MAHMOOD QURESHI

CONSORTIUM OF NEUROSURGICAL SITES OF TRAINING OF THE EAST, CENTRAL, AND SOUTHERN AFRICAN REGION

AN ANGLOPHONE WFNS REFERENCE TRAINING SITE

Almost ten years ago, WFNS did promote the creation of a training center giving support to Kenya, Uganda, Tanzania, Ethiopia, Zambia, Malawi, and Rwanda. This center is based in Nairobi, under the direction of Dr. Mahmood Qureshi.

The Neurosurgical Training program of the East, Central, and Southern African region is known as the “Consortium of Collaborative Neurosurgical Sites of Training of the East, Central and Southern African region (C-CNS-ECSAR)”. The program commenced in January 2006, The C-CNS-ECSAR incorporates neurosurgical training at major hospitals in the East African region of Sub-Saharan Africa. It was accredited as the second (Anglophone) WFNS Reference Training Centre in Africa, during a visit in August 2012, led by Prof Armando Basso, Chairman of the WFNS Foundation at the time. This followed in the footsteps of the first (Francophone) WFNS Reference Training site in Rabat, Morocco.

The initiative, led by Dr. Mahmood Qureshi, of Kenya, Prof Paul H Young of the Foundation for International Education in Neurosurgery (FIENS), and Dr. Benjamin Warf who was working in Mbale, Uganda at the time, followed meetings with neurosurgical leadership from across the region, culminating in a Stakeholders meeting in Nairobi on 29th September 2004.

Figure 1. Representatives from East Africa during the Stakeholders meeting on 29th September 2004. Included Dr. Ben Warf (CURE hospital Mbale, Uganda); Dr. Michael Muhumuza (Mulago Medical Complex- Uganda),; Dr. Paul Young (Missouri-USA); Dr. Bert Part (Tenwek Mission Hospital, Kenya); Dr. Nimrod Mwangombe (University of Nairobi); Dr. Mahmood Qureshi (Kenyatta National Hospital – Nairobi),  among other East African neurosurgical leadership.

Figure 2. Left to Right: Dr. Florentius Koech (Moi Teaching and Referral Hospital – Eldoret), Dr. Chris Musau (University of Nairobi), Dr. Mahmood Qureshi (Kenyatta National Hospital) during the Stakeholders meeting 29th Sept 2004.

This was followed by the development of a neurosurgical training Curriculum, known as the Neurosurgical Training Program of the ECSA region (NSTP-ECSA) with input from various regional stakeholders. The hospitals accredited to train to include the following:

– Kenyatta National Hospital, Aga Khan University Hospital in Kenya, Coast General Hospital in Mombasa

– Mulago Medical Complex and CURE Children’s Hospital (Uganda)

– Black Lion Hospital and Myun Sung Mission Hospital (Ethiopia)

– Muhimbili Orthopaedic and Neurosurgery Hospital (Tanzania), The Mnazi Mmoja NED Institute in Zanzibar, Tanzania

The Centres have been accredited on the basis that they had the capacity to provide varying levels of training, with none having the capacity to provide fully comprehensive training at this time. The aim of the Consortium is to consolidate the diverse capabilities of the various centers that would enable internationally accredited levels of training. Trainees are enrolled in the program, upon completing the Membership of the College of Surgeons (MCS), a two-year program following an Internship after graduating from Medical School. (4)

Figure 1. Educational pathways to becoming a neurosurgeon offered by different training programs in East Africa. MCS-ECSA, Member of College of Surgeons; FCS-ECSA, Fellowship of the College of Surgeons; M.Med, Master of medicine; MSc, Master of Science.

Once enrolled into the Fellowship Program (FCS), Neurosurgical Training is commenced at the accredited Sites. Following an initial 1 year training in their base center, training takes place for a further 3 years in centers outside their base center, in order to achieve comprehensive training. The accredited Centres are shown in Figure 4.

Country in ECSA region

City/ Town

Accredited Centre

Kenya

Nairobi

Kenyatta National Hospital; Aga Khan University Hospital;

Kenya

Mombasa

Coast Provincial

General hospital

Kenya

Bomet

Tenwek Mission

Hospital

Uganda

Kampala

Mulago Medical

Complex (Makerere University)

Uganda

Mbarara

Mbarara University Teaching Hospital

Tanzania

Dar es salaam

Muhimbili Orth & Neuro Institute

 

Tanzania

Zanzibar

Mnazi Mmoja/

Neurosurgical Education

& Development

(NED) Institute

 

Ethiopia

Addis Ababa

Black Lion Hosp

 

Zambia

Lusaka

Lusaka University Teaching Hospital

 

Malawi

Blantyre

Queen Elizabeth

Teaching Hospital

 

Rwanda

Kigali

King Feisal Hosp

 

Figure 4. COSECSA Accredited Sites

To enhance their experience, an external rotation is carried out at renowned centers abroad. Centers in Mumbai (under the Directorship of Prof Basant Misra), Valencia and Alicante in Spain (under the Directorship of Prof Jose Piquer and Prof Pablo Gonzales, respectively)), Izmir (under Prof Mehmet Zileli in Turkey), and Bristol (England, under Dr. Richard Nelson), have provided such support.

Following a 6 year training (2 years to complete the MCS and 4 years for the FCS), the graduates receive the Award of Fellow of the College of East Central and Southern Africa in Neurosurgery (FCS-ECSA, Neuro), at the College Graduation Ceremony.  (Figure 5)

Figure 5: COSECSA Graduation Ceremony, 2018 – Zambia

Kenya

Drs

John Boore;

Peter Mwangi;

Peter K Wanyoike;

Benjamin O. Okanga;

Andrew N, Nyaoncha;

Daniel Njeru Mugendi

Uganda

Drs David Kitya;

Alexander Muhindo;

Oscar Obige;

Blessing Taremwa;

Juliet Nalwanga

Tanzania

Drs Gerald Mayaya;

Boniface Kivevele;

Happiness Rabiel

Aingaya Kaale

 

 

Ethiopia

Drs Abenezar Tirsit;

Tsegazeab Laeke;

Azarius Kassahun

Mozumbique

Dr Sergio Salvador

Figure 6: Residents who have completed their training through the program, and are currently working as certified neurosurgeons, having been certified by their respective National Medical Practitioners Boards, as per the COSECSA Secretariat in Arusha, Tanzania (7)

A further 9 candidates are enrolled in the program. (5 Kenyans, 1 Tanzanian, 2 Ugandans, and one trainee from the Democratic Republic of Congo (DRC).

The Training program along with several others in Africa was evaluated by  Prof Peter Black, Past President of the WFNS, and a report published in World Neurosurgery(6). The assessment included evaluation of training quality standards, utilizing universal metrics used by each program during and, at the completion of training. The scores obtained by each program were outlined by the authors of this publication (6). The purpose of these metrics was to ensure graduates in the various programs had attained the judgment and skills necessary to be safe and effective neurosurgeons upon graduating from the programs.

The positive evaluation, ranking the East African (COSECSA) program, comparable in standard to established programs and scoring favorably along with other programs on the African continent, has been an encouraging start to this young program. The recognition of the C-CNS-ECSAR site as a Reference Training site by the WFNS has provided a boost to the Program. An additional boost has been the support of the WFNS through its Foundation. Following the accreditation by the WFNS as a Reference Training Site in 2012, the WFNS Foundation approved an annual stipend of USD $5400/= per resident per annum. This has been increased to USD$6000 per annum, from January 2021, for five residents in the program.  Two Kenyan, two Ugandan, and one candidate from the DRC training in Uganda are current recipients of the WFNS Foundation scholarships.

a) Mbarara University Teaching Hospital

b) Mnazi Mmoja/NED Institute: launch by former Zanzibar President, H.E. Mohamed Ali Shein, in February 2015

c) Mulago Medical Complex, Makerere University, Kampala, Uganda

d) Kenyatta National Hospital, Nairobi, Kenya

e) Tenwek Hospital, Bomet County, Kenya

f) Surgical Skills Lab at the Addis Ababa University, Ethiopia.

The support of the WFNS Foundation has contributed significantly to the training of neurosurgeons, who now hold leadership positions in several hospitals in the East, Central, and Southern African region. The list of specialists is shown in Figure 6. Along with funding support, the WFNS Foundation has provided equipment in form of Operating microscopes, high-speed drills, Bipolar sets, cranial and spinal sets to several of the neurosurgeons who have set up new services within the region. These are in towns, which include Mombasa, Embu, Nyeri in Kenya, Mbarara in Uganda, Mwanza and Mbeya in Tanzania, and the Mnazi Mmoja NED Institute in Zanzibar.

It is gratifying that the regional program has, since its inception in 2006, produced 19 holders of an FCS-ECSA(Neuro). Two additional candidates, Dr. William Copeland, an American Board eligible neurosurgeon, and Dr. Edwin Mogere, a graduate of the South African College of Neurosurgeons, have taken the COSECSA exam, with the intention of obtaining accreditation of their Units as Training sites at Tenwek Mission Hospital and Aga Khan University Hospital, the latter for purpose of re-accreditation. The COSECSA graduates are currently among the leadership of hospitals in the region, with others taking on the responsibility of starting new neurosurgical units in cities and towns outside of the capitals in their countries. This is in line with the objective of the Regional C-CNS-ECSAR of providing an opportunity for training to young African candidates, within Africa without the need to travel to centers in Europe or the West for their general neurosurgical training. This latter model of training in centers in Europe and the West had resulted in a large number of trained specialists not returning back home to practice and make a contribution to their countries.

Following the development of the Regional Program, several National Programs have also developed during this period. These include:

  • The M.Med (Neurosurgery) Program at the University of Nairobi, Kenya,
  • MSc (Neurosurgery) program in Tanzania (Fig 3),
  • Med (Neurosurgery) in Uganda,
  • Med (Neurosurgery) in Harare, Zimbabwe, and
  • the Certificate of Neurosurgery of the University of Addis Ababa, in Ethiopia.

As a result of the Collegiate (COSECSA), neurosurgical initiatives commenced in 2005, neurosurgical training and the resultant increase in numbers of specialists, has seen a gratifying advancement of neurosurgical standards and availability, in the East, Central, and Southern African region.

REFERENCEES

  1. Abdeslam El Khamlichi. Emerging Neurosurgery in Africa; pg 55
  2. Adeloye Adelola. Neurosurgery in Africa, 1989, Ibadan University Press
  3. Qureshi MM, Oluoch-Olunya D. History of neurosurgery in Kenya, East Africa. World Neurosurgery, 2010; 73: 261-263
  4. Neurosurgery in East Africa: Foundations. Harinder S. Mangat, M M Qureshi et al World Neurosurgery. (2018) 113:411-424
  5. Kinasha A, Kucia EJ, Vargas J, Kavolus J, Magarik J, Ellegala DB, et al. Neurosurgery in Tanzania: a discussion of culture, socioeconomics, and humanitarians. World Neurosurg. 2012;78:31-34
  6. Jaime Gasco, Sean M. Barber, Ian E. McCutcheon, Peter M. Black Neurosurgery Certification in Member Societies of the WFNS: Africa and the Middle East. World Neurosurgery DOI:10.1016/j.wneu.2010.09.006 18-27
  7. COSECSA Secretariat http://www.cosecsa.org
  8. J W M Kiryabirwe: Neurosurgery in Uganda. Neurosurgery Vol 20, No 4, 1987, 664-665

Abbreviations:

COSECSA –College of Surgeons of East, Central, and Southern Africa

C-CNS-ECSAR; Consortium of Collaborative Neurosurgical Sites of Training in the ECSA region

DRC – Democratic Republic of Congo

ECSA- East, Central and Southern Africa

FCS- Fellowship of the College of Surgeons

MCS- Membership of the College of Surgeons

MMC – Muhimbili Medical Center

MOI – Muhimbili Orthopaedic Institute

NED – Neurosurgical Education Development

NSTP-ECSA – Neurosurgical Training Program of the East, Central, and Southern Africa.