Teaching Neurosurgery in Africa
MADISON – Sixteen years of volunteerism have convinced Robert Dempsey, MD, (pictured, second from right) chair of the UW Hospital and Clinics neurosurgery program, that a little effort can go a long way in improving health care in developing countries.
Dr. Dempsey returned from Africa in late August after a 10-day “vacation” during which he worked to establish a neurosurgical education and training program in Nairobi, Kenya. The trip was a continuation of his involvement with the Foundation for International Education in Neurological Surgery (FIENS), an organization dedicated to addressing the critical lack of trained neurosurgeons worldwide, and added to a legacy of altruism he and his wife Diane have tried to instill in their children, Kara and Conor, at an early age.
“I wanted our children to grow up seeing this was the kind of thing our family did,” Dr. Dempsey says. “It has everything to do with what you value and how you spend your time.”
Their work began in Central and South America in 1991, and though Dr. Dempsey’s medical knowledge was certainly appreciated, he was surprised to find his young daughter’s company more sought-after than his.
“Kara would take care of the patients and translate for them and comfort them,” he says. “She was far more popular. I’d show up and they’d say, ‘Fine, the brain surgeon is here. Dónde está Kara?’”
Kara is in graduate school now, and Dr. Dempsey’s sojourns continue. Few countries need his attention more than Kenya. A country of 37 million on Africa’s eastern coast, Kenya endures poverty and destitution almost unimaginable to Americans. Its gross national income per capita is barely more than $1,000. By comparison, U.S. gross national income per capita is approaching $42,000.
As with most poor countries, medical care suffers proportionally. According to World Health Organization statistics, the average Kenyan life expectancy is 51 years.
Statistically 120 of every 1,000 Kenyans born will die before the age of five. By comparison, U.S. life expectancy is 75 years and only eight of every 1,000 Americans will die before the age of five.
Medical funding is also inadequate. Kenya directs 4.1 percent of its gross national product toward health care. The United States allots 15 percent of its GDP to a similar purpose.
As would be expected, the complex field of neurosurgery is woefully underdeveloped. Estimates vary, but the number of neurosurgeons practicing in all of Kenya is thought to be between eight and 12. UW Hospital and Clinics has 13 neurosurgeons on staff, by way of comparison.
“There is no training of neurosurgeons in east Africa,” Dr. Dempsey says. “So what happens if you have a brain tumor or if your child is born with a birth defect? The outcome is horrible.”
Building upon the groundwork FIENS has laid in previous years, Dr. Dempsey and two other neurosurgeons – Dr. Paul Young of the Microsurgery and Brain Research Institute (MBRI) in St. Louis and Dr. Jose Picard of Spain – met with the Kenyan Ministry of Health to gain approval for the program.
With the Ministry’s blessing they went to work, operating on patients every day and teaching their cadre of African residents essential neurosurgical techniques. The group also installed donated medical equipment at hospitals that would make any American patient think twice before complaining about a long wait at their local clinic.
At Kenyatta National Hospital, where a good portion of the FIENS training took place, Dr. Dempsey estimated the number of beds at 3,000 and the number of patients likely between 4,000 and 5,000.
In the Volunteer Efforts section of its Web site, MBRI describes Kenyatta succinctly: “Overcrowding and a general lack of even basic equipment and supplies are the rule at KNH. Patients (especially pediatric) are frequently forced to share beds or spend hours, days, or weeks waiting for admission to the wards. Attempts are made to maintain cleanliness of the facility, but only so much can be done with bare naked concrete cubicles and rusty iron beds.”
Despite the dire conditions, Dempsey believes the group made great progress, in part because the residents were eager to learn.
“The quality of the people is excellent,” he says. “They are very caring, very dedicated and interested in learning. They haven’t been exposed to what we can do with modern medicine with even limited equipment. But they’re quick learners.”
“The trainees are well-trained in the fundamentals” of general surgery, Dr. Young says. “With neurosurgery, it’s a very advanced area of expertise. They haven’t had the exposure to the technical aspects. That’s what we do. We take individual groups of surgeons and try to teach the details.”
One of the advantages of working in countries of great need is that every step forward is significant. Dr. Picard had great success teaching how to treat hydrocephalus without plastic shunts, important because shunts are expensive. And the introduction of what might be considered rudimentary equipment can have a revolutionary, positive impact.
“You can do tremendous things,” Dr. Dempsey says. “A drill, a microscope, can really change the way health care is delivered for an entire country. That’s what’s exciting about this field.”
Dr. Dempsey is back in Madison now. But he has plans to return to Kenya in the near future with FIENS, to assess progress and fill the gaps in the country’s neurosurgical training programs. The short-term goal is to have the residents he taught rotate to clinics in the outlying provinces, where access to physicians is extremely limited.
“There is no care out there,” Dr. Dempsey says, fully aware his work has just begun. “We will continue to support them. We’re very dedicated to education. A generation of new knowledge is the concept of the university, the concept of the Wisconsin Idea, taken globally.”
Date Published: 12/28/2007