The Evolution of a New Field: Global Neurosurgery

The 2016 Bogotá Declaration

In December 2016 in Bogotá Colombia, a group of neurosurgeons recognized the massive deficit in neurosurgical care, particularly in the developing world, and called upon the leaders of organized neurosurgery to take action(1). From this meeting the final version of the Bogotá Declaration on Global Neurosurgery was released, after a series of subsequent revisions and additions from leaders in the field at various society meetings across the world. The declaration was the first of its kind to acknowledge the massive deficit in global neurosurgical care and also place responsibility onto our own professional community to create collective and unified efforts to improve access to neurosurgical care.

A Growing Field

Thus, momentum has been growing within the neurosurgical field in the areas of education and training, research, policy, and advocacy to advance the new global agenda. Numerous commentaries and editorials have emerged calling to action for mobilization and involvement of neurosurgeons and proposing recommendations for all stakeholders(2,3). More and more academic centers and national and international neurosurgical societies are now creating separate initiatives to tackle this large unmet need. Further evidence of this expanding subspecialty can be seen in Figure 1, that demonstrates the exponential growth in articles pertaining to “global neurosurgery” since 2016.

Figure 1.

The timing of this movement is critical. With the advent of the Lancet Commission on Global Surgery and the passing of the World Health Assembly Resolution 68.15 in 2015, the global health community is at the precipice of a paradigm shift( 4,5). There is a new focus on the development of robust health systems that are sustainable and integrative as well as a renewed vigor to work together to achieve the Sustainable Development Goals. The global neurosurgery community is growing and can be the catalyst for the broader global surgery movement.

Weill Cornell Hosts the Global Neurosurgery 2019 Symposium

Approximately two years after the release of the Bogotá Declaration, the Weill Cornell Brain and Spine Center hosted the first ever Global Neurosurgery 2019: A Practical Symposium in snowy New York City. Attendees represented five continents across the globe and leaders of the practice presented on different neurosurgical initiatives in low and middle income countries (LMICs). Many projects concentrate efforts on education and training and capacity building in the form of equipment donations and the construction of operative facilities. However, several emerging themes became clear: 1) Considerable efforts are being made by high income country programs to partner with LMIC programs. 2) While training and education are valuable endeavors, neurosurgeons are stakeholders in policy and should become strong advocates for these causes. 3) Many efforts are isolated and disparate, and there is a need to unify global neurosurgery actors, from individual practioners, academic departments, to national and international professional societies.

Moving Forward

In light of these realizations, we echo the original call to action that was mandated by the Bogotá Declaration and hope to continue to nurture and expand the field of global neurosurgery. We must also focus on public awareness and policy change, such as helmet laws or surgical systems development with an eye for the specific needs of neurotrauma care. Additionally, there is a need for the formation of a global neurosurgery steering committee to oversee these efforts and act as liaisons between the many collaborators and stakeholders across the world.

It is said that after completing his internship in 1895, Harvey Cushing professed, “A physician is obligated to consider more than a diseased organ, more even that the whole man—he must view the man in his world”(6).This is truer now than ever before, and neurosurgeons must use their natural position of leadership to promote policy change so that no person may experience undue death or disability from neurosurgical disease, regardless of location or socioeconomic status. The time to act is now.

Sources

1. Global Neurosurgery. Global Neurosurgery Available at: https://globalneurosurgery.org/. (Accessed: 29th January 2019)

2. Park, K. B., Johnson, W. D. & Dempsey, R. J. Global Neurosurgery: The Unmet Need. World Neurosurgery 88, 32–35 (2016).

3. Corley, J. A. & Haglund, M. Letter: How Neurosurgery Fits Into the Global Surgery 2030 Agenda. Neurosurgery 79, E544-545 (2016).

4. Sixty-Eith World Health Assemby. WHA Resolution 68.15- Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage. (2015).

5. Lancet Commission on Global Surgery. Lancet Commission on Global Surgery Available at: http://www.lancetglobalsurgery.org. (Accessed: 6th August 2018)

6. Ruhnke, G. W. & Warshaw, A. L. A most unusual patient at the Massachusetts General Hospital. Ann. Surg. 254, 845–849 (2011).