Is there a dedicated neurocritical care specialist at your center
(Muhimbili National Hospital / Muhimbili Orthopedic
Institute) for neurosurgical and neurocritically ill patients?
There is not a single neurocritical care specialist at MOI or
Muhimbili National Hospital (or in Tanzania that I know of).
What are your plans in this regard?
We have several plans, but due to lack of funding, some programs
fall back due to overriding priorities. We would love to have
a boost in this respect. The essential surgical skills training
is ongoing under the funding from Canadian Network for
International Surgery. That way at least the basic life support skills
are learned.
What is the size of your neurocritical care unit (beds)?
MOI is now in phase three of expansion. We shall have a 20-bed
ICU and 30 bed step down ICU. This is excluding the human
workforce development requirement necessary at the beginning.
What is the nursing-to-patient ratio in your neurocritical
care unit?
The current ratio is two patients to one nurse.
Who is in charge of your neurocritically ill patients?
Our unit is staffed primarily by anaesthesiologists.
Do you have a fellowship or other formal training program for
trainees in your neurocritical care unit?
Most staff are trained at the Muhimibili Univeristy of Health and
Allied Sciences (MUHAS); currently, there is no such a training
program at MUHAS
Are your trainees trained in ENLS (Emergency Neurologic
Life Support)?
There is no ENLS training in Tanzania (responds with a laugh).
Please introduce this.
Is your institution represented in the Neurocritical Care Society
or any other local neurocritical care societies?
We are unfortunately not involved in the Neurocritical Care
Society. Let’s get started if possible.
Are there resources that you would like to have to serve your
patient population better?
These are important questions! I don’t know where to start. My
advice is to welcome anyone interested in this so we can work
together. We also need to engage in resource needs analysis
and plan the way forward. Currently, Dr. Halinder Mangat, a
neurointensivist from Weil Cornell is paying regular annual visits
here during the neurotrauma course.
What is your vision for neurocritical care in Tanzania and
East Africa in the next five years?
The future is bright if we establish one center of excellence;
then all expansion starts from there. MOI is ready to support
such innovation.
References:
1. https://www.braintrauma.org/news/article/partnerspotlight
tanzania-neurosurgery-project
2. Dekker MCJ, Urasa SJ, Howlett WP. Neurological letter
from Kilimanjaro. Practical Neurology 2017;17:412-416.
3. Walker, Richard et al. Stroke incidence in rural and
urban Tanzania: a prospective, community-based study.
The Lancet Neurology , Volume 9 , Issue 8 , 786 – 792
4. Kigocha Okeng’o, Pilly Chillo, William K. Gray, Richard
W. Walker, William Matuja, Early Mortality and
Associated Factors among Patients with Stroke Admitted
to a Large Teaching Hospital in Tanzania, Journal of Stroke
and Cerebrovascular Diseases, 2017, 26, 4, 871
5. R.W. Walker, K. Wakefield, W.K. Gray, et al.Case-fatality
and disability in the Tanzanian Stroke Incidence
Project cohort Acta Neurol Scand, 133 (2016), pp. 49-54
6. Nogueira RG, Jadhav AP, Haussen DC, et al.
Thrombectomy 6 to 24 hours after stroke with a
mismatch between deficit and infarct. N Engl J Med.
DOI: 10.1056/NEJMoa1706442
7. Jüttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici
M, Woitzik J, Witte S, Jenetzky E, Hacke W; DESTINY
Study Group. Decompressive Surgery for the Treatment
of Malignant Infarction of the Middle Cerebral Artery
(DESTINY): a randomized, controlled trial. Stroke. 2007
Sep;38(9):2518-25.
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