The start-up of a neurosurgical service in an East Indonesian archipelagic province: The first 2-year experience of North Maluku Database in Neurosurgery (NOMADEN)

Abstract

Background: Despite encouraging developments after its initial founding in Indonesia more than seven decades ago, inequity in access and availability of neurosurgical services throughout the country continues to pose a challenge. We aimed to elaborate on the start-up of a previously inactive neurosurgical service in North Maluku, an archipelagic province in East Indonesia, and describe cases managed within the first two years of service. Methods: In the North Maluku Database in the Neurosurgery register, demographic and clinical information of neurosurgical patients admitted to Chasan Boesoirie General Hospital, Ternate, from January 2021 to December 2022, were analyzed. Surgically managed patients were rendered visually according to their decades of life and districts of events. Results: There were 998 new patients (mean age ± standard deviation [SD]: 34.7 ± 19.6 years, 60.3% male) managed and 216 neurosurgical procedures (mean age ± SD: 33 ± 20.4 years, 67.1% male) performed. The majority of patients operated were within the 1st decade of life (18.5%), presented to the emergency room (56.5%), covered by national health insurance (69.4%), from outside Ternate (62.5%), diagnosed with neurotrauma (40.7%), and discharged alive (80.1%). Ternate was the only district where all seven types of neurological diseases were encountered. No surgeries were performed for patients from Taliabu, the farthest district from Ternate. Conclusion: A large portion of neurosurgical patients in North Maluku were those young and at productive age who were transported from outside Ternate with acute neurological disease (particularly neurotrauma). Distance and geographical circumstances may have a profound effect on access to neurosurgical services.