Neurotrauma and Critical Care in Tanzania:
Collaboration With Muhimbili Orthopedic Institute
(MOI), Dar-es-Salam
By Halinder S. Mangat, MD
My wife and I both lived in Africa at different
stages of our lives, so there was no hesitation
when opportunity arose via the Global
Health Department at Weill Cornell Medicine
to return to this enigmatic continent. In
addition to teaching the curriculum in
neurology at the second biggest university
hospital, Weill Bugando Medical Center,
Mwanza, from 2012, I joined an international
collaborative effort in neurotrauma, led by Dr. Roger Härtl,
professor of neurosurgery at Weill Cornell.
The neurotrauma project includes both education and research.
Education entails exchange of trainees in neurosurgery, whereby
Tanzanian residents spend up to three months each at Cornell
learning neurosurgical skills in a cadaver lab as well as observing
spine, cranial and vascular cases. In addition, they spend time in
the neurocritical care unit and attend all related conferences. Some
neurosurgical residents from Cornell also choose to spend time
at MOI under the supervision of Dr. Hamisi Shabani, professor
and chairman of the Department of Neurosurgery. Once a year,
the group comes together to organize a conference on brain
and spine trauma, which includes lectures, workshops, invited
international guest speakers and presentation of research data.
After two days of lectures, surgical training for basic techniques
occurs at the operating rooms at MOI. In 2017, we hosted the
first day of lectures in neurocritical care and plan to host ENLS in
2018. This conference is now supported by the College of Surgery
for East, Central and Southern Africa (COSECSA) Brain Trauma
Foundation and endorsed by the Neurocritical Care Society and
has had more than 100 attendees from the region for the past
several years.
Concurrently, we host a detailed severe TBI database, supported
by the BTF. Data analysis and projects from these emerge as part
of a quality improvement program, based on a similar project
by the BTF in New York State. The database provides objective
data on gaps in the care of severe TBI patients, which range from
admission to ICU, initial resuscitation, delays and pragmatic
difficulties in obtaining imaging, prompt surgical intervention and
post-traumatic ICU care. Several students have completed these
projects as part of their undergraduate and post-graduate theses.
Critical care in Tanzania is provided by anesthesiologists, yet
no formal training curriculum exists. It is our goal over the next
several years to focus on the development of neurocritical care by
twinning with MOI in education and research to provide objective
data for improvement in care and reduction in mortality after
neurotrauma. As with neurosurgery, we hope to fund resident
global health critical care fellows at MOI in the near future and
initiate a training program.
Our close-knit relationship with the surgeons at MOI under
the leadership of Dr. Hamisi Shabani would not be possible
without everyone’s enthusiastic participation in weekly Skype
calls, adopting trainees, supervising each other’s students and
their projects. And, of course, the support of the chairs of the
Department of Neurosurgery and Neurology at Cornell, Drs.
Philip Stieg and Matthew Fink, is quintessential.
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