African Neurosurgeons Research Articles

Barriers Encountered Toward Pursuing a Neurosurgical Career: A Cross-Sectional Study Among Medical Students, Interns, and Junior Doctors in Africa

Africa has an increased burden of neurosurgical diseases with an estimate of 1,986,392 neurosurgical cases, 108,824 neurosurgical case capacity, and 1,877,568 case deficits yearly. Literature suggests that about 8420 neurosurgeons are needed to fill this vast gap. The main objective of this study is to elucidate barriers encountered in pursuing neurosurgery training in the African context. A cross-sectional electronic survey, developed in English and subsequently translated into French, was utilized. This was disseminated among medical students, medical interns, and junior doctors in all 5 African regions. A total of 491 responses were received from the following 5 African regions: West Africa (30.5%), East Africa (30.3%), Central Africa (18.1%), North Africa (11.8%), and Southern Africa (9.2%). Of the participants, 55.2% were men and 44.8% were women. Seventy-six percent of respondents were aware of the neurosurgery deficit in Africa. Barriers to pursuing neurosurgery included discouragement from others over lack of an "ideal personality" trait, culture/cultural beliefs as related to gender roles, lack of mentorship, inadequate neurosurgical training opportunities, poor health infrastructure for neurosurgical practice in Africa, poor patient outcomes, and challenges with work/life balance were some of the barriers highlighted to pursuing neurosurgical career on the continent. Even with its robust population growth, Africa is not producing enough neurosurgeons to meet the demands of the population due to several barriers. Delineating these challenges and barriers represents an important step in developing sustainable mechanisms for recruitment, training, mentorship, and support of burgeoning African neurosurgeons.

Establishing the First Neurosurgical Skill Laboratory in West Africa: An Initiative for an Affordable Regional Education Center

BackgroundThe benefits of a neurosurgical skill laboratory (NSL) are unquestionable. Despite the increasing number of sub-Saharan African neurosurgeons, few cadaveric laboratories are available for neurosurgical education. The first of its kind in West Africa, a NSL opened in 2019 in Abidjan, Cote d’Ivoire to promote neurosurgeons' education and technical skills. We have described our experience in creating and running this facility.MethodsNSL is a private academic center in Abidjan, Cote d’Ivoire. It includes 2 rooms dedicated to cadaveric hands-on training and microscopic neurosurgery and multipurpose rooms, which contain 7 table-mounted microscopes and 3 endoscopes. The designed layout replicates an operating room. The curriculum was designed to meet the needs for training for complex brain and spine surgeries.ResultsThe training covers skull base (conventional and extended) approaches, microsuturing, and anterolateral and posterior approaches for spine surgeries. The training was open to residents and consultants. The faculty members included anatomists, neurosurgeons, otolaryngologists, and orthopedists. Additionally, the NSL welcomes fellows from foreign countries. Fellows from 4 countries have been trained, and 14 educational activities have been organized.ConclusionsIn the present report, we have provided insight into a sub-Saharan African neurosurgical laboratory striving toward an affordable and self-sustainable center. The short-term goal of the NSL is to be a center for developing technical skills for African neurosurgeons for better patient outcomes.

Neurosurgical Equipment Donations: A Qualitative Study.

IntroductionNeurosurgical equipment donation from high-income countries (HICs) to low-and-middle income countries (LMICs) exists. However, there is currently no published literature on whether there is a need for neurosurgical equipment donations or how to design equipment donation programmes that meet the needs of LMIC neurosurgeons. The primary aims of this study were to explore: (1) the need for the donation of neurosurgical equipment from the UK and Ireland to LMICs within the African continent, and (2) the ways through which neurosurgical equipment donations could meet the needs of LMIC neurosurgeons.MethodsThis was a qualitative study using semi-structured, one-on-one, audio-recorded interviews. Purposive sampling was used to recruit and interview consultants or attending neurosurgeons from Ireland, the UK and LMICs in Africa in a continuous process until data saturation. Interviews were conducted by members of the Association of Future African Neurosurgeons during March 2021. Qualitative analysis used a thematic approach using open and axial coding.ResultsFive HIC and 3 LMIC neurosurgeons were interviewed. Five overarching themes were identified: (1) inequality of access to neurosurgical equipment, (2) identifying specific neurosurgical equipment needs, (3) importance of organisations, (4) partnerships between LMIC and HIC centres, and (5) donations are insufficient in isolation.ConclusionThere is a need for greater access to neurosurgical equipment in LMICs. It is unclear if neurosurgical equipment donations are the optimal solution to this issue. Other solutions that are not linked to dependency need to be explored and executed. Collaborative relationships between LMICs and HICs better ensures that neurosurgical equipment donations meet the needs of the recipients. These relationships may be best created within an organisation framework that has the logistical capabilities of coordinating international equipment donation and providing a quality control measure.

The latest covid-19 impact on the neurosurgery resident admission and training in Morocco

The Kingdom of Morocco is also affected by the COVID-19 in all filed. The coronavirus shutdown has been a great challenge for health policymakers, the citizens, and those traveling down for various reasons. Among them, there are undergraduate students, physicians seeking postgraduate education…etc. Some were lucky enough to start their courses online, pending the time to come to Morocco for continuing their studies. But unfortunately, this was not the case for the potential neurosurgical residents that were already accepted, and some were even holding scholarships but were unable to join their training centers. Meanwhile, a substantial effort has been made to feel the tremendous lack of neurosurgeons in Sub-Saharan Africa by quality massive education and training of neurosurgeons from those countries. Thus, these consequences of the COVID-19 shutdown are a dropping stone in a quiet lack, delaying the important project of the WFNS and others to fill up this gap. At the same time, it is worth thinking about the innovative model of neurosurgical education and training for the new generation of Sub-Saharan African neurosurgeons.

Letter to the Editor Regarding "Research Equity in Otolaryngology-Head and Neck Surgery".

We read with a lot of interest the commentary by Patterson et al1 titled “Research Equity in Otolaryngology–Head and Neck Surgery (OHNS).” The authors highlight inequity in global OHNS and propose a framework to build local research capacity and increase representation.1 The collaborative’s research equity guidelines include stakeholder analysis and involvement, early and clear definition of roles, attribution of authorship positions based on meritocracy, and study validation by experienced researchers. In a recent bibliometric analysis of Global OHNS research,2 we identified influential contributors and themes. The following low- and middle-income country (LMIC) institutions had the most publications in their regions: the University of the Witwatersrand (sub-Saharan Africa), Mahidol University (East Asia and Pacific), University of São Paulo (Latin America and the Caribbean), Tehran University of Medical Sciences (Middle East and North Africa), Hacettepe University (Europe and Central Asia), and All India Institute of Medical Science (South Asia).2 As highlighted by Patterson et al,1 high-income country authors and institutions were major contributors of Global OHNS. Four of the 10 most prolific countries were high-income countries contributing to 67.4% of the top 10 publications.2 The Middle East and North Africa published the least, followed by Latin America and the Caribbean, and sub-Saharan Africa. Regional differences in the total number of publications (P =. 016), citations (P =. 013), and collaborations (P =. 001) were statistically significant.2 These findings highlight regions in need of research capacity building. The initiative can equally leverage the experience of higher-performing LMIC centers to foster “South-South” collaboration. The thematic analysis of Global OHNS articles revealed the emergence of coronavirus disease 2019 (COVID-19) as an influential topic.2 The COVIDSurg Collaborative estimates that COVID-19 has led to the cancellation of up to 81.9% of nononcologic OHNS.3 These cancellations have increased the surgical backlog, morbidity, and mortality due to diseases amenable to OHNS.3, 4 These findings highlight the need to study the pandemic’s impact on other aspects of Global OHNS. For example, we must evaluate the pandemic’s impact on LMIC OHNS workforce given the professional risk OHNS specialists face. Once again, we salute Patterson et al1 for their brilliant piece on research equity in Global OHNS. We look forward to seeing the product of their research equity framework on the quality and output of research from LMICs. Competing interests: None. Sponsorships: None. Olga Mbougo Djoutsop, MD Jolyvette Voufo Mbougo, MD Faculty of Medicine, Bel Campus University of Technology, Kinshasa, Democratic Republic of Congo Ulrick Sidney Kanmounye, MD Research Department, Association of Future African Neurosurgeons, Kinshasa, Democratic Republic of Congo

Training the Next Generation of Academic Global Neurosurgeons: Experience of the Association of Future African Neurosurgeons.

Introduction: Although the past decade has seen a substantial increase in African neurosurgeons' academic productivity, productivity remains low compared to their colleagues from other regions. Aspiring neurosurgeons can contribute to the academic neurosurgery workforce by taking care of less technical and time-consuming research tasks. Fortunately, global neurosurgery institutions have also made efforts to increase research exposure and scholarly output in academic global neurosurgery. The Association of Future African Neurosurgeons (AFAN) created a research incubator for aspiring academic global neurosurgeons in Africa to provide enrollees with mentorship, skills, and experience. This study assesses and reports the activities and results of the research incubator.Methods: Aspiring academic global neurosurgeons were enrolled in the AFAN Research Incubator Program (ARIP), whose primary objective was to provide enrollees with foundational skills in all aspects of the research cycle. ARIP enrollees participated in didactic and practical activities with the aim of publishing ≥1 article and presenting ≥1 abstracts at international conferences in one year.Results: Fifteen AFAN members aged 25.0 ± 3.0 years enrolled in ARIP: 7 (46.7%) medical students, 4 (26.7%) general practitioners, and 4 (26.7%) residents. Eleven (73.3%) were male, 6 (40.0%) were from Cameroon and 6 (40.0%) had no previous research experience. Two (13.3%) enrollees dropped out. ARIP enrollees published a total of 28 articles, and enrollees published a median of 1.0 (IQR = 2) first-author articles on neurosurgical system strengthening. Additionally, ARIP enrollees presented 20 abstracts with a median of one abstract (IQR = 3.0).Conclusion: South-South research collaborations like ARIP can contribute to improving global neurosurgery research capacity and output. These collaborations can set up the foundations for robust research in low- and middle-income countries.

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice.Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant.Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category.Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group.

Understanding the motivations, needs, and challenges faced by aspiring neurosurgeons in Africa: an E-survey

Introduction Three million African patients need a neurosurgical consultation every year, but there are not enough neurosurgeons to meet this need. Efforts have been made to increase the neurosurgical capacity through the creation of training programs in Africa. Although these programs have been successful, there is still a long way to go. Aspiring African neurosurgeons (AANs) will become neurosurgeons in the future if they are given the resources and opportunities. The authors set out to understand the perceptions, needs, and difficulties faced by AANs. Methods An e-survey containing 45 questions was created using Google Forms and distributed via social media. The survey was anonymous, and it was distributed from June 2, 2020, to June 16, 2020. Summary descriptive statistics and the Chi-Square test were calculated. The p-value was considered to be significant below .05. Results A total of 221 AANs aged 23.5 ± 3.3 years and from 22 African countries responded to the survey. Most were male (66.1%) and medical students (84.6%). Few had assisted a neurosurgical intervention in-person (24.9%), had a mentor (29.0%) or attended a journal club (10.3%). A small proportion was unwilling to train in their home country (19.5%) or a neighboring country (16.3%). The top three reasons for choosing neurosurgery were prestige, advice from a family member, and projected income. Also, respondents felt neurosurgery was expensive. Conclusion AANs are passionate about neurosurgery but lack the information, guidance, or opportunities to fulfil their wish.

The Impact of COVID-19 on Neurosurgical Services in Africa

IntroductionCOVID-19 has affected the global provision of neurosurgical services. We sought to review the impact of COVID-19 on the neurosurgical services in Africa.MethodsA cross-sectional survey was distributed to African neurosurgeons seeking to review demographics, national and neurosurgical preparedness, and change in clinical services in April 2020.ResultsA total of 316 responses from 42 countries were received. Of these, 81.6% of respondents were male and 79.11% were under the age of 45 years. In our sample, 123 (38.92%) respondents were in training. Most (94.3%) respondents stated they had COVID-19 cases reported in their country as of April 2020. Only 31 (41.50%) had received training on managing COVID-19. A total of 173 (54.70%) respondents were not performing elective surgery. There was a deficit in the provision of personal protective equipment (PPE): surgical masks (90.80%), gloves (84.80%), N95 masks (50.80%), and shoe covers (49.10%). Health ministry (80.40%), World Health Organization (74.50%), and journal papers (41.40%) were the most common sources of information on COVID-19. A total of 43.60% had a neurosurgeon in the COVID-19 preparedness team; 59.8% were concerned they may contract COVID-19 at work with a further 25.90% worried they may infect their family. Mental stress as a result of COVID-19 was reported by 14.20% of respondents. As of April 2020, 73.40% had no change in their income.ConclusionsMost African countries have a national COVID-19 policy response plan that is not always fully suited to the local neurosurgery services. There is an ongoing need for PPE and training for COVID-19 preparedness. There has been a reduction in clinical activities both in clinic and surgeries undertaken.

Erratum. Emerging Neurosurgery in Africa - WFNS Rabat Reference Center (WFNS-RTC) for Training African Neurosurgeons.

Erratum. Emerging Neurosurgery in Africa - WFNS Rabat Reference Center (WFNS-RTC) for Training African Neurosurgeons.

The Role of Young and Future Neurosurgeons in Global Neurosurgery: Perspectives from the Association of Future African Neurosurgeons.

The Role of Young and Future Neurosurgeons in Global Neurosurgery: Perspectives from the Association of Future African Neurosurgeons.

Collaborative International Neurosurgery Education for Africa–The Journey So Far and the Way Forward

Lack of standard neurosurgical training has long been a major factor limiting the availability of neurosurgical services in most parts of Africa. International collaborative efforts have however, to a large extent, resolved this challenge. A review of previous international collaborative programs and educational initiatives in Africa along with their outcomes and accomplishments was conducted. We make a few recommendations on how these programs could be further improved upon toward more productivity and better output with the few available facilities in Africa. Various international collaborative programs focusing on neurosurgery education and training currently exist in East Africa with well-documented advancements in achieving their goals and especially include Neurosurgery Education and Development Foundation, the Weill Cornell Tanzania Neurosurgery project, Duke East Africa Neurosurgery Program, Duke Global Neurosurgery and Neurosciences, and CURE Hydrocephalus Program. In West Africa, they include the Swedish African Neurosurgical Collaboration and the Association of West African Neurosurgeons. So far, collaborative neurosurgical education and training has been an effective approach in efficiently and progressively increasing capacity in Africa. To further improve the quality of neurosurgical care in Africa in the face of difficult economic circumstances and significant neurosurgical disease burden, implementation of the suggested recommendations will enhance the capacity and sustainability of these existing programs with the few available facilities and equipment and would go a long way in further reducing the burden in Africa.

The impact of African-trained neurosurgeons on sub-Saharan Africa.

Sub-Saharan Africa (SSA) represents 17% of the world's land, 14% of the population, and 1% of the gross domestic product. Previous reports have indicated that 81/500 African neurosurgeons (16.2%) worked in SSA-i.e., 1 neurosurgeon per 6 million inhabitants. Over the past decades, efforts have been made to improve neurosurgery availability in SSA. In this study, the authors provide an update by means of the polling of neurosurgeons who trained in North Africa and went back to practice in SSA. Neurosurgeons who had full training at the World Federation of Neurosurgical Societies (WFNS) Rabat Training Center (RTC) over the past 16 years were polled with an 18-question survey focused on demographics, practice/case types, and operating room equipment availability. Data collected from all 21 (100%) WFNS RTC graduates showed that all neurosurgeons returned to work to SSA in 12 different countries, 90% working in low-income and 10% in lower-middle-income countries, defined by the World Bank as a Gross National Income per capita of ≤ US$995 and US$996-$3895, respectively. The cumulative population in the geographical areas in which they practice is 267 million, with a total of 102 neurosurgeons reported, resulting in 1 neurosurgeon per 2.62 million inhabitants. Upon return to SSA, WFNS RTC graduates were employed in public/private hospitals (62%), military hospitals (14.3%), academic centers (14.3%), and private practice (9.5%). The majority reported an even split between spine and cranial and between trauma and elective; 71% performed between 50 and more than 100 neurosurgical procedures/year. Equipment available varied across the cohort. A CT scanner was available to 86%, MRI to 38%, surgical microscope to 33%, endoscope to 19.1%, and neuronavigation to 0%. Three (14.3%) neurosurgeons had access to none of the above. Neurosurgery availability in SSA has significantly improved over the past decade thanks to the dedication of senior African neurosurgeons, organizations, and volunteers who believed in forming the new neurosurgery generation in the same continent where they practice. Challenges include limited resources and the need to continue expanding efforts in local neurosurgery training and continuing medical education. Focus on affordable and low-maintenance technology is needed.

Neurosurgical education in Egypt and Africa.

Africa still significantly lags in the development of neurosurgery. Egypt, located in North Africa, is well-developed in this specialty, with the largest number of neurosurgeons among all African countries. This article provides insight into neurosurgical training in Egypt, the challenges African neurosurgeons are facing, and the requirements needed to enhance neurosurgical education and build up the required neurosurgical capacity in Africa. The information presented in the current work was collected from databases of the Egyptian Society of Neurological Surgeons and the World Federation of Neurosurgical Societies. There are two types of neurosurgical certification in Egypt. The first type is granted by the universities (MD), and the second is awarded by the Ministry of Health (Fellow of Neurosurgery). The program in both types ranges from 6 to 9 years. The number of qualified neurosurgeons in Egypt constitutes one-third of the total number of African neurosurgeons. There is a significant shortage of neurological surgeons in Africa, and the distribution is entirely unbalanced, with the majority of neurosurgeons concentrated in the North and South regions. The most important challenge facing neurosurgery in Africa is lack of resources, which is considered to be the main obstacle to the development of neurosurgery. Other challenges include the limited number of neurosurgeons, lack of training programs, and lack of collaboration among the different regions. Proper collaboration among the different regions within the African continent regarding neurosurgical education will enhance African neurosurgical capacity and make neurosurgery an independent specialty. The definite functional polarity among different regions, regarding both the number of qualified neurosurgeons and the neurosurgical capacity, is an important factor that could help in the development of neurosurgery in this continent.

The World Federation of Neurosurgical Societies Rabat Reference Center for Training African Neurosurgeons: An Experience Worthy of Duplication

he Fifth World Federation of Neurosurgical Societies (WFNS) Rabat Reference Center-Mohammed V UniverT sity Souissi Conference for African Neurosurgeons, held on November 8e11, 2012, in Rabat, was the occasion to celebrate the 10th Anniversary of the WFNS Rabat Reference Center for Training of African Neurosurgeons. Both events were organized under the High Patronage of His Majesty King Mohammed VI of Morocco, in collaboration with the ministries of Higher Education, of Health, and of Foreign Affairs, with the Moroccan Society of Neurosurgery, the Education and Research Unit in Neurosurgery at the Faculty of Medicine and Pharmacy of Rabat. That the Moroccan authorities are involved so greatly in the celebration of the 10th Anniversary of the Center is proof of its importance, its role as a model in advanced medical training, and its significance in South-South cooperation.

The 2011 Egyptian Revolution: A Neurosurgical Perspective

To the best of our knowledge, no previous study has assessed the neurosurgical publications from Africa. A bibliometric analysis was performed in the present study to evaluate the contribution of African authors in neurosurgical journals worldwide and to discuss the approaches that could be used to enhance the quantity and quality of publications on this issue.A literature search of neurosurgical publications by African investigators was performed using the PubMed database from 1999 to 2018. The total number of articles per country was tabulated and normalized by the number of neurosurgeons in each country.A total of 974 articles reported from 1999 to 2018 from 31 African countries were identified and analyzed. The number of African neurosurgical publications have increased remarkably during the past decade. However, a wide disparity exists in the productivity among the countries, especially when normalized by the number of neurosurgeons. Most of the research publications have been case series and case reports, with very few clinical trials, meta-analyses, or international collaborations. According to the neurosurgical research areas, the most representative subspecialties were the spine, intracranial tumor, hydrocephalus, and head injury.African neurosurgeons will be able to meet the challenges of the new century with the appropriate use of its resources and staff, regardless of the difficulties they face. However, African neurosurgical research could be improved by teaching research methods and medical writing and should focus more on modern neurosurgical topics by highlighting continental particularities. African neurosurgeons should collaborate with each other (locally, regionally, and abroad) and with foreign centers for better quality research and international visibility.

Impact of Mobile Endoscopy on Neurosurgical Development in East Africa

Hydrocephalus, a disease frequently associated with poverty, becomes even more challenging to treat in developing regions because of lack of neurosurgical manpower, inadequately equipped public health care facilities, meager resource allocations, high rates of neonatal infection, difficulty of accessibility to hospitals able to treat hydrocephalus, and high complication rates in patients who are able to access and receive shunting procedures. Definitive treatment of hydrocephalus that avoids shunting procedures and long-term shunt dependence is a safer option. In environments such as Sub-Saharan Africa (and, indeed, in other similar resource-challenged regions), neuroendoscopic ventriculostomy (NEV), in appropriately selected patients can overcome the problems associated with shunting, including long-term shunt dependence. A novel approach promoted by volunteer neurosurgical teams from the Neurosurgery Education Development (NED) Foundation is described, and its important role in successfully providing NEV at hospitals in regional sites away from main tertiary referral hospitals is outlined. Using a single portable neuroendoscopy equipment system and a versatile free-hand, single operator neuroendoscope, an easily mobile outreach model has been successfully used to perform 187 procedures in 19 hospital sites around six countries and on two continents. Neuroendoscopy is not just a priority surgical tool for East Africa; it represents a best practices philosophy of what is possible within a highly sophisticated surgical speciality like neurosurgery in developing countries. It offers an opportunity to highlight the importance of tertiary care specialties like neurosurgery in this region, to develop closer relationships between African neurosurgeons and to convince medical students, general residents, and nurses that "world-class neurosurgery" can be possible in a developing region.

African Neurosurgery, the 21st-Century Challenge

Two major challenges facing African neurosurgery include quality and quantity, in both recourses and personnel. Discrepancy is noted between the two poles, namely, the north and south of the continent and the sub-Saharan area. Although reasonably advanced in the north and south, neurosurgery remains poorly distributed and has multiple deficiencies. The sub-Saharan region, where the demand is high and services are scarce, suffers from a similar lack of both qualified personnel and well-equipped neurosurgical facilities. Insufficient state funding and research facilities aggravate the situation and discourage the few well-trained African neurosurgeons to practice in their homeland. For those who do return home, cultural, social, economical, and political issues hinder their performance and hence the quality of neurosurgery delivered in Africa. Strategies for rectification of these handicaps are presented, including the need for high-standard local training and support from international organizations.

African neurosurgery: current situation, priorities, and needs.

The beginning of a new millennium causes us to reflect on the state of neurosurgery in the African countries and to affirm that we are eager to provide quality health care for our people. This study is important because its main purpose is to assess progress toward achievements and to identify potential problems, so that remedial action can be taken. To attain these objectives, the following steps were performed: planning, surveying, analyzing feedback, and reporting. We first formed the World Health Organization African Subcommittee. In a meeting held in Dakar on May 25, 1998, we agreed on a strategy and devised a statistical form to adopt. After the drafts were approved, they were distributed to 51 African countries. The survey was performed by representatives who spent 6 months analyzing and collecting data. The results were alarming. After data analysis, we classified the countries into four main groups with respect to the number of neurosurgeons, the equipment potential, and the training capacity. One of the main observations is the need for organization and structured training. Another weakness is the lack of medicosurgical equipment. Poor funding and a lack of resources are responsible for this situation. Overcoming these problems will require that African neurosurgeons target a number of priorities, i.e., devising local training programs and obtaining the necessary equipment. We appeal to national and international institutions to focus on these two points to ensure long-term results, including greater involvement of African countries in local training and greater cooperation in terms of technical support and funding.

The Department of Neurosurgery of the University of Cape Town: a brief historical overview.

Neurosurgery as an independent discipline at Groote Schuur Hospital in Cape Town commenced with the return of Hermann de Villiers Hammann from Munich in 1946. He developed the unit with Alex Gonski, J.P. Van Niekerk, P. Keet, and A.P. Rose-Innes. Jacquez (Kay) C. de Villiers followed in 1966, becoming the first Helen and Morris Mauerberger Professor and chairman of neurosurgery at Groote Schuur Hospital, the Red Cross War Memorial Children's Hospital, and Conradie Hospital. During that period, many contemporary South African neurosurgeons received their training, and the unit developed and expanded its reputation as a center of excellence in Africa. Since 1994, Jonathan C. Peter has been the Helen and Morris Mauerberger Professor and chairman of the department, which now consists of six full-time neurosurgeons, six part-time consultants, seven registrars, and two interns. Two to three thousand outpatients are treated each year, and approximately 1000 surgical procedures are performed. Sociopolitical changes in South Africa have resulted in a reduction in funding of tertiary academic health services, and this presents major challenges for the future.