Many countries in Africa are facing a severe shortage of clinicians in many specialties, including neurosurgery. Although efforts are underway to train more young clinicians and expand access to neurosurgical care across the continent, another gap must also be addressed: the lack of collaboration between neurosurgeons and technical experts.
As a specialty, neurosurgery has seen unprecedented improvements in techniques and outcomes due to technological innovation. Facility with biomedical technology is thus an essential component to provide optimal care and to develop innovative tools that are suited to the specific local clinical and technical challenges.
Alexandra J. Golby, MD, an attending neurosurgeon at Brigham and Women’s Hospital as well as professor of neurosurgery and professor of radiology at Harvard Medical School, was recently named a Fulbright Global Scholar on the strength of her proposal to tackle this issue.
“While professional education has made big strides in many developing countries, interdisciplinary collaboration has not been a point of emphasis,” she explained. “The same holds true in many developed countries as well. My goal with this award is to build bridges between clinicians and biomedical engineers in order to facilitate cooperation and innovation.”
Balancing Neurosurgical Expertise With Technical Competencies
As a medical student three decades ago, Dr. Golby traveled to East Africa to do research. In the late 2000s, she re-engaged with contacts in Africa via a former Brigham fellow who had developed a program to teach neurosurgery to clinicians in Tanzania. Dr. Golby has since visited Tanzania, Rwanda and Mauritania to mentor neurosurgeons and neurosurgeons-in-training.
While pleased to see the advances made in training, Dr. Golby notes the extreme challenges of providing neurosurgical care in such vastly under-resourced settings.
“You’re often seeing patients very, very late in the course of their illnesses,” she said. “These are illnesses far beyond when we commonly see in the U.S., and the clinicians have very few technical resources.”
By exposing clinicians to technologies including laboratory testing, imaging, monitoring and therapeutic devices, Dr. Golby hopes to enhance the quality of neurosurgical care available in Africa.
Nurturing Collaborations Between Neurosurgery and Biomedical Engineering
Dr. Golby’s project will aim to foster close collaborations between her home institutions, the Brigham and Harvard Medical School, and clinicians and biomedical engineers in Rwanda and Morocco. Both countries, she noted, have made significant investments in educating specialty trained surgeons and other physicians.
Her host in Kigali, Rwanda, is the director of the Regional Centre of Excellence in Biomedical Engineering and eHealth at the University of Rwanda. The university recently enrolled its first class of biomedical engineering students there. Dr. Golby is also partnering with the Reference Center for Training of Young African Neurosurgeons in Rabat, Morocco. Established in 2002, the program has trained dozens of young neurosurgeons who have returned to their home countries throughout Africa to train other neurosurgeons and set up neurosurgical care centers.
At each site, Dr. Golby will bring together people from the worlds of clinical medicine and biomedical engineering to learn about one another’s roles, identify clinical needs and brainstorm solutions. In the first academic year, participants will cover a curriculum and brainstorm projects during Dr. Golby’s initial in-country visits. They will continue to develop their projects in the interim with remote mentoring by Dr. Golby. In the second academic year, she will return to each site to lead discussions about what participants accomplished and what goals to pursue in the future.
Dr. Golby sees her role as a facilitator who encourages participants to conceptualize a problem to solve in collaboration with cross-disciplinary partners.
“I know I had certain questions that I’d formulated toward the end of my training that I’m still working on 20 years later,” she said. “What was so fruitful to me—and what I want to impart to these folks—is how helpful it was to have these types of discussions, which helped me decide what was important to study, what tools I’d need to start asking these questions and what relationships I’d have to build to address the questions.
“One very high-level idea is to teach people to dream big and that dreaming big is easier to do when you have partners with you.”
Support for an Unconventional Career Trajectory
Dr. Golby joined the neurosurgery faculty at the Brigham in 2003. She also has an appointment in radiology and works closely with colleagues in neurology and psychiatry through her research on applying brain mapping techniques to neurosurgical patients. In addition, she collaborates with physicists, engineers and computer scientists on the development and application of novel imaging and interventional tools.
“Everything I do is a little outside of the norm of what neurosurgeons typically do,” she said. “I’ve been incredibly lucky not only for the fertile overall environment at the Brigham, but also to have a neurosurgical chair in Dr. [Nino] Chiocca who has been incredibly supportive of me in this unconventional trajectory through academic neurosurgery.”