NEUROSURGERY IN THE DEMOCRATIC REPUBLIC OF CONGO: PAST, PRESENT AND FUTURE
Article by Ulrick S. Kanmounye email: firstname.lastname@example.org
According to the Lancet Commission on Global Surgery, more than two thirds of the global population do not have access to safe and affordable surgical care and most of them live in Low and Middle Income Countries (LMIC). There are many reasons that explain this: first, patients from these regions lack geographical and financial access to specialist surgeries. Secondly, surgeons in LMIC do not have access to equipment necessary to practise complex surgery. A typical LMIC example that illustrates this is the Democratic Republic of Congo (DRC). The DRC is a central African country with a population of 77.8 million people of whom 50 million earn less than $ 1.90, no universal health coverage system, a surface area of 2,3 million square kilometers and a low surgical workforce. All of these factors make it difficult to financially and physically cover most regions. This is especially true for neurosurgery as the neurosurgical workforce is made up of 16 surgeons: of which 7 are locally based neurosurgeons, 4 are neurosurgeons based abroad and 5 are general surgeons dedicated to neurosurgical practice. This has not always been the case. In fact, up until 10 years ago there was only 1 neurosurgeon in the DRC.
Members of the Congolese Neurosurgical Society
The history of Congolese neurosurgery dates back to 1979 with the return to the DRC of late Pr Shako Djunga after he had completed training in the United States and in Belgium. From the time he returned in 1979 to 1983, Pr Shako took Dr Antoine Beltchika then a general surgeon, under his wing. Later on, from 1983 to 1987 Dr Beltchika went to Toulouse, France where he was a resident under Pr Yves Lasorte. When Dr Beltchika returned, he practised at the Kinshasa University Hospital and at the Neuro-psychopathologic Centre. From 1987 to 2008, Dr Beltchika, current president of the Congolese Neurosurgical Society, served as the only neurosurgeon nationwide. During this time, he would receive help from diasporan neurosurgeons – Pr Kalangu Kazadi (Zimbabwe) and Pr Jean-Pierre Kalala (Belgium). Between 2008 and 2013, the surgical workforce gained a helping hand when late Dr Mudjir Didier set up practice at the Ngaliema Clinic. Since 2010, there have been 6 new neurosurgeons: Pr Glennie Ntsambi, Dr Jeff Ntalaja, Dr Charles Kashungulu, Dr Safari Mudekereza, Dr Trésor Ngamasata and Dr Adalbert Shweka. In addition to these six, two more diasporan neurosurgeons have been lending a helping hand to their homebased counterparts – Dr Orphée Makiese (France) and Dr Lubansu (Belgium). Finally, in the next three to six years, there will be a total of 9 new Congolese neurosurgeons. These future neurosurgeons are currently in neurosurgery residency programmes in Zimbabwe, Morocco, Senegal, Brasil and South Africa.
Given the rapidly growing workforce and the numerous problems they faced, Congolese neurosurgeons decided in 2015 to create the Congolese Neurosurgical Society (SCNC). The SCNC has been working to provide global neurosurgery in the DRC by advocating for the training of neurosurgeons, advancement of neurosurgical research and the treatment of neurosurgical patients indiscriminate of their social status or geographical location. In order to cover the neurosurgical demand, the SCNC decided to divide the country into 4 neurosurgical zones with headquarters in Kisangani (North), Lubumbashi (South), Kinshasa (West) and Bukavu (East). The most active zone is currently in the west where the capital of the DRC, Kinshasa, is located. This is because the western zone has more than half of the SCNC’s workforce, two major public hospitals (Kinshasa University Clinic and Ngaliema Clinic) and better equipment including: microsurgical equipment, clips, Mayfield skull clamps, and hypophyseal surgery equipment. With this new equipment, the SCNC has increased the scope and number of neurosurgical interventions across all subspecialty fields. While most of this equipment is currently at the Ngaliema Clinic, the SCNC has planned to equip each zone equally.
Neurosurgical Zones of the Democratic Republic of Congo
In the future, the SCNC hopes to offer advanced techniques (skull and spine neuronavigation, scoliosis surgery, ultrasonic surgical aspiration, functional neurosurgery…) and to increase the number of neurosurgeons locally. Unfortunately, very few medical students have picked up neurosurgery because till date, those aspiring to become neurosurgeons have to be trained abroad which usually implies high costs and separation from loved ones. Another deterrent has been the lack of neurosurgical equipment in most facilities. Fortunately, most of these issues are been solved by the World Federation of Neurosurgical Societies (WFNS), the Continental Association of African Neurosurgical Societies, the SCNC and other partners. For example, they have made it possible to train future neurosurgeons on scholarships in Morocco and China with a clause stating that on completion of their training, neurosurgeons have to return home. Also, the WFNS has helped the SCNC in the acquisition of most of its current and future equipment.
Clipping of an aneurysm at the Ngaliema Clinic by a Moroccan and two Congolese neurosurgeons