By Samwel Doe Ouma @samweldoe
Shortage of neurosurgeons in the country leads to delays in managing neurological diseases such as traumatic injuries, brain tumours, strokes, spine trauma and hydrocephalus, a consultant Neurosurgeon reveals.
According to Dr. Michael Augustus Magoha, a consultant neurosurgeon and lecturer, Kenya is improving its neurosurgical capacity in infrastructure, technology and training of neurosurgeons.
He said this will ensure proper patient evaluation, identification of therapeutic options, read scans and clinical research to successfully operate on complex neurosurgical conditions.
“Every neurological case can be handled in the country,” Magoha said, adding that “all complex neurosurgical interventions can be managed at Kenyatta National Hospital and Moi Teaching and Referral Hospital.”
However, he said there are high mortality and morbidity rates from neurosurgical diseases, especially posttraumatic hematomas, brain abscesses, hydrocephalus, and benign tumours.
This he says is as a result of delayed and suboptimal delivery of neurosurgical care, contributed by factors such as high cost of neurosurgical care, extreme scarcity of facilities and basic equipment’s required for procedures.
In Kenya, complex neurosurgical interventions can only be performed in two hospitals, Kenyatta National Hospital and Moi Teaching and referral hospital. This results in increased patient population seeking delayed interventions from accident trauma, strokes and brain tumours.
“Because of delays in diagnosis, patients often present themselves with advanced gross pathological features, resulting in difficulties in providing intensive care and neurosurgical management,” he expounded.
Neurosurgery is a skilled branch of the medicine involving high risks and it takes a long period of study to qualify.
In Kenya and Sub Saharan Africa Neurosurgery is only taught at the University of Nairobi. At the present time, there are few doctors are undergoing training to meet the increased surgical demands of the growing population.
“Every treatment we do is guided by protocol and guidelines based on International accepted standards. If you have standard guidelines then the treatment becomes uniform to anyone in the world,” Magoha explained.
Neurosurgery medicine is divided into five main tenets, Neuro oncology which deals with brain tumours, Neuro spine dealing with basic and complex spinal cases, Paediatrics neurosurgery dealing mostly with congenital anomalies, neuro vascular surgery and neuro endoscopy.
Neurosurgery voids in Kenya
The scarcity of neurosurgeons is a common problem throughout East African countries. With an approximated population of about 45 million people, Kenya has only about 20 to 30 neurosurgeons. This means that there is one neurosurgeon for every 2.4 million people.
“It is one of the courses with high attrition rates in the world. It does not only take a long time to train a neurosurgeon but it is also technically demanding and capital intensive,” he explained.
Apart from the huge deficit of neurosurgeons, the sub-specialty is further complicated by lack of neurosurgical equipment, impacting on patient care.
Because every neurosurgical procedure is complex and difficult, successful neurosurgical interventions need mandatory surrounding infrastructure like critical care unit, the main station to care for both post-operative and critical neurosurgery patients.
“Lack of basic technological requirements, such as neurosurgical diagnosis facilities, operating microscopes, bipolar coagulation equipment, and micro instruments and limited ability of patient’s financial access to meet cost affects availability and outcomes of neurosurgical interventions,” he said.
He said there is also need for experienced supportive staff like neuro nurses, neuro radiologists, interventional radiologists, neuro intensivists and a physiotherapist.
Magoha observed that MRI ranges between Sh16,000 to Sh25,000 and CT scan ranging between Sh6,000 to Sh8,000.
He said to bridge the delayed care gap all level five hospitals in the country need to invest in operating theatres and procure basic surgical equipment like operating microscopes and endoscopes, staff and infrastructure that can enable them set up neurosurgery units.
“Basic emergency units should be available at all level five hospitals to provide emergency care to accident victims, only complex cases should be referred to KNH or MTRH,” he advised.
KNH for instance handles between 30 to 40 Nuero trauma cases per week, he said, adding that there is no data on prevalence studies of brain tumours and types of common tumours although it is approximated that around 1500 cases of brain tumours have been operated on at KNH.
He added that Kenya Medical Research Institute (KEMRI) and University of Nairobi have started a register to collate statistics and types of brain tumours.
Prevention of neurological disorders
In a recent article published in the Lancet, it is estimated that the economic burden of neurological disorders would cost a total of US$12.3 trillion between 2015 and 2030.
Basic care such as wearing helmets to protect from severe head injuries, not drinking and driving can help reduce frequency of crashes. Setting up trauma centres with neurosurgical theatres near accident prone areas can also help, he added.
He emphasized that there is need to prioritize stroke awareness campaigns to sensitize the public on factors that can predispose them to stroke.
In addition, Magoha noted treatment time is critical for better interventions outcomes since the first three to four hours of lapses without quick intervention patients’ risks suffering from brain damage manifesting into coma, profound paralysis or even death.
He says that BEFAST a pattern or Protocol developed by experts can help in detecting strokes. For example if one recognizes Balance lost (B) ,Eyes blurring (E) Facial dropping (F),Arm or leg weakness (A) ,Speech difficulty (S),care givers should know that its Time (T) to call for emergency intervention this will ensure that the patient get quick and early care.
