The lone neurosurgeon who caters to a region of 17 million in Sub-Saharan Africa says this with a heavy sigh, as he once again cheats death and beats the odds by saving another life in far from ideal conditions.
Surgery is often referred to as the ‘neglected stepchild’ of global health (Farmer and Kim 2008). Literature shows that more people die each year due to the inability to access surgical care than from communicable diseases such as HIV, tuberculosis, and malaria. The inability to access required surgical intervention is often due to a scarcity of economic resources amongst various other factors. However, when people do manage to put together the money needed for life-saving procedures, what are they provided with?
This question is what piqued my interest and brought me to a rural city in East Africa. I worked alongside the neurosurgical team for six weeks and was privileged to get an insider view of what they do.
First and foremost, I have the greatest admiration for the surgeons who work tirelessly to give their best in such frustrating conditions. What I thought were necessities in regards to surgical care are actually luxuries for them. The neurosurgeon is forced to carry out operations without having access to MRI images (one MRI is available in a private hospital which many cannot afford), no neuronavigation technology and no microscopes. Instead, he has to use primitive tools, many of them faulty, and face technical issues such as poor lighting and power outages. Having already completed neurosurgical electives in Ireland, Australia, and the US, I never could have imagined these operations without all the equipment mentioned above. To me, it felt like the surgeon was going in ‘blind’. I was in complete awe! Definitely, an extensive knowledge of neuroanatomy and a healthy dose of self-confidence is needed here.
Moreover, there are additional barriers to a high level of quality surgical care, such as the state of the operating rooms. I was shocked to see that the neurosurgical theatre was one large room divided by a steel board. The doors were left open and people came and left as they pleased. The scrub room was far from sterile with one scrub sink and an open bottle of antiseptic washing liquid. The scrub gowns were reusable and the gloves seemed to be of the cheapest quality.
Furthermore, there was a saddening lack of structure. The safe surgery checklist was not completed. What was the most alarming to me though, was that the neurosurgeon sometimes functioned as resident, porter and scrub nurse. These designated positions which are formally carried out in the developed world, were not custom practice here. Often the neurosurgeon would have to shout loudly for a nurse in another room to bring a tool or change the setting on the machine. At times, I would even have to function as the scrub nurse, quickly learning all the different tools and trying my best to maintain some organization in the chaos.
This experience highlights one hospital’s battles in providing optimal surgical care. Despite the many limitations, we have to acknowledge that surgeries are often successful and patients rejoice at being cured. However, there are times that lifesaving procedures cannot be adequately performed because of the restrictions described above. In fact, procedures that are deemed ‘common’ in developed countries (e.g. aneurysmal repairs), are not offered here. Patients with cerebral aneurysms are referred to India, and of course, this is at their own personal expense.
Quality healthcare is a basic human right. Why is it that we have so many people suffering ever so silently? Undergoing a neurosurgical procedure is no easy task: patients are at their most vulnerable and aware of the significant risks involved. Imagine that the only neurosurgical care facility in your region has outdated tools and falls short on some of the most basic safety protocols. Imagine that there is only one neurosurgeon, sleep deprived due to the relentless volume of cases, is going to be operating on you soon. These people have no other alternative. Some are not even fortunate enough to afford the surgery in the first place. In the words of the neurosurgeon, whose commitment to his art is utterly inspirational, “life is not easy”. We must come together and address these issues. Once there is hope and an eagerness to help, we can raise the standard of healthcare throughout the world.
1. Farmer, PE. Kim, JY. (2008). Surgery and Global Health: A View from Beyond the OR. World Journal of Surgery. 32 (4), 533-536.