Spotlight On: Association of Future African Neurosurgeons

Global Neurosurgery In Africa: Initiatives of the Association of Future African Neurosurgeons

Yvan Zolo [1,2], Lorraine Arabang Sebopelo [1,3] , Endalle Genevieve [1,2 ]


1. Research Department, Association of Future African Neurosurgeons, Cameroon

2. Faculty of Health Sciences, University of Buea, Buea, Cameroon

3. Faculty of Medicine, University of Botswana, Gaborone, Botswana

Corresponding author: Yvan Zolo, yvanzolovie@gmail.com

Neurosurgery in Africa: Workforce deficit, burden of disease


Global neurosurgery is “an area for study, research, practice, and advocacy that prioritises improving health outcomes and achieving health equity for all people worldwide who are affected by neurosurgical conditions or have a need for neurosurgical care.”[1] Currently there are significant disparities in access between high-income and low- and middle-income countries (LMICs). Every year, 22.6 million patients suffer from neurological disorders or injuries that warrant the expertise of a neurosurgeon and as many as 13.8 million require surgery.[2] Most of these patients live in LMICs. In 2015, the Lancet Commission on Global Surgery estimated that 143 million additional surgical procedures are needed in low- and middle-income countries each year, and a subsequent study revealed that 15% of these surgical procedures are neurosurgical.[3]

While the demand for neurosurgical care is important, there are not enough neurosurgical providers to meet the demand. There are only 49,940 neurosurgeons worldwide[3] and 23,300 additional neurosurgeons are needed to address the excess 5 million unmet essential neurosurgical cases in LMICs.[2]


Africa faces an important global neurosurgery dilemma. A recent estimate put the neurosurgeon workforce density at 1 per 4,000,000 instead of the recommended 1 per 212,000.[4] Thus, there is a gross disparity in the allocation of the surgical workforce, leaving large geographic treatment gaps in the continent.[5]

Africa needs more neurosurgery providers but it equally needs to invest in other aspects of its healthcare system. The focus has been placed currently on the neurosurgical workforce deficit. One way the workforce deficit can be curtailed is through task-shifting and task-sharing. Another way is the training of aspiring neurosurgeons. Africa can increase the number of aspiring neurosurgeons if it fosters neurosurgery interest among medical students. This can be done through education and the creation of opportunities. The midterm goal is to facilitate the admission of these aspiring neurosurgeons in training programs and subsequently their return into the African neurosurgical care delivery system.[6]


Unfortunately, most African medical students lack interest in neurosurgery and until recently, those with interest in neurosurgery lacked the information, mentorship, and opportunities to nurture their interest.[7] There was a need for an organised body whose aim would be to guide Africa’s future neurosurgeons into training programs and subsequently facilitate their career development, as well as their relocation post-training in the neurosurgical care delivery system in Africa.[8]

Global Neurosurgery in Africa: Current initiatives by the Association of Future African Neurosurgeons, AFAN


A neurosurgery interest group called the Association of Future African Neurosurgeons (AFAN) was created almost two years ago with the vision to become the largest and most efficient community of aspiring African neurosurgeons. AFAN is a non-governmental and non-profit organization that provides networking, education, and research in neurosurgery. 


Most of AFAN’s activities are held online. The Internet appears to be an essential tool to bridge this gap and African medical students’ need to incorporate the internet in their career development armamentarium.[9] The AFAN online electronic learning model promotes the long-distance acquisition of neurosurgical skills without compromising quality. This model provides a cost-effective solution to learning, but its most significant challenge is sustainability.[9] AFAN invites students to free online educational activities and to this date, AFAN has organised more than 50 online presentations and journal clubs. AFAN recognizes that Africa needs evidence-based practice guidelines developed from quality local research. AFAN has set out to build the research capacity of its members so they will generate the locally-sourced evidence for best practice guidlines.[9] AFAN offers a research fellowship to aspiring African neurosurgeons with a structured curriculum and practical research activities. AFAN’s research activities do not only improve individual capacity, they equally reduce the neurosurgical research gap between high-income countries (HICs) and Africa.[10]


To achieve safe, accessible, and affordable neurosurgical care for all, AFAN believes African neurosurgeons should participate in national and international global neurosurgical activities, develop disruptive solutions to local problems and work with local stakeholders to address global neurosurgery problems. So, AFAN members advocate for better neurosurgical care by speaking up on, drawing the community’s attention to, and proposing solutions on global neurosurgery through

Opinion pieces in scientific journals (Letter to the Editor, Commentary, Editorial). Ex: The Implications of Global Neurosurgery for Low- and Middle-Income Countries. The Case of Cameroon.[11]

Future Global Neurosurgery initiatives by the Association of Future African Neurosurgeons 


AFAN has a myriad of activities being planned to train students in order to facilitate accessibility to safe, timely, affordable and quality neurosurgical care for all. These activities are mainly targeting medical students in order to build their capacities and facilitate their insertion in the Neurosurgical care delivery system. Some of these include the participation of medical students in international global neurosurgery studies, submission and presentation of abstracts at international global neurosurgery conferences. Moreover, AFAN plans to organize neurosurgical training boot camps, international symposiums, as well as to create a medical student neurosurgery journal, and scholarships for medical students and residents. Boot camps will go a long way to equip medical students with practical skills in neurosurgery. Medical student neurosurgery journals will train students in reviewing, editing, and publishing. These skills are needed on the continent given the paucity of specialized journals. Finally, the provision of scholarships to students will help subsidize the fees of medical students thereby facilitating their career development in neurosurgery.

Conclusion

The current neurosurgical workforce in Africa cannot meet the needs of its people. Without intervention there will be no progress. AFAN proposes sustainable and efficient solutions to this issue. 

Competing interests

The authors declare no competing interest.

Authors' contributions

YZ: Conceptualization, Project administration, Supervision, Writing - original draft, Writing - review and editing.

LAS, EG: Writing - original draft, Writing - review and editing. 


References

1. Park KB, Johnson WD, Dempsey RJ. Global Neurosurgery: The Unmet Need. World Neurosurg 2016; 88: 32–5.

2. Dewan MC, Rattani A, Fieggen G, et al. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. J Neurosurg 2018; : 1–10.

3. Mukhopadhyay S, Punchak M, Rattani A, et al. The global neurosurgical workforce: a mixed-methods assessment of density and growth. J Neurosurg 2019; 130: 1142–8.

4. Rabiu TB, Komolafe EO. Neurosurgery in rural Nigeria: A prospective study. J Neurosci Rural Pract 2016; 7: 485–8.

5. Dewan MC, Rattani A, Fieggen G, et al. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. J Neurosurg 2018; : 1–10.

6. Agarwal N, Norrmén-Smith IO, Tomei KL, Prestigiacomo CJ, Gandhi CD. Improving medical student recruitment into neurological surgery: a single institution’s experience. World Neurosurg 2013; 80: 745–50.

7. Kanmounye US, Zolo Y, Tsopmene M, Nguembu et al. Medical student perceptions of clinical neurosurgery teaching in an undergraduate medical school curriculum. ResearchGate. 2020. https://www.researchgate.net/publication/317269630_Medical_student_perceptions_of_clinical_neurosurgery_teaching_in_an_undergraduate_medical_school_curriculum (accessed July 15, 2020).

8. Career Interest Groups | School of Medicine. http://www.bumc.bu.edu/busm/student-affairs/student-life/career-interest-groups/ (accessed July 15, 2020).

9. Tetinou F, Djiofack D, Ghomsi NC, Kanmounye US. The Role of Young and Future Neurosurgeons in Global Neurosurgery: Perspectives from the Association of Future African Neurosurgeons. J Neurosci Rural Pract 2020; published online July 2. DOI:10.1055/s-0040-1713715.

10. Advancing medical research in sub-Saharan Africa: barriers, facilitators, and proposed solutions. https://www.clinical-medicine.panafrican-med-journal.com/content/article/3/83/full/ (accessed July 9, 2020).

11. Kanmounye US, Ghomsi NC, Djiofack D, et al. The Implications of Global Neurosurgery for Low- and Middle-Income Countries. The Case of Cameroon. Iran J Neurosurg 2020; 6: 2–2.

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