Going Big: A Cross-Continental Global Health Project Aims for Systemic Change
By Sarah Grace Engel, M.T.S., Program Coordinator, Bass Connections
Nigeria, a West African nation about two thirds as populous as the United States, has only 138 neurosurgeons. Alvan Ukachukwu knows what it’s like to be one of them.
Ukachukwu trained as a neurosurgeon in Nigeria, then practiced there for four years before coming to Duke to earn his Master of Science degree in global health. He now serves as a research scholar for Duke Global Neurosurgery and Neurology. This year, alongside Timothy Dunn and Anthony Fuller, he is leading a Bass Connections team to address the shortages of labor, funds and infrastructure in neurosurgical settings around the world.
The team is studying neurosurgical systems in Nigeria and Uganda. Their ultimate goal is to design interventions that help expand capacity in these and other nations with deficits in neurosurgical care. However, Ukachukwu explained, the team must first understand the factors that are currently straining the system.
Using the World Health Organization’s health system building blocks — from research and technology to service delivery — team members are assessing the big-picture challenges facing these countries’ overloaded neurosurgeons.
Ukachukwu isn’t the only member of the team who can speak from experience. Several team members are medical students and practicing neurosurgeons at universities and hospitals in Nigeria, Uganda and the Democratic Republic of the Congo who are balancing the demands of operating theaters and half a day of time difference to participate on the team.
“You can be enclosed in your own institution and not know what’s happening outside it, let alone outside your country,” said Joseph Mary Ssembatya, a neurosurgery resident in Uganda. Physicians and researchers from diverse backgrounds have to work together in order to address systemic problems, like the shortage of medical professionals from neurosurgeons to nurses to anesthesiologists and more.
Olaoluwa Dada, a medical student in Nigeria, agreed: “The future of ensuring that the workforce gap is breached is collaboration.” Equitable partnerships must be “sustained and replicated” in global neurosurgery.
This philosophy is part of the project’s ethos. Team leader Anthony Fuller has led other Bass Connections teams that work closely with Mbarara University of Science and Technology and Mulago National Referral Hospital in Uganda, leveraging Duke’s existing partnerships with both institutions. This team, however, has expanded those connections in hopes of finding broadly applicable recommendations to support overburdened neurosurgical systems around the world.
“I think a lot of people, when they think about global health, still think about it in terms of infectious diseases and maternal and child health,” said team member Paula Njeru. “Those are all are very important, but there are also noncommunicable diseases and injuries related to neurosurgery. It’s really important for this to receive some recognition.”
Njeru became a doctor in Kenya, but wanted further research opportunities. So, like Ukachukwu, she entered Duke’s Master of Science in Global Health program. The work of Duke Global Neurosurgery and Neurology soon caught her attention, and she is now crafting her master’s thesis on global neurosurgery — all while mentoring undergraduates who are stepping into the field for the first time.
Duke sophomore Eugene Cho hopes to become a doctor herself one day. Like many premed students, she sought out research and clinical opportunities, but Bass Connections offered a unique entry point. “I wanted to work with these great mentors who have a vision for the future of global health,” she explained. At the same time, she is enjoying the chance to be step out on her own: “They create an outline of what is expected, but if you’re interested in something, you can pursue it and do the research yourself.”
Throughout the fall, team members painstakingly researched specific possible interventions, building toward neurosurgical development plans that are feasible for each country. The honing, implementation and assessment of those plans, however, constitute the exciting challenge ahead. “We are a new team,” Ukachukwu said, “but we have high hopes to impact not just the individuals in one country, but the systems in multiple countries.
“Go big or go home,” he added — spoken like a true one-in-1.6 million neurosurgeon.