title: Effect of Geopolitical Forces on Neurosurgical Training in Sub-Saharan Africa.
abstract: BACKGROUND
  The population of Sub-Saharan Africa suffers from a critical shortage and maldistribution of health care professionals, especially highlighted in surgical subspecialties, such as neurosurgery. In light of The Lancet report and the World Health Organization's directive to provide essential surgical care through the developing world, solutions need to be found to close this training and distribution gap.
  
  
  METHODS
  Methods correcting the situation will only succeed if one understands the geopolitical forces which have shaped the distribution of health care in the region and continue to this day. Solutions have evolved from service to service with education. The partnering organizations, the Foundation of International Education in Neurological Surgery and the World Federation of Neurosurgical Societies, have supported neurosurgical training in the developing world, including curriculum, equipment, facilities, certification, and local acceptance, with a goal of developing a self-sustaining program within the developing country.
  
  
  RESULTS
  These ideas heavily rely on partnerships to address classic geopolitical forces, including geography, drought, warfare, ethnic tensions, poverty, and lack of training facilities. Each can be addressed through partnerships, such as development of dyads with programs in developed countries and ongoing programs owned by the countries in question, but partnered with multiple international societies, institutions, and universities.
  
  
  CONCLUSIONS
  This paper provides both a historic and topical overview of the forces at work which need to be addressed for success in delivering specialized care. This must always result in a self-sustaining program operated by the people of the home country with worldwide support through philanthropy and partnerships.
authors.affiliation: Department of Geography of Planning, Appalachian State University, Boone, North Carolina, USA.
authors.forename: Kara E
authors.initials: KE
authors.lastname: Dempsey
authors.affiliation: Neurosurgical Training Program East, Central and Southern Africa, Nairobi, Kenya.
authors.forename: Mahmood M
authors.initials: MM
authors.lastname: Qureshi
authors.affiliation: Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA.
authors.forename: Solomon M
authors.initials: SM
authors.lastname: Ondoma
authors.affiliation: Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA. Electronic address: dempsey@neurosurgery.wisc.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Dempsey
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D006801:Humans; D008507:Medically Underserved Area; D000069471:Neurosurgeons / Q000191:economics / Q000193:education* / Q000639:trends; D019635:Neurosurgical Procedures / Q000191:economics / Q000193:education* / Q000639:trends; D011057:Politics; D012955:Societies, Medical / Q000191:economics / Q000639:trends; D012959:Socioeconomic Factors
keywords: Africa; Educational partnerships; FIENS (Foundation of International Education in Neurological Surgery); Geopolitics; Neurosurgical residency; WFNS (World Federation of Neurosurgical Societies)