Letter: In Memoriam: Paul Farmer and Global Neurosurgery.

Abstract

To the Editor: On February 21, 2022, in Butaro, Rwanda, Dr Paul Farmer unexpectedly died because of “a cardiac event while he was sleeping.”1 He was aged 62 years at the time. As we honor his life and contributions, it is paramount to reflect on his legacy to fuel a collective impetus for improving the lives of our world's most vulnerable. A few statements from Dr Farmer resonate with this sentiment:“The poorest parts of the world are by and large the places in which one can best view the worst of medicine and not because doctors in these countries have different ideas about what constitutes modern medicine. It's the system and its limitations that are to blame.” “I can't sleep. There's always somebody not getting treatment. I can't stand that.” At Harvard Medical School, the program in Global Surgery and Social Change represents a collaborative initiative between the Harvard Medical School (HMS), Harvard teaching hospitals including Massachusetts General Hospital and Brigham and Women's Hospital, HMS Department of Global Health and Social Medicine, Boston Children's Hospital, and Partners in Health, the latter Dr Farmer cofounded in 1987. HMS offers the Paul Farmer Global Surgery Fellowship which among many attributes trains leaders in policy development and implementation with aim to equilibrate health outcomes for at-risk populations around the world. The fellowship consists of 2 separate tracks—research fellow and research associate. On the first track, a research fellow is a medical school graduate (resident, registrar, or international equivalent) who for 2 years conducts research pertinent to global surgery, anesthesia, and obstetrics and gynecology while providing care and advocating for patients in resource limited settings worldwide. Neurosurgery residents are encouraged to apply to this role as scholarly pursuit during their postgraduate year (PGY)-5 and PGY-6. On the second track, a research associate is a 1-year position for students enrolled in any health-related graduate degree (including MD and MBBS) with aim to jumpstart or further interest in global surgical care. As part of HMS program for Global Surgery and Social Change, the Paul Farmer Global Surgery Fellowship enables young leaders a platform to meaningfully contribute to the vision for a better future for children and adults alike stricken by disease. Recently, a proposal was made to incorporate a “Global Neurosurgery” section or category into neurosurgical journals, with aim to “highlight research regarding strategies for developing sustainable neurosurgical training models, augmenting neurosurgical clinical and research capacity, and strengthening health systems through policy and advocacy.”2 Discourse centering around providing this addition to neurosurgical, including in NEUROSURGERY Publications, involved providing a space where neurotrauma groups around the world could provide pearls of knowledge concerning dealing with the global burden of disease with specific locoregional adaptations to reflect the multifaceted nature of caring for diverse groups. For NEUROSURGERY Publications, specifically, an alternative could be made by the Editorial Board: the creation of an entirely new journal, published electronically, which would still allow print Neurosurgery to be fully operational. In that frame, published works in the new journal would consist of invited manuscripts of a specific preapproved topic in Global Neurosurgery, which when published would be open access. This proposal is similar to that in 1996 which led to the creation of Neurosurgical Focus within the Journal of Neurosurgery Publishing Group. To date, Neurosurgical Focus has had 52 volumes and 322 issues—including 15 issue supplementals. As the leader and most complete window in contemporary neurosurgery, if NEUROSURGERY Publications were to create a new journal on Global Neurosurgery, it would serve as a model for neurosurgical journals and signal to importance of global health and equity. This journal could include volumes which may be read as a textbook, typically consisting of an introductory chapter or “Editorial” into the global health subject of interest, followed by the most up-to-date peer-reviewed information and ending with a “Letter” or “Commentary” on the current state and future directions of a contemporaneous topic of interest decided on by the Editorial Board. In addition, this Global Neurosurgery journal could offer continuing medical education credit to Congress of Neurological Surgeons members, granting constituents the ability to earn up to 3 hours of category I continuing medical education each month. Still, whether incorporating Global Neurosurgery into NEUROSURGERY Publications is finalized in the form of a Category, Section, or Journal; this addition will withstand the test of time while advancing our knowledge and understanding of medicine and technology in resource-constrained settings. Death is to be regarded with remembrance and reflection. Dr Farmer was an introverted leader who stood up for people in their times of need and a humble man who stuck to his family and faith while revitalizing the vision for social justice and global equity. It is our turn to elevate our hero as we further contribute fuel to the vehicle of Global Neurosurgery.