Dar es Salaam
Tanzania developed an independent neurosurgery training program in Dar es Salaam. While significant progress has been made, a number of training deficiencies remain. To address these deficiencies, the Muhimbili Orthopedic Institute (MOI) Division of Neurosurgery and the University of Colorado School of Medicine Department of Neurosurgery set up a Memorandum of Understanding in 2016. This relationship was developed with the perspective of a “collaboration of equals.” Through this collaboration, faculty members and trainees from both institutions have the opportunity to participate in international exchange, join in collaborative research, experience the culture and friendship of a new country, and share scholarship through presentations and teaching. Ultimately, through this international partnership, mutual improvement in the care of the neurosurgical patient will develop, bringing programs like MOI out of isolation and obscurity. From Dar es Salaam, a center of excellence is developing to train neurosurgeons who can go well equipped throughout Tanzania to improve the care of the neurosurgical patient everywhere. The authors encourage further such exchanges to be developed between partnership training programs throughout the world, improving the scholarship, subspecialization, and teaching expertise of partner programs throughout the world 1).
The purpose of a paper is to propose and qualify a novel funding mechanism for international neurosurgical nonprofits. The article first identifies and explains neurosurgeons' means for practicing in the developing world through a literature review. After this examination of the current funding methods for surgical care in low-income regions, the work transitions to an explanation of the applications and limitations of a new resource: the internal wealth of a developing country. This wealth may be leveraged by way of a for-profit hospital to create sustainable and domestic funding for nonprofit neurosurgical training. The applicability of the proposed mechanism extends beyond the field of neurosurgery to nonprofits in any health-related discipline. Factors influencing the viability of this mechanism (including local disease burden, economic trajectory, and political stability) are examined to create a baseline set of conditions for success 2) 3).
A 78-year-old female with a history of lower extremity weakness after a fall, which fully resolved after conservative treatment. However, the symptoms recurred 4 years later, and the patient became unable to walk. The patient had no superficial or deep sensation below the level of T9, and she also had urinary retention. Magnetic resonance imaging showed that hypertrophic dura mater was compressing the spinal cord from T2 to T10. Blood testing revealed increased anti-HTLV-1 antibody, rheumatoid factor, elevation of anti-SS-A antibody and antinuclear antibody. The cerebrospinal fluid contained markedly elevated levels of total protein and cell numbers. Biopsy of the labial gland of the lip revealed chronic sialadenitis.
In collaboration with a neurologist, we diagnosed this patient with hypertrophic spinal pachymeningitis associated with HTLV-1 infection and Sjogren's syndrome. We performed laminectomy at the affected spinal levels, resected the thickened dura, and maintained the patient on steroid therapy. The patient attained a marked recovery; she could walk with a cane and her urinary retention was improved.
For the management of HSP associated with HTLV-1 and SS, we recommend surgical decompression with subsequent prolonged steroid therapy and prolonged close monitoring to achieve a good long-term outcome 4).
The second International African Federation of Neurological Surgeons course was organized on January 24 to 28, 2011, at the Seacliff Hotel and Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. President Jakaya Mrisho Kikwete graced the official opening with high ranking government officials in attendance. The targeted participants were young neurosurgeons in the East, Central, and South African region. More than 80 surgeons, residents, and neurosurgical nurses came from Tanzania, Kenya, Uganda, Rwanda, Ethiopia, Zambia, and Zimbabwe. The objectives of the course were to teach and train young local surgeons in the essential-relevant for the region-and current techniques and management principles of brain and spinal diseases, acquire new skills through hands-on practical sessions, and share experiences. The course consisted of didactic sessions, practical aspects on spine internal fixation, cadaver dissections, and live microscopic and endoscopic surgery. Experienced faculty from different states of the United States, Spain, Turkey, India, Egypt, and Ethiopia facilitated the course. The objectives of the course were met with a favorable evaluation report. The collaboration and experience gained will be reinvested in organizing similar courses in the region 5).