title: Expanding neurosurgical care in Northwest Tanzania: the early experience of an initiative to teach neurosurgery at Bugando Medical Centre.
abstract: OBJECTIVE
  Tanzania suffers from a severe lack of health practitioners trained in neurosurgical procedures. To address this problem, we have implemented an initiative, modeled after the experience of other pioneers in international neurosurgery, to establish cost-effective and sustainable neurosurgical care by teaching fundamental neurosurgical skills to local surgeons. In this report we describe our early experience in Northwest Tanzania and discuss the potential for this training model to improve neurosurgical care to a region in need.
  
  
  METHODS
  Between September 2009 and October 2010, three residents and two attendings from our institution spent a total of 15 weeks at Bugando Medical Centre in Mwanza, Tanzania. During this time, we focused on teaching neurosurgical techniques, intraoperative decision-making, and clinical management skills to two local surgeons. The emphasis of our presence was on teaching and providing sustainable neurosurgical care.
  
  
  RESULTS
  During this period, we performed 41 neurosurgical procedures with one of two local surgeons. The most common procedures performed were ventriculoperitoneal shunts (22%), myelomeningocele repairs (22%), and cranial trauma cases (17%). Five (12%) cases required the placement of spinal instrumentation. Thirty-nine (95%) patients remained stable or improved at discharge. There were 2 (5%) perioperative deaths.
  
  
  CONCLUSIONS
  Although numerous challenges remain, our experience demonstrates the potential of this teaching model in providing sustainable neurosurgical care in Northwest Tanzania.
authors.affiliation: Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Wilson
authors.forename: Mark P
authors.initials: MP
authors.lastname: Garrett
authors.forename: Scott D
authors.initials: SD
authors.lastname: Wait
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Kucia
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Saguda
authors.forename: Isidor
authors.initials: I
authors.lastname: Ngayomela
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000601:surgery; D001932:Brain Neoplasms / Q000601:surgery; D002574:Cervical Vertebrae / Q000293:injuries / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D008279:Magnetic Resonance Imaging; D008297:Male; D008591:Meningomyelocele / Q000601:surgery; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education* / Q000706:statistics & numerical data; D009837:Oligodendroglioma / Q000601:surgery; D010525:Peripheral Nerves / Q000601:surgery; D010820:Physicians / Q000600:supply & distribution; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D016103:Spinal Fractures / Q000601:surgery; D013636:Tanzania; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000601:surgery; D055815:Young Adult