• Lessons Learned: Interviews with Neuorsurgery’s Great Philanthropists

    Author: Martin Stippler

    There are a great many neurosurgeons dedicating their time and talents around the globe to treat patients and train local surgeons. Our editor, Dr. Martina Stippler, sat down with three CNS Members to learn about their experiences over decades in this work.

     

    Dr. Barth Green


    Professor of Neurological Surgery, University of Miami School of Medecine

     

     

    How did you get interested in humanitarian efforts in neurosurgery?

    I was raised in a family that was very involved in philanthropy. My father, who was a family practitioner, took care of a lot of underserved patients in his rural practice and my mother was also very devoted to social justice. She, for example, marched with Martin Luther King. Often she brought home people who needed a place to stay and food. She was a very generous person and you could say that this mission stayed with me from the time I grew up. Later, my early medical school experience working with paralyzed Vietnam veterans showed me how courageous they were. I gained such respect for them that I decided right then and there that in my neurosurgical career I would cure paralysis. The commitment started in the 60s and evolved into the Miami Project to Cure Paralysis—the largest neuroscience center of its type in the world focused on this mission. Can you call this humanitarian work: to improve the quality of life of people who suffer catastrophic injuries of the spinal cord and or brain? I don’t know, but it’s been a large part of my life.

    During medical school I opened up the first clinics for unfunded patients run by medical students. After becoming a neurosurgeon, I realized that there were gross health care disparities between America and other countries. I started working with underserved patients in South America—initially in Ecuador. I would fly to these cities and bring my own tools, medications, and gowns. We operated late at night because there was no air conditioning and it was too hot during the day. Later, I went to Colombia and did the same thing. I actually got kidnapped by a drug cartel when their leader got shot in the back in a gun fight.


    Tell us about one experience you had because of your humanitarian work that stayed with you.

    I took a short trip to Haiti, joining a medical mission group in the cities and I went to a little area. There was one building. It was the church, and the school, and the County Hall. There were dozens of people waiting to get medical care and I just fell in love with people there and have committed myself and my philanthropic work to Haiti and its people. In 1994, I cofounded a group called Project Medishare for Haiti (https://projectmedishare.org/team/). Now 30 years later, we treat more than 200,000 people a year.

    Today we employ several hundred community health workers, birthing agents, midwives, and physicians who actually provide community health to a population over 100,000 people in this rural area, from birth to death. We have two maternal health centers, the only two in the country. Haiti had the highest infant and maternal mortality rate anywhere in the Western hemisphere; in the past 2 years we haven’t lost one baby!

    Where should future humanitarian efforts in neurosurgery be directed?

    To me the biggest to epidemic in the world now is head trauma, and if you look at developing countries TBI is major cause of death—more than cancer, malaria, or TB. In these developing nations the main means of transportation are bicycles and motorbikes; these vehicles have no defense and many catastrophic accidents happen.

    So, for me, the biggest responsibility right now in the world is for neurosurgeons to do what we’re doing in Haiti. To initiate building trauma centers that can save lives and focus on the 5 major treatable cause of death: trauma, heart attack, stroke, maternal emergencies, or severe burns. Those people all die in developing nations because there are no resources to save their lives. How do you do that? Through capacity building in the health care sector. That is setting up residency programs like we’ve done in Haiti and my colleagues have done in Africa. With these residency programs in developing nations, you can teach these young physicians to take care of trauma and save lives. And we can do it remotely. I can be teaching somebody how to do a spinal tumor operation in Uganda right now and it’s as if I’m in the same room because this technology exists.

    Neurosurgery is so committed to education and research and creating new knowledge. We should also be sharing this knowledge. I think this would be a very important mission that should be adopted and could be making a contribution toward this global effort to reduce TBI mortality.

    Gail Rosseau, MD

     

    George Washington University School of Medicine and Health Sciences Washington, DC

     

     

     

    Tell us about one experience you had because of your humanitarian work that stayed with you.

    I was very moved by a trip to Somaliland earlier this year. There are no local neurosurgeons for a population of nearly 4 million. Of course, that doesn’t mean there are no neurosurgical cases…just that there is no one specifically trained in neurosurgery to deal with the many cases that exist. I worked with General Surgeons who had been trained by volunteer, missionary surgeons from Kenya. They are prudent, skilled and very eager for education and training by neurosurgeons.

    As in all of Africa, there are many children with post-infectious hydrocephalus, and the local surgeons are experienced and skilled in placing shunts in children. I was amazed however, when we saw a young adult with hydrocephalus from aqueductal stenosis who needed a shunt, and learned that there are no cranial perforators in the entire country. Cranial access for infants and toddlers by rotating a scalpel in thin, cartilaginous skull is not difficult, but becomes more challenging in an adult skull. I was able to remedy the problem as soon as I returned to the States…did you know that one can buy a brand-new Hudson-Brace on e-Bay for less than $50? I just wish all equipment problems in the developing world were that easy to solve!

    Tell us about a change you catalyzed.

    In Somaliland, all neurosurgical cases are transferred to the capital, Hargeisa. Of course, this means many patients never get to the attention of someone with enough neurosurgical knowledge or skill to help them. But it did make it fairly straightforward to conduct a survey of all facilities that treat neurosurgical patients (Rosseau G et al., Neurosurgery in Somaliland; in press). Three local young physicians who wish to train in neurosurgery identified themselves and we are working to facilitate their training in Africa, with a goal of returning to Somaliland for their careers. A that point, we can provide them with equipment and ongoing educational opportunities from the WFNS Foundation (https://www.wfns.org/) and partnerships with Foundation for International Education in Neurosurgery (FIENS; www.fiends.org) and InterSurgeon (www.intersurgeon.org). The many educational resources provided by the CNS and fellowships listed on the CNS website (www.cns.org) are extremely valuable in low and middle income countries and I recommend them all the time.

    What would you want to tell other neurosurgeon wanting to follow in your footsteps?

    I don’t know that anyone needs or wants to “follow in my footsteps” but I do know that there are many kind, competent and cosmopolitan neurosurgeons in high income countries (HIC) who want to do what they can to be of service to fellow neurosurgeons in low and middle income countries (LMIC) and their patients. We just developed a course, Global Neurosurgical Practice, that prepares neurosurgeons to be effective volunteers in LMIC. (Rosseau g, et. al, “Training the Trainers: A Neurosurgical Course for Preparing Neurosurgeon Volunteers”, Accepted abstract, EANS Annual Meeting, Sept 24-29, 2019, Dublin, Ireland.) While neurosurgeons at every stage of career are welcome, most participants are equally divided between two main groups: (1) Chief residents/1st2nd year in practice and (2) those in practice 30 years or more. The CNS traditionally attracts neurosurgeons very early in their careers and I welcome the opportunity to discuss opportunities with any readers who may be interested (gailrosseaumd@gmail.com). The European Association of Neurosurgical Societies (EANS, www.eans.org) and WFNS are working with us to sponsor future courses. FIENS is a great resource for those who wish to become involved in Global Neurosurgery, as is the G4 Alliance (www.theg4alliance.org). ThinkFirst has chapters in over 30 countries and global neurosurgeons are actively involved in prevention of neurotrauma, which is a serious and increasing problem in LMIC. (www.thinkfirst.org)

    What surprises you most about the people you work with?

    There are 5 billion people: 2/3 of the world’s population who do not have access to event emergency and essential surgery. We have a global deficit of 23,000 neurosurgeons, and it is estimated that over 10 million necessary neurosurgical operations are left undone every year due to shortages of manpower and other resources. The good will and optimism of neurosurgeons, despite the incredible needs we face, is surprising…and inspiring.

    Robert Dempsey, MD

    Chair, Department of Neurological Surgery
    Faculty, University of Wisconsin School of Medicine and Public Health

     

     

     

    Tell us about one experience you had because of your humanitarian work that stayed with you.

    Early on, I was like most people doing humanitarian medical service in that I had a desire to take care of, or in my case, operate on every single person in need in an entire country. I was working in Guatemala during their civil war and had opportunity after caring for hundreds of patients to see a child who was not sick. This beautiful child was selling fruit outside the clinic. I asked and received permission to photograph the child, and her picture stays in my office to this day, because I asked myself, “Who would care for her when she got sick and I was not there?” That was the day I became a teacher of doctors because it became clear to me that I could care for thousands of people, but my students and their students could care for millions and actually change patient care worldwide. So that was a very telling experience that made me think that my service should be through education, as a lasting way to change neurosurgical care to become self-sustaining in areas of need. This is what happens when the people you train are able to practice in their home area and train their students in a self-sustaining fashion.

    Tell us about a change you catalyzed.

    One of the things I am most proud of is the Foundation for International Education in Neurosurgery (FIENS) and its adoption of this concept of service through education. This organization, now in its 50th year has developed or supported over 20 neurosurgical training sites in areas of greatest need on 4 continents. That catalyst has been able to facilitate so many neurosurgical humanitarians to have an impact beyond that of their own service. The organization itself primarily serves to facilitate and channel the wonderful philanthropic energy of neurosurgeons throughout the world by identifying the barriers to self-sustaining care and working slowly and gradually over the years to break them down until self-sustaining training programs can exist. This further allows a productive channel for people with such humanitarian interests to allow us to maximize the benefit possible from the energy, skill and intellect of the remarkable men and women that make up this world of neurosurgery.

    What would you want to tell other neurosurgeons wanting to follow in your footsteps?

    The most important thing for a young neurosurgeon with an interest in humanitarian neurosurgery to understand is that this is something you can do. If you are in neurosurgery, you have special talents and skills to bring to humanitarian efforts, but it is important to know you need not be alone, nor do you need repeat the mistakes that so many of us made along the way. I do think that someone who is considering making this part of their career already realizes that this is the sort of thing that helps them to remember why they wished to become a doctor and a surgeon in the first place. If you never lose track of that, you have assured yourself of a career of fulfillment and satisfaction.

    What surprises you most about the people you work with?

    I never cease to be amazed at the remarkable talents and kindness of people worldwide. Even in areas of great conflict, the individual people are kind, hardworking and share the common goals for family, safety and culture that we all do. I learn so much from our colleagues in areas of need by watching and listening to their remarkable skills at problem solving, innovation and persistence. I am amazed each day to work with people that dedicated.

    Where should future humanitarian efforts in neurosurgery be directed?

    I strongly believe that education is the way we change our future. We do that by providing education to the best and brightest in the world’s areas of need and we adapt our neurosurgical specialty to focus on where the patient need is. This may be geographically, regions of the world or the United States that we have a mal distribution of neurosurgical care, but it is also within our specialty of neurosurgery where we need to emphasize not simply fascinating surgical procedures, but also direct our efforts to the disorders and conditions that most affect our patients worldwide.

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