Report of the Global Neurosurgery Committee - 17th WFNS Congress Bogotá



Report of the Global Neurosurgery Committee - 17th WFNS Congress Bogotá

Edward I Ham, Hodan Abdi, Camilla Grøver Aukrust, Kee B Park

Introduction

Global Neurosurgery is defined as “the clinical and public health practice of neurosurgery with the primary purpose of ensuring safe, affordable and timely neurosurgical care to all who need it”.1 Since the Bogotá Declaration in 2016, the global neurosurgical community has grown exponentially. Consequently, the WFNS launched the Global Neurosurgery Committee (GNC) in 2019 during the International Conference on Recent Advance in Neurotraumatology (ICRAN) in Peshawar, Pakistan. This committee serves as a coordinating body for all global neurosurgical efforts – aiming to promote collaboration and to discourage working in silos. We here highlight the GNC’s activity at the 17th WFNS World Congress of Neurosurgery for three specific days.

Sunday March 13, 2022

On March 13th, during the pre-congress program, the GNC organized a three-session course. The first session included a summary of global neurosurgical activity, the second session was an update of the GNC 1.0 Global Action Plan, the third session was an overview of the next steps for the GNC 2.0. All sessions were moderated by Dr. Kee Park (Committee Chair 2021-2023).

  1. During the first session, Dr. Kee Park gave his opening remarks and introduced the GNC. Dr. Walter Johnson followed this introduction with an overview of global health policy and neurosurgery, making a case for neurosurgical involvement in National Surgical, Obstetric, Anesthesia Plans (NSOAPs). This was followed by Dr. Gail Rosseau, who discussed the role of the G4 Alliance in advocacy efforts within global neurosurgery – specifically highlighting the work by the Global Alliance for Prevention of Spina Bifida F (GAPSBi-F). Dr. Ahmed Negida discussed the recent publication of the Comprehensive Policy Recommendations for the Management of Spina Bifida & Hydrocephalus (CHYSPR) in low- and middle-income countries (LMICs). Last, Dr. Jeffrey Blount discussed folic acid fortification to prevent neural tube defects and the critical need for preventive strategies in global neurosurgical activity.
  2. For the second session, GNC members Hodan Abdi and Edward Ham provided an update for the GNC 1.0 Global Action Plan. The Global Action Plan has five objectives: “1) amplifying access to neurosurgical care, 2) aligning global neurosurgical activity, 3) advancing relevant research, especially from LMIC authors, 4) assimilating neurosurgical capacity building into surgical systems planning, and 5) advocating for (neuro)surgical care within universal health coverage.”2 There were 22 specific objectives across these five targets: 36% of these objectives were attained, 50% were in progress, and 13.6% were not assigned/measured.
  3. For 2021-2023, the GNC 2.0 consists of 10 teams led (or co-led) by the members in Figure 1. Each team has developed a mini-strategic plan with Specific, Measurable, Attainable, Relevant, and Time-based (SMART) objectives. At the pre-congress program, Dr. Tariq Khan shared his strategic plan and discussed the importance of coordination. Dr. Frederick Boop discussed the need for external relations – emphasizing the collaborative approach needed to develop pediatric neuro-oncology in LMICs. Dr. James Johnston discussed accelerating neurosurgical capacity building in LMICs through technology and innovation – sharing work done with Dr. William Harkness to develop InterSurgeon. Dr. Najia El Abbadi (WFNS President-elect) shared her closing remarks and offered her support for the movement.


Figure 1. Leads and co-leads for the Global Neurosurgery Committee 2.0 teams.

Tuesday March 15, 2022

On March 15th, members of GNC 2.0 gathered through a hybrid meeting. In-person participants: Dr. Kee Park, Dr. Gail Rosseau, Dr. Walter Johnson, Dr. Tariq Khan, Dr. Abdesaamad El Ouahabi, Dr. Ernest Barthelemy, Dr. Roxanna Garcia, Dr. Anthony Fuller, Dr. Jeffery Blount, Dr. Philippe Schucht, Dr. Mehmet Zileli, Dr. Graham Fieggen, Dr. Nicolò Marchesini, Dr. Ahmed Negida, Dr. Martina Gonzalez, Anastasia Smith, Hodan Abdi, Daniela Perez-Chadid, and Edward Ham. Virtual participants: Dr. Jogi Pattisapu, Dr. Ariana Barkley, Dr. Nqobile Thango, Dr. Fredrick Boop, Dr. Radzi Hamzah, Camilla Aukrust, and Yee Yit Cheng.

The goal was to establish big-picture goals for the GNC prior to the next WFNS World Congress December 2023 in South Africa. Dr. Park called attention to the rapid growth of the community, then asking a question to the group, “What should global neurosurgery look like at that time? As a new discipline in neurosurgery, what are some things you expect [us] to do?”

Dr. Rosseau and Dr. Marchesini both agreed there was a lot of interest across the board – from older, retiring neurosurgeons in the USA and younger neurosurgeons throughout Europe. Dr. Blount and Dr. Rosseau highlighted efforts by GAPSBi-F to show how neurosurgeons have already been proactive in preventative initiatives at the policy-level. Dr. Pattisapu followed this discussion by inviting all the participants to join the GNC 2.0 Policy and Advocacy meetings – where two main priorities will be integrating recommendations for global folate fortification and advocating for policy-level guidelines for the prevention of traumatic brain injuries.

Dr. Schucht discussed the merit of performing an ethical review of international neurosurgical outreach efforts. Dr. Johnson and Dr. Barthelemy agreed ethics should be a priority area, mentioning Dr. Beverly Cheserem as a candidate to lead this effort. Dr. Barthelemy, Dr. Thango, Dr. Garcia, Dr. Khan, and Dr. Abdesaamad also commented on the need to develop research capacity and other educational efforts. More specifically, Dr. Barthelemy and Dr. Garcia promoted the idea of having more formalized training opportunities. Dr. Fuller discussed the need for sustainable funding mechanisms for both training and research programs, while Dr. Barkley discussed the role of technology in accelerating these efforts. Camilla Aukrust and Yee Yit Cheng discussed the importance of including neurosurgical nursing in the movement.

To wrap up, Dr. Park asked the group if they want to organize a mid-term meeting in December 2022 (Peshawar, Pakistan) to discuss progress and get updates from other GNC teams. There was unanimous support for this suggestion, and the possibility of co-hosting this meeting with the Liaison Committee and the Young Neurosurgeons Forum of the WFNS was explored.

Friday March 18, 2022

On March 18th, the plenary session was held to celebrate the sixth anniversary of the signing of the Bogotá Declaration, a document that affirms “the collective and unified effort in improving all aspects of neurosurgical care”. The panelists for this session were Dr. Enrique Osorio-Fonseca, Dr. Najia El-Abbadi, Dr. Kee Park, Dr. Gail Rosseau, Dr. Walter Johnson, and Dr. Andrés Rubiano.

Figure 2. The panelists for the Global Neurosurgery plenary session.

Dr. Park started the session by delivering a powerful speech on the progress that has been made since 2016. He highlighted the work of the GNC to improve neurosurgical care in LMICs, the endeavors of the Program in Global Surgery and Social Change to address unmet surgical needs globally, and the USAID’s effort to strengthen surgical health capacity. Dr. Park also highlighted how global neurosurgery is moving away from missionary and charity care, focusing on empowering health systems through solidarity and collaboration instead. Dr. Park briefly mentioned the Journal of Global Neurosurgery – a free, open access journal that gives preferences to LMIC authors. He concluded his speech with optimism, stating, “the future of global neurosurgery is bright, and there is more to look forward to”.

The Vice President of Ecuador, Dr. Alfredo Borrero, delivered a keynote speech remotely. He mentioned his dedication to the field of neurosurgery – having spent over 35 years as a neurosurgeon in his country, where he was elected Vice President on May 24, 2021. Since his election, he has pledged to work on the development of appropriate policies and initiatives to improve surgical capacity in his country. He talked about the need for advocating within the global neurosurgery movement. He emphasized that our voices must be heard at the national level as well as at international forums, such as the World Health Assembly. To decrease neural tube defects, Ecuador has decided to implement policies to fortify flour with folic acid. He concluded his speech by emphasizing the importance of research for the advancement of the global neurosurgical movement.

Dr. Rosseau discussed changes that are happening in global neurosurgery. She stated, “the progress the movement made in such a short time is inspiring”, and she congratulated everyone on their leadership in advancing global neurosurgery. Dr. El-Abbadi thanked all the panelists, attendees, and organizers. In her concluding remarks, she expressed that the WFNS will remain committed to supporting the global neurosurgery movement. To end the plenary session, Dr. Osorio-Fonseca thanked and awarded Dr. Park and Dr El-Abbadi for their commitment to advancing global neurosurgery.

Conclusion

The Global Neurosurgery Committee’s strong presence at the 17th WFNS World Congress highlights the community’s energy, passion, and dedication to the field. The future of global neurosurgery is bright, and we welcome everyone’s participation and support!

References

  • Esene, Ignatius, and Kee B. Park. "The Journal of Global Neurosurgery." Journal of Global Neurosurgery 1.1 (2021): 10-12.
  • Rosseau, Gail, et al. "Global neurosurgery: continued momentum at the 72nd World Health Assembly." Journal of Neurosurgery 132.4 (2020): 1256-1260.

 

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