Weill Cornell Neurosurgeons Conduct First Hands-on Neurotrauma Training Course in Tanzania

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In March 2014, a neurosurgical team from the Weill Cornell Brain and Spine Center conducted the first neurotrauma training course for health care providers from East, Central, and Southern Africa, teaching much-needed neurosurgical skills to African surgeons, physicians, residents, and nurses.  The weeklong course, presented in collaboration with the Muhimbili Orthopedic Institute (MOI) in Dar Es Salaam, was led by Dr. Roger Härtl, who started the Cornell Neurosurgery Initiative in Tanzania in 2008. Dr. Härtl was joined this year by Neurosurgeon-in-Chief Dr. Philip Stieg, pediatric neurosurgeon Dr. Jeffrey Greenfield, and our neurointensive care specialist Dr. Hal Mangat along with several other Weill Cornell personnel that included anesthesiologists, fellows, and  nurses.

The Cornell Neurosurgery Initiative in Tanzania was created to fill a significant need in that East African nation, where there are five certified neurosurgeons for 45 million people. With access to neurosurgical care severely limited, neurosurgical training is critical to establishing an infrastructure for treating traumatic injuries to the brain and spine, which is the leading cause of death and disability in young adults worldwide. To create that infrastructure, Weill Cornell collaborates with (MOI) and the Tanzanian office of Health Ministry and other academic institutions in North America and Europe to develop neurosurgical care and training programs.

Dr. Härtl leads annual missions to Tanzania to implement those programs, with a goal of training local surgeons in basic neurosurgical procedures using locally available equipment and resources as well as integrating donated equipment into the hospital’s existing facilities. This year’s course included lectures and hands-on laboratory activities to demonstrate basic neurosurgical skills, followed by live surgeries directed by the Weill Cornell team and its European affiliates. The team’s goal is not to perform surgery themselves but to use hands-on training to educate neurosurgeons, nurses, and other medical personnel to provide ongoing care on their own—an approach that is both dynamic and empowering.

This year the focus of the training course was on care and treatments for patients with traumatic brain and spine injuries.  These debilitating injuries frequently require surgical decompression and stabilization in order to preserve and restore neurological function.  The course began with opening remarks from the office of the Ministry of Health, followed by classroom training on the characteristics and clinical management of traumatic brain injury (TBI).  Highlights of the classroom training included:

  • Dr. Moody Qureshi of Kenya discussed the importance of basic training, citing developing safety standards as a simple and tremendously effective first step. 
  • Dr. Härtl explained the history behind current management for traumatic brain injuries — a story that echoed Dr. Qureshi’s comment on the efficacy of standard protocols.
  • Dr. Stieg outlined surgical management of brain injuries.
  • Dr. Greenfield discussed the special considerations in the treatment of pediatric neurosurgical patients.
  • Dr. Anthony Figaji, a South African neurosurgeon, and Dr. Hal Mangat reviewed nonsurgical intensive care protocols.
  • Dr. Othman of Tanzania discussed imaging techniques.

 
Other speakers included neurosurgeons and nurses from affiliated institutions in the U.S. and Europe.

The lectures were followed by breakout demonstrations of the cervical spine, craniotomies for TBI, and ventricular drainage placement and management.   The training then moved into the MOI operating rooms, where the visiting faculty directed local surgeons and residents in several cases:

  • Dr. Stieg and Dr. Greenfield directed MOI neurosurgeons in the case of a patient with a posterior communicating artery aneurysm, becoming the first American neurosurgeons to participate in clipping a brain aneurysm in Tanzania.The patient was treated successfully with no intraoperative complications, and she was moved to the ICU for her recovery.
  • A seven-year-old girl who presented with tunnel vision in clinic was diagnosed with a craniopharyngioma that had produced a massive cyst compressing her optic chiasm. Dr. Stieg and Dr. Greenfield, along with our Tanzanian colleagues, successfully removed the tumor and the child was sent to the critical care and recovery unit.
  • Thanks to the generosity of private donors and companies such as Brainlab, Depuy Synthes, NuVasive and others, Dr. Härtl’s team and local doctors were able to perform the first minimally invasive spinal instrumentation and decompression procedures with 2D navigation. We hope this may open up future opportunities to make these technologies available on a consistent basis. Patients who were treated with minimally invasive decompression and 2D navigation technology did very well after surgery.

 
In all, more than 100 individuals attended this neurotrauma course, with participants from not only Tanzania but Kenya, Uganda, Sudan, and South Africa—all of whom will bring their newfound skills and knowledge back to their local health care facilities.

Tanzanian neurosurgeon Dr. Othman closed the neurotrauma course with these remarks: 

As this year’s course concluded, we were, once again, humbled by the lessons we have learned from our Tanzanian friends – lessons of passion, determination, and will. It is evident that neurological surgery is critically needed in Africa and, with proper training and guidance, it becomes even clearer that the enthusiasm and capacity for such work exists. We are grateful to our Tanzanian colleagues for hosting yet another successful course, and we look forward to future collaborations. The previous model of global health, which depended on medical missions, has been beneficial but largely limiting and unsustainable. With the emerging model of providing education and fostering academic collaborations, the idea of long-term global neurosurgical healthcare may be attainable.  In time, we hope that these efforts will act as a pilot model for other hospitals and continue to improve patient outcomes.

Dr. Joseph Kahamba, head of neurosurgery at Muhimbili Orthopedic Institute, summarized the event this way:

“…The level of coordinated and synchronized actions between surgeons, anesthesiologists, intensivists, nurses, Brainlab, and all, despite of the shortcomings, was impeccable!! Word from participants is that they would come again for such similar course. All patients operated on are doing well and Japhet will present them at our clinical meeting. … "

Download the 2014 update (PDF)

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