Neurosurgery in Papua New Guinea: quo vadis?

The key health priorities for Papua New Guinea (PNG) are to alleviate poverty, improve nutrition, ensure safe drinking water and sanitation, prevent and treat infectious diseases such as malaria, pneumonia, gastroenteritis, tuberculosis and HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome), reduce infant and maternal mortality, and reduce the disability and death arising from trauma, cardiovascular disease and diabetes. Despite these overwhelming priorities, surgical services are also essential. Most surgery in PNG is performed by general and gynaecological surgeons or by rural medical officers. Since Independence over 70 national surgeons have been trained in PNG to Master of Medicine (MMed) level. These now include specialist surgeons in otolaryngology, ophthalmology, urology, paediatric surgery, head and neck surgery, oral and maxillofacial surgery and, since 2004, the first in neurosurgery (1). Neurosurgery may seem an esoteric technology-hungry, highly expensive luxury only needed by a few people and therefore of little value to the developing world including PNG because there are other more urgent health priorities. Even some doctors and public health administrators who reside and work in developing counties or who are involved in international health organizations are of this view. However, a ratio of one neurosurgeon to 200,000 population is the recommended requirement for neurosurgical services (2). Although most developing countries do not come close to this ratio, PNG with a population of 5.7 million has one neurosurgeon, which is clearly far below this ratio. More neurosurgeons will certainly be needed in the future but all within the context of a specialist workforce plan. The common neurosurgery problems encountered in PNG are trauma to the head and spine, central nervous system (CNS) infection such as brain abscess, and congenital disorders such as hydrocephalus, spinal dysraphism and encephalocele (3,4). General surgeons with the appropriate training, but using basic equipment and resources, can treat most of these neurosurgery problems with acceptable morbidity and mortality. Less common neurosurgical conditions require the expertise of a neurosurgeon and include cerebral and spinal tumours, aneurysmal subarachnoid haemorrhage, hypertensive intracerebral haemorrhage, cerebral vascular malformations, subdural empyema, spinal tuberculosis, syringomyelia, cerebellar ectopia, diseases of the skull, peripheral nerve disorders, and a myriad of other neurosurgical problems. Surgery for epilepsy is well developed in many specialized neurosurgery centres including developing countries such as India and Pakistan (5-7). Neurosurgeons from Australia sent by the Tertiary Health Services Programme of AusAID and the Royal Australasian College of Surgeons have been regularly visiting and supporting …