to gain by working in the Third World. Research to monitor the incidence and resource utilization of emerging problems such as stroke is needed to influence public policy. The economic burden and lost productivity caused by neurologic disease in this part of the world has not been appreciated or explored. Disease beyond the scope of Western experience manifests daily in places like Chikankata. Entities such as tabes neurosyphilis, which previous generations of neurologists used as the basis for their training, still abound in Zambia. Much personal satisfaction can be gained in providing care to this vulnerable and underserved population.

Challenges in the diagnosis and treatment of CNS demyelinating disorders in Zambia

“…15 The better we understand the barriers to making a diagnosis of relapsing–remitting demyelinating disease in this patient population, the greater the opportunities for improvement in management and outcomes. It may also help guide further resource utilization and encourage outside assistance for this resource-limited setting.…”

Challenges in the diagnosis and treatment of CNS demyelinating disorders in Zambia

“…15 The better we understand the barriers to making a diagnosis of relapsing–remitting demyelinating disease in this patient population, the greater the opportunities for improvement in management and outcomes. It may also help guide further resource utilization and encourage outside assistance for this resource-limited setting.…”

Profile of neurological disorders in an adult neurology clinic in Kumasi, Ghana

“…In this cohort of 1812 patients referred to an adult neurology specialist clinic in an urban Ghanaian setting, we found that stroke was the commonest presenting neurologic disorder followed by epilepsy and movement disorders. At the global level epilepsy, headaches and cerebrovascular disorders are among the top three prevalent neurological disorders [5] , [6] , [7] , [8] , [9] seen at specialist neurology services whilst in primary care setting headaches, epilepsy and vertebral disorders featured most frequently [10] , [11] , [12] , [13] , [14] . Thus with the notable exception of headaches which had a lower frequency in the present study, the spectrum of neurologic disorders concur with other similar studies.…”

Neurocognitive and sensory impairments in cerebral palsy

“…This is consistent with previous reports from Sweden [19], Bangladesh [11] and Canada [21] which reported epilepsy in 33%, 38.7% and 47% of children with CP respectively. The implications of this include an increased economic burden and significant psychological stress from the myths and stigmatization associated with having an epileptic child in developing African country [13]. Hearing impairment was present in 33% of the children.…”

Challenges in the diagnosis and treatment of CNS demyelinating disorders in Zambia

“…15 The better we understand the barriers to making a diagnosis of relapsing–remitting demyelinating disease in this patient population, the greater the opportunities for improvement in management and outcomes. It may also help guide further resource utilization and encourage outside assistance for this resource-limited setting.…”

Profile of neurological disorders in an adult neurology clinic in Kumasi, Ghana

“…In this cohort of 1812 patients referred to an adult neurology specialist clinic in an urban Ghanaian setting, we found that stroke was the commonest presenting neurologic disorder followed by epilepsy and movement disorders. At the global level epilepsy, headaches and cerebrovascular disorders are among the top three prevalent neurological disorders [5] , [6] , [7] , [8] , [9] seen at specialist neurology services whilst in primary care setting headaches, epilepsy and vertebral disorders featured most frequently [10] , [11] , [12] , [13] , [14] . Thus with the notable exception of headaches which had a lower frequency in the present study, the spectrum of neurologic disorders concur with other similar studies.…”

Neurocognitive and sensory impairments in cerebral palsy

“…This is consistent with previous reports from Sweden [19], Bangladesh [11] and Canada [21] which reported epilepsy in 33%, 38.7% and 47% of children with CP respectively. The implications of this include an increased economic burden and significant psychological stress from the myths and stigmatization associated with having an epileptic child in developing African country [13]. Hearing impairment was present in 33% of the children.…”

Challenges in the diagnosis and treatment of CNS demyelinating disorders in Zambia

“…15 The better we understand the barriers to making a diagnosis of relapsing–remitting demyelinating disease in this patient population, the greater the opportunities for improvement in management and outcomes. It may also help guide further resource utilization and encourage outside assistance for this resource-limited setting.…”

Profile of neurological disorders in an adult neurology clinic in Kumasi, Ghana

“…In this cohort of 1812 patients referred to an adult neurology specialist clinic in an urban Ghanaian setting, we found that stroke was the commonest presenting neurologic disorder followed by epilepsy and movement disorders. At the global level epilepsy, headaches and cerebrovascular disorders are among the top three prevalent neurological disorders [5] , [6] , [7] , [8] , [9] seen at specialist neurology services whilst in primary care setting headaches, epilepsy and vertebral disorders featured most frequently [10] , [11] , [12] , [13] , [14] . Thus with the notable exception of headaches which had a lower frequency in the present study, the spectrum of neurologic disorders concur with other similar studies.…”

Neurocognitive and sensory impairments in cerebral palsy

“…This is consistent with previous reports from Sweden [19], Bangladesh [11] and Canada [21] which reported epilepsy in 33%, 38.7% and 47% of children with CP respectively. The implications of this include an increased economic burden and significant psychological stress from the myths and stigmatization associated with having an epileptic child in developing African country [13]. Hearing impairment was present in 33% of the children.…”