Initial audit of a basic and emergency neurosurgical training program in rural Tanzania

Objective: As of 2006, only three formally trained neurosurgeons are licensed in Tanzania. Recently, efforts have increased toward training local Tanzanian physicians and assistant medical officers (AMOs) to meet the basic neurosurgical needs of nonurban areas. Between January and July 2006, an initial attempt at such an apprenticeship was undertaken with a locally trained AMO already performing general surgery at Haydom Lutheran Hospital, Tanzania. Methods: Fifty-one neurosurgical patients were identified and their patient charts were requested from the medical records office. Records were not available for 4 of the 51 patients for undeterminable reasons. Results: The neurosurgical infrastructure at HLH is basic but adequate for a number of procedures. Cases performed included ventriculoperitoneal shunts, repair of myelomeningoceles, and burr holes and craniotomies for trauma and biopsies. Of 51 patients initially identified, 14 (27%) were confirmed deceased and 20 (39%) confirmed living. The remaining 17 (33%) were lost to follow-up. There were no significant differences in the mortality rates of patients receiving care from the American-trained neurosurgeon and those receiving care from the Tanzanian AMO trained and mentored by the American neurosurgeon. Conclusions: This initial audit provides support for the development of limited neurosurgery programs in underserved communities. Combined utilization of available neurosurgeons and continued training for available local clinicians may help to meet this need. © 2010 Elsevier Inc

Neurosurgery in tanzania: A discussion of culture, socioeconomics, and humanitarians

Objective: To elucidate the progress of neurosurgical practices in Tanzania, taking into account humanitarian, socioeconomic, and geographic influences. Method: Articles, records, and historical texts were consulted to establish a timeline and history of neurosurgery in Tanzania. Results: Reulen, a German neurosurgeon, was integral to the development of sustainable neurosurgical services in Tanzania. By training Tanzanians who returned to their country to practice, Reulen helped to establish a continuity of care and legacy on which future Tanzanian surgeons could build. Subsequently, as neurosurgical services were integrated into the Muhimbili Orthopedic Institute, surgeons found a hospital to call home and a place to focus their efforts. Neurosurgical services have now been offered to the Tanzanian people for \u3e40 years, a direct consequence of international influences coupled with certain extraordinary Tanzanian physicians. Conclusions: Neurosurgery in Tanzania and Africa more generally has a long history; however, it was not until more recent efforts of certain local pioneers and educational advisors abroad that modernization occurred. The progress of the past 50 years is substantial and with continued efforts advances will continue to be made. © 2012 Elsevier Inc