title: Multi-institutional neurosurgical training initiative at a tertiary referral center in Mwanza, Tanzania: where we are after 2 years.
abstract: BACKGROUND
  The paucity of neurosurgical care in East Africa remains largely unaddressed. A sustained investment in local health infrastructures and staff training is needed to create an independent surgical capacity. The Madaktari organization has addressed this issue by starting initiatives to train local general surgeons and assistant medical officers in basic neurosurgical procedures. We report illustrative cases since beginning of the program in Mwanza in 2009 and focus on the most recent training period.
  
  
  METHODS
  A multi-institutional neurosurgical training program and a surgical database was created at a tertiary referral center in Mwanza, Tanzania. We collected clinical data on consecutive patients who underwent a neurosurgical procedure between September 9th and December 1st, 2011. All procedures were performed by a local surgeon under the supervision of a visiting neurosurgeon. Since the inception of the training initiative, comprehensive multidisciplinary training courses in Tanzania and an annual visiting fellowship for East African surgeons to travel to a major U.S. medical center have been established.
  
  
  RESULTS
  At initial visits infrastructure and feasibility of complex case scenarios was assessed. Surgeries for brain tumors and complex spinal cases were performed. During the 3-month training period, 62 patients underwent surgery. Pediatric hydrocephalus comprised 52% of patients, 11% suffered from meningomyelocelia, and 6% presented with an encephalocele. A total of 24% of patients were treated for trauma-related conditions, representing 75% of the adult patients. A total of 10% of patients had surgery because of traumatic spine injury, and 15% of operations were on patients with severe head injury. A total of 6% of patients presented with degenerative spine disease. One patient sustained a fatal perioperative complication. At the end of the training period, the local general surgeon was able to perform all basic neurosurgical cases independently.
  
  
  CONCLUSIONS
  Neurosurgical care in Tanzania needs to address a diverse, unique disease burden. We found that local surgeons could be enabled to safely perform basic cranial and spinal neurosurgical procedures through immersive, 1-on-1 on-site collaborations, multidisciplinary courses, and educational visiting fellowships.
authors.affiliation: Department of Neurosurgery, University of Ulm, Ulm, Germany. Electronic address: jancoburger@gmx.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Coburger
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors.forename: Lewis Z
authors.initials: LZ
authors.lastname: Leng
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Rubin
authors.affiliation: Department of Surgery, Bugando Medical Center, Mwanza, Tanzania.
authors.forename: Gerald
authors.initials: G
authors.lastname: Mayaya
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Ricky
authors.initials: R
authors.lastname: Medel
authors.affiliation: Department of Surgery, Bugando Medical Center, Mwanza, Tanzania.
authors.forename: Isidor
authors.initials: I
authors.lastname: Ngayomela
authors.affiliation: Centra Neuroscience Institute, Lynchburg, Virginia, USA.
authors.forename: Dilantha
authors.initials: D
authors.lastname: Ellegala
authors.affiliation: Department of Anaesthesia and Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Durieux
authors.affiliation: College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Nicholas
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Härtl
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000601:surgery; D003244:Consciousness Disorders; D003399:Craniotomy; D003415:Crime; D003422:Critical Care; D005060:Europe; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007362:Intensive Care Units; D007391:International Cooperation; D007393:International Educational Exchange; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education*; D013636:Tanzania; D062606:Tertiary Care Centers / Q000458:organization & administration*; D016862:Tuberculoma, Intracranial / Q000601:surgery; D014481:United States