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Neurotrauma and Critical Care in Tanzania: Collaboration With Muhimbili Orthopedic Institute (MOI), Dar-es-Salam

By Currents Editor posted 06-28-2018 15:28

  
By Halinder S. Mangat, MD

Halinder_Mangat_Headshot.jpgMy wife and I both lived in Africa at different stages of our lives, so there was no hesitation when opportunity arose via the Global Health Department at Weill Cornell Medicine to return to this enigmatic continent. In addition to teaching the curriculum in neurology at the second biggest university hospital, Weill Bugando Medical Center, Mwanza, from 2012, I joined an international collaborative effort in neurotrauma, led by Dr. Roger Härtl, professor of neurosurgery at Weill Cornell.

The neurotrauma project includes both education and research. Education entails exchange of trainees in neurosurgery, whereby Tanzanian residents spend up to three months each at Cornell learning neurosurgical skills in a cadaver lab as well as observing spine, cranial and vascular cases. In addition, they spend time in the neurocritical care unit and attend all related conferences. Some neurosurgical residents from Cornell also choose to spend time at MOI under the supervision of Dr. Hamisi Shabani, professor and chairman of the Department of Neurosurgery. Once a year, the group comes together to organize a conference on brain and spine trauma, which includes lectures, workshops, invited international guest speakers and presentation of research data. After two days of lectures, surgical training for basic techniques occurs at the operating rooms at MOI. In 2017, we hosted the first day of lectures in neurocritical care and plan to host ENLS in 2018. This conference is now supported by the College of Surgery for East, Central and Southern Africa (COSECSA) Brain Trauma Foundation and endorsed by the Neurocritical Care Society and has had more than 100 attendees from the region for the past several years.

Concurrently, we host a detailed severe TBI database, supported by the BTF. Data analysis and projects from these emerge as part of a quality improvement program, based on a similar project by the BTF in New York State. The database provides objective data on gaps in the care of severe TBI patients, which range from admission to ICU, initial resuscitation, delays and pragmatic difficulties in obtaining imaging, prompt surgical intervention and post-traumatic ICU care. Several students have completed these projects as part of their undergraduate and post-graduate theses.

Critical care in Tanzania is provided by anesthesiologists, yet no formal training curriculum exists. It is our goal over the next several years to focus on the development of neurocritical care by twinning with MOI in education and research to provide objective data for improvement in care and reduction in mortality after neurotrauma. As with neurosurgery, we hope to fund resident global health critical care fellows at MOI in the near future and initiate a training program.

Our close-knit relationship with the surgeons at MOI under the leadership of Dr. Hamisi Shabani would not be possible without everyone’s enthusiastic participation in weekly Skype calls, adopting trainees, supervising each other’s students and their projects. And, of course, the support of the chairs of the Department of Neurosurgery and Neurology at Cornell, Drs. Philip Stieg and Matthew Fink, is quintessential.

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#NCSRoundup #International #Tanzania #HalinderSMangat #June2018​​​​​
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