• A Collaboration of Equals: Partnership in Dar es Salaam, Tanzania

    Authors: Jeremy Hosein, MD
    Katherine Kunigelis, MD

    Since 2016, the University of Colorado Department of Neurosurgery (CU) has partnered with the Muhimbili Orthopedic Institute (MOI) in Dar es Salaam, Tanzania. Why Tanzania? “There are 11 neurosurgeons in a country of 57 million people,” answers Ryan Ormond, MD, a CU Neurosurgeon and faculty for the CU-MOI partnership. Recent publication of articles in global neurosurgery highlight a transition from personal mission trips to international collaboration for sustainable development of neurosurgical care in low- and middle-income countries (LMIC). This has been the experience at CU, which has developed an institutional collaboration focused on individualized professional development, residency training, and the establishment of formal educational exchanges.

    Faculty neurosurgeons at MOI have trained all over the world – including Japan, Germany, and Australia- and have made personal sacrifices to return home and establish neurosurgical care in their country. As part of a collaborative partnership, they have the experience and knowledge to direct an international educational exchange based on the needs of the local population. In this setting, Dr. Ormond noted, “A few weeks a year, if focused appropriately, and driven by the local partners, we can make a real difference in the lives of patients.”

    CU Neurosurgery faculty and residents travel as a team to Tanzania for two weeks each year. Since assisting with the development of MOI’s neurosurgery training program, they work with the local faculty and residents to understand infrastructure and resources, provide focused educational content both in and out of the OR, and collaborate on research. Dr. Kevin Lillehei, Chair of CU Neurosurgery and principal faculty of the CU MOI partnership, believes the international rotation for residents is important. “The exposure is eye-opening for what medicine is like in the rest of the world. That type of exposure invariably makes an impact that there’s more to neurosurgery than what we’re able to teach in our program.” Yearly, a neurosurgical faculty member or resident from MOI is also hosted for a four to six-week observership in Colorado with an emphasis on surgical techniques and access to a cadaver lab for hands-on practice.

    An example of the educational collaboration is the intraoperative ultrasound course at MOI. The course focuses on adapting existing ultrasound units already available at MOI for use intraoperatively to improve realtime estimation of the extent of resection, surgical planning, and navigation for both cranial and spine tumor surgeries. In fact, the first time intraoperative ultrasound was used at MOI was to tailor the enlargement of a craniotomy before dural opening to allow for better resection of a brain tumor. This technology can also be applied to aid in the evacuation of traumatic hematomas or pediatric pathologies. The use of intraoperative ultrasound is making surgery safer and more efficacious for MOI’s patients in a place where surgical navigation software is not available, intraoperative MRI is not accessible, and many patients cannot afford postoperative imaging.


    PGY5 CU Neurosurgery Resident Katherine Kunigelis learns to do a trauma craniotomy with Hudson brace and Gigli saw while on an exchange trip to MOI in Spring 2018.
    Photo courtesy of D. Ryan Ormond, MD.

    Another emphasis of global neurosurgery is the need for multidisciplinary teams and training to support the neurosurgical mission. CU has partnered with the Departments of
    Pathology and Neuro-Oncology as part of this collaborative effort. The CU Neuropathology group reviews specimens from surgical resections at MOI (where specimens are reviewed with general pathologists without subspecialty training in neurological disease) and is in the process of arranging a one-month educational opportunity for a pathologist from MOI to travel to Denver. Additionally, this year will be the first annual Neuro-Oncology international conference hosted in Dar es Salaam.

    As a global community, we continue to have significant work to address disparities in neurosurgical care, but partnerships like these create enduring and sustainable solutions. Focusing efforts on a collaboration between teams allows for the continued development of the LMIC program. Supplementing residency education with observerships and exchanges allows for the continued growth of a neurosurgical network within a country. Notably, the development of an institutional partnership has bidirectional benefits. “Every time I do this, it puts everything back into perspective,” reflects Dr. Lillehei. “All you have to do is spend time there and you realize what’s really important in Neurosurgery.”


    References

    Ormond, D. MD, Kahamba, J. MD, Lillehei, K. O. MD, & Rutabasibwa, N. MD. (2018). Overcoming barriers to neurosurgical training in Tanzania: international exchange, curriculum development, and novel methods of resource utilization and subspecialty development, Neurosurgical Focus FOC, 45(4), E6. Retrieved May 28, 2019, from https://thejns.org/view/journals/neurosurg-focus/45/4/article-pE6.xml

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