Global Neurosurgery

A Collaboration of Equals: CU Neurosurgery Partnership with Muhimbili Orthopedic and Neurosurgical Institute, Dar es Salaam, Tanzania

Faculty and residents have been traveling from CU Neurosurgery to Tanzania since 2007. This began as a training mission teaching general surgeons and others basic neurosurgical skills to improve neurosurgical trauma and hydrocephalus support in areas of the country without access to neurosurgery. Beginning in 2016, a Memorandum of Understanding was signed between CU Neurosurgery and the Muhimbili Orthopedic and Neurosurgical Institute (MOI), which represented a transition for CU Neurosurgery from personal mission trips to Sub-Saharan East Africa to an international collaboration and exchange program for sustainable development of neurosurgical specialty care and training in low- and middle-income countries.

MOI Neurosurgery

Faculty neurosurgeons at MOI have trained all over the world—including Japan, Germany, Morocco, South Africa, Australia, etc., and then made personal sacrifices to return home to establish and expand neurosurgical care in their own country. The recent establishment of a neurosurgery residency training program and a National Center of Excellence in neurosurgery has improved access to neurosurgery services in Tanzania, with additional neurosurgeons slowly filling the need for neurosurgical care across a vast country of greater than 60 million people with fewer than 15 neurosurgeons.

CU Neurosurgery

CU Neurosurgery is a dynamic, rapidly growing enterprise specializing in clinical, research and educational excellence, representing one of the largest Neurosurgery Departments in the western United States. Within the department are nine Programs of Excellence, offering unrivaled educational opportunities for medical students, residents and fellows in this state-of-the-art Center for education, clinical programs, research and innovation.

CU-MOI Partnership

International Symposium

Each year, CU Neurosurgery and MOI faculty and residents come together in Dar es Salaam to host an International Neuro-Oncology, Neurovascular and Neurocritical Care Symposium. This conference includes didactic lectures, practical sessions and live OR demonstrations. Breakout sessions for neurosurgery, critical care, oncology, pathology, radiation oncology, radiology and nursing make this a unique conference covering all aspects of neurosurgical patient care and clinical practice within these subspecialty areas of neurosurgery. With more countries represented at the Symposium each year, attendance has ballooned to over 300 attendees, with overflow participation wired to conference rooms throughout MOI.

International Exchange

Each year, neurosurgery residents and fellows travel to Tanzania along with CU faculty to experience neurosurgical care in Sub-Saharan East Africa. This is a unique opportunity, beloved by residents and fellows, allowing an opportunity to learn about neurosurgical care in resource limited environments. In return, neurosurgery and related specialty trainees and providers come to Colorado for four-to-six-week observerships in the subspecialty area of their choice, to assist in their development into independently practicing clinicians.

Examples of improved care through collaboration

Intraoperative Ultrasound in Neurosurgery

Without access to cost prohibitive navigation technologies including intraoperative MRI, CT, or frameless stereotactic systems or robotics, Tanzanian neurosurgeons previously had no access to intraoperative guidance for cranial and spine surgeries. After discussion, a training program was created to teach intraoperative ultrasound for guidance for brain and spine surgery at MOI. This collaboration began in 2018 and was a collaboration between CU Neurosurgery and the Departments of Neurosurgery, Anesthesia and Radiology at MOI. CU Neurosurgery provided basic training and demonstrations with a hands-on course. Following this, neurosurgeons invited radiology into the operating room to assist in normal and abnormal anatomic interpretation while neurosurgeons at MOI developed their own improved understanding of the use and interpretation of ultrasound imaging. Ultrasound units already owned by MOI for use in radiology and anesthesia were used now in neurosurgery, making this an easy transition financially for a LMIC institution. The utility of this training became apparent from the very first case it was used, where a larger craniotomy was required prior to dural opening for adequate access for brain tumor excision. Ultrasound has been shown to be a low-cost and efficacious alternative form of intraoperative guidance and imaging that is quite useful in both the developed and developing world. Further advanced ultrasound teaching occurs now in Tanzania, with other CU courses slowly expanding this technology to other countries and regions across Sub-Saharan East Africa.

Advanced Endoscopy

Many years ago, CURE Children’s Hospital of Uganda (https://cure.org) began training surgeons on the use of flexible endoscopy for performing endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). After a period of formal training, they would then facilitate the donation of a flexible endoscope and monitor tower for the surgeon to return to their home hospital and continue performing surgeries for hydrocephalus across different parts of the developing world. With interest in expanding endoscopic procedures beyond ETV, we began a training program in advanced neurosurgical endoscopy. This has led to the expansion at MOI into endonasal endoscopy and will ultimately expand into advanced ventriculoscopy, endoscopic assisted surgery and spine endoscopy.

Collaborative Research

The CU/MOI collaboration has led to a number of publications with continued collaborative research ongoing. Examples follow:

1. Ormond DR, Kahamba J, Lillehei KO, Rutabasibwa N. Overcoming barriers to neurosurgical training in Tanzania:  international exchange, curriculum development, and novel methods of resource utilization and subspecialty development. Neurosurgical Focus. 2018; 45(4):E6.
2. Kaale AJ, Rutabasibwa N, Mchome LL, Lillehei KO, Honce JM, Kahamba J, Ormond DR. The use of intraoperative neurosurgical ultrasound for surgical navigation in low and middle income countries:  the initial experience in Tanzania. J Neurosurg. 2020 Feb 28:1-8. doi: 10.3171/2019.12.JNS192851.
3. Zerd F, Moore BE, Malango AE, Hosokawa PW, Lillehei KO, Mchome LL, Ormond DR. Photomicrograph-based Neuropathology Consultation in Tanzania: The utility of static-image teleneuropathology in low- and middle-income countries. Journal of Clinical Pathology. 2020 Jul 27;aqaa084. doi: 10.1093/ajcp/aqaa084. PubMed PMID: 32715312.

Opportunities to Expand Impact

A number of opportunities will help us expand the impact of this program through your help and assistance.

Equipment/Supplies Donations

Prior donations of medical equipment and supplies have made a significant impact on the lives of patients and the efficacy and safety of neurosurgery. We are actively seeking vendor or other industry sponsored donations of lightly used (functional) equipment and sterile supplies. Please reach out for additional details of specific needs and regulatory requirements.

Monetary Donations

Your donation can make a great impact on the strength of our program. Thank you so much for considering a monetary donation to assist with increasing our impact in Sub-Saharan East Africa.