To the Editor: In late January 2023, the Global Brainsurgery Initiative (GBI), an international neurosurgery education organization, spent a week-long mission in Accra, Ghana. Drs Jean, Felbaum, and Syed operated with Ghanaian colleagues and taught residents. It is in this context that we read the recent letter written by Tenkorang et al1 with great interest. In the weeks before our mission to Ghana, we had been in communication with our host neurosurgeon, Dr Teddy Totimeh regarding providing cerebrovascular care during the trip. We ultimately performed 3 cerebral angiograms and clipped 2 previously ruptured aneurysms. During our mission, we spoke at length with him (Dr Totimeh with University of Ghana Medical Center) and his colleagues at Korle Bu Hospital (Dr Bankah) regarding ways to help elevate the level of cerebrovascular care in the country. We arrived at these conclusions: Government Support—The Ghanaian government supports a single federally funded health insurance system. Subspecialized health care is not covered, and as a result, any neurosurgical care is an out-of-pocket expense. For the patients with social support, expenses are offset by crowdsourcing from family, friends, and their church. Because of the pervasive belief in faith-healing and herbalists, as well as the lack of access to affordable imaging, most brain tumors and spinal conditions present late in their natural history. Most neurosurgical interventions are therefore urgent or emergent. A petition must be made to the government and health officials to change the health insurance and add neurosurgical coverage. Early diagnosis and intervention, although initially resource intense, can provide durable results to patients in their professional prime and restore them to a full and productive life within their community. Cerebrovascular Care—As stated in the original commentary,1 the time sensitivity and resource dependence for acute ischemic care treatment using tPa or mechanical thrombectomy would likely require significant changes to the health care systems. We believe an important first step toward improving cerebrovascular care would be the treatment of hemorrhagic strokes, especially from aneurysms, arteriovenous malformations, and cavernomas. Currently, patients with subarachnoid hemorrhage who survive transport to the hospital and can afford imaging can get care. The patients are managed on a general medical ward and discharged if they have had their trial of life. At this point, they are referred to the only neurointerventionalist in the country for endovascular treatment, but the cost of coils is prohibitively expensive for the average Ghanaian populace. The only teaching hospital in the country with neurosurgical residents, Korle Bu, does not have an operating microscope. The trainees are dependent on overseas observerships, if they are lucky enough to procure, to be exposed to microsurgical technique. The Gigli saw is still widely used in Ghana. The power drill, nonstick bipolars, and hemostatic agents are still rarities. Single-use consumables, such as drill bits and arachnoid knives, are resterilized many times over and reused. Availability of the operating microscope and microsurgical training must be the first steps to this overhaul. As a global neurosurgical community, we must provide Ghanaian trainees better access to worldwide training courses. Once trainees gain exposure and proficiency to microsurgical technique, then the next step would be access and further endovascular training. We believe that the cost of endovascular intervention, as it stands, is too expensive. After securing training, the trainees would be re-entering with skills but would have limited opportunities to use them because of cost. As a global community, working with industry partners to improve affordability is another priority. Personnel Expertise—As every neurosurgeon knows, the technical expertise for the operation is just the beginning of patient care. Excellent preoperative management, neuroanesthesia practice, and neurocritical care in the perioperative period are mandatory for a good patient outcome. It is truly a team effort. Not surprisingly, Ghana is currently short on well-trained anesthesiologists and neurointensivists. Given the paucity of patients undergoing neurosurgical procedures, experience with nursing the neurosurgical patient is also lacking. From setting the back table in preparation for a tumor resection or aneurysm clipping, to performing neurological examinations in the ICU, we found that nursing staff ill-prepared to manage patients. Any effort to raise the standard of neurosurgical care must include considerations of all these other teams and raising their standards as well. There are currently 22 neurosurgeons practicing in Ghana with a population of 31 million. There are just as many neurosurgeons with Ghanaian roots practicing in the United States! Most of the graduating physicians, nurses, and staff in Ghana seek employment opportunities abroad because of more lucrative salaries. To minimize this, a top-down approach from the government to incentivize training abroad, with a promise to return home, is mandatory. In our initial experience working with local neurosurgical community in Ghana, we have no delusions of our inability to solve the country's problems. Although we were saddened by the pervasive scenes of poverty which surrounded us during the week, it hit home that something was seriously wrong when we realized that patients who rupture their aneurysm either die in the hospital or, if they survive their first stay, wait to die on their inevitable next rupture. In the 21st century, this simply cannot stand. Furthermore, traumatic brain injury is the leading cause of death in young people in Ghana—a cause that can be remediated with better access to neurosurgeons. We hope to spur our global neurosurgical colleagues to come together and help advocate for our African colleagues. At the very least, we hope to increase awareness of the needs of our African neurosurgical colleagues and more importantly, their patients.