Original article by Johan A. Aarli, MD published 14 August 2012 in World Neurology Vol 27 No. 4, Editor-in-Chief's Column


 

In 2004, only half of the countries in the African WHO region that communicated with the WHO had a national neurological association.

 

The World Federation of Neurology and other international neuroscience organizations can and should do more to address the lack of specialists in neurology in Africa by assisting African universities in establishing training programs in clinical neuroscience at their medical schools.

Why are there so few specialists in neurology in sub-Saharan Africa? Most African universities have their own medical schools, but the neuroscience curricula are not consistent. The World Federation of Neurosurgical Societies (WFNS) supported neurosurgery in Africa from the very beginning, but the World Federation of Neurology (WFN) has been more concerned about principles for organizing neurological societies. Sharon Juliano also recently pointed out that neuroscience and related disciplines are subjects feared and shunned by students of medicine and science in Africa.1

The main reason for this difference is not in the presentation of curricula for postgraduate education, but more in the differences presented by the WFN and the WFNS.2 Although the WFNS almost immediately admitted African neurosurgeons into their international system, the WFN required the integration of trained neurologists even before their presence in the national health system. According to the rules, any national society of neurologists with more than five members may apply for membership in the WFN, and can nominate a delegate with a voting right to the Council of Delegates. WFN membership is therefore restricted to national neurological societies comprising qualified neurologists.

However, in 2006, the Council of Delegates concluded that the WFN should be inclusive rather than exclusive in accepting membership applications. It is a part of the mandate of the WFN's Africa Initiative to monitor the status of neurology training in sub-Saharan Africa. The Africa Initiative therefore seeks to address the special problems faced by countries on the African continent.

Let me use this occasion to thank the Turkish Neurological Society for making this possible, and the WFN Education Committee for their work. There were 16 applicants from various countries, and two of them have been selected. Philip Babatunde Adebayo from Nigeria visited at Cerrahpasa, and Mehila Zebenigus from Ethiopia at Hacettepe. I am impressed by what I have read, both the excellent preparatory work made by the Turkish colleagues, and the presentations of modern neuromedicine made visible to the guests.

Postgraduate training in clinical neuroscience is an important goal for several organizations related to neurosciences: the World Health Organization (WHO), the International Brain Research Organization (IBRO), the European Federation of Neurological Societies (EFNS), the International League Against Epilepsy (ILAE), and the WFN.

Two relevant examples of a lack of postgraduate training in clinical neuroscience are the medically advanced countries of Ghana and Tanzania. Neurosurgery is well established in both countries, which also have active epilepsy associations. Ghana has a population of more than 20 million people, and there are five public universities. In 1988, the Eighth Pan African Association of Neurological Societies (PAANS) Congress took place in Accra. Unfortunately, Prof. James Mustaffah, the doyen of neurosciences in Ghana, passed away in 1999, with harmful consequences.2 Tanzania is twice as big as Ghana with a population of 43 million people, and has been spared the internal strife and conflicts of many neighbouring countries. But neither Ghana nor Tanzania has a national neurological association. In 2004, only half of the countries in the African WHO Region that communicated with the WHO had a national neurological association.3

The number of specialists in neurology in Africa, at 0.03 per 100,000 population, is lower than in the other WHO regions.

 

The WHO system is based upon a public health system. Important sources of information are the reported frequencies of neurological disorders and of neurological service in primary care, the number of neurological beds, financing for neurological services, and disability benefits. The number of specialists in neurology is lower in Africa than in the other WHO regions; the median number of neurologists per 100,000 population is extremely low in Africa (0.03 vs. 0.07 in Southeast Asia, 0.32 in the Eastern Mediterranean, 0.77 in the Western Pacific, 0.89 in the Americas, and 4.84 in Europe).3 The WHO report demonstrated a lack of trained neurologists in Africa. Epilepsy is at the forefront of neurological health problems in Africa and must be viewed from the public health perspective. The care of patients with epilepsy in sub-Saharan Africa is mainly provided by nonspecialists. If there are no neurologists, then general practitioners, neurological nurses, and other groups of health personnel are even more important and necessary. But they are not trained to diagnose and treat epilepsy, which is the most common neurological disorder seen in primary care in developing regions of the world. And after a first seizure, patients with epilepsy may go years without appropriate therapy.

The EFNS has pioneered establishing Teaching Tools Workshops in Africa, and has had strong support from the WFN, the IBRO, and the WHO. The first Teaching Tools Workshop in neuroscience was held in Senegal in 2009, and 27 students from 11 different countries attended the most recent Teaching Tools Workshop in Ghana.1 The ILAE also has a broad network in Africa and works closely together with the WHO. These organizations, when working together, can be even more active in assisting African universities in establishing training programs in clinical neuroscience at their medical schools. We need specialists with training in modern treatment of epilepsy. ■

 

References

  1. Juliano SL. Report on the African Teaching Tools Workshops. Neurology 2012;78:1797-1799.
  2. Adeloye A, Ruberti R. The Pan African Association of Neurological Sciences (PAANS). The First Thirty Years 1972- 2002. Book Builders, Edition Africa. Ibadan 2008.
  3. WHO Atlas. Country Resources for Neurological Disorders 2004. Neurological Associations and NGOs. Geneva 2004, 15-16.

 


Peter J Koehler

Johan A. Aarli, MD

WFN is a Regional Organization

The WFN is an integrated part of a network formed by the WHO, the coordinating authority for health within the United Nations, as well as by governmental and nongovernmental health administrations. It is important for the WFN, with its geographical and regional programs, to operate within the geography of the WHO, whose structure serves as a model for regionalization of neurology and other specialty-related organizations.

The WHO is not structured according to the clinical specialties in medicine. It is a governmental organization with a main responsibility for public health, so its member nations are grouped into six geographical regions (the African, American, South-East Asian, European, Eastern Mediterranean, and Western Pacific regions). Some nations have been assigned to regions outside their traditional geographic area. Algeria is a part of the WHO African region and not of the Eastern Mediterranean region, whereas Morocco, Tunisia, Libya, Egypt, Eritrea, Sudan, and Somalia are outside the WHO African region.

Each WHO region has its own regional office; in Brazzaville, Congo, for the African region; in New Delhi, India, for the South-East Asian region; in Washington, DC, USA, for the American region; in Copenhagen, Denmark, for the European region; in Cairo, Egypt, for the Eastern Mediterranean region; and in Manila, Philippines, for the Western Pacific region.

The WFN regional system is based upon the WHO structure. There are two main structural differences from the WHO. The WFN found it practical to have one North American and one Latin American region because neurology is so well developed in the Americas, and also for linguistic reasons. The WFN Asian-Oceanian Region comprises the South-East Asia and Western Pacific WHO regions.

The WHO South-East Asia Region comprises Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor Leste. The WHO Western Pacific Region is huge, with approximately 1.6 billion inhabitants and nearly one-third of the world's population.