Neurosurgery in Papua New Guinea Jeffrey V Rosenfeld MBBS FRACS FRCS(Ed) MS(Melb)* David A K W a t t e r s ChM FRCS(Ed) t Department of Neurosurgery*, The Melbourne Neuroscience Centre, Royal Melbourne Hospital. Department of Surgery t, University of Papua New Guinea Journal of Clinical Neuroscience 1995, 2 (2) :118-120 © Pearson Professional (Australia) Pty Ltd Keywords: Papua New Guinea, Developing country, Tropics, Neurosurgery, Health care resources, Postgraduate training T h e war torn or famine stricken u n d e r d e v e l o p e d countries such as Somalia, Ethiopia and Rwanda clearly have very basic health care needs. Primary and preventive strategies should be the priority. However, in politically stable developing countries such as Papua New Guinea where food supplies are available and primary health care services and infrastructure are developed, there is a need for adequately resourced and staffed secondary and tertiary health care facilities. The World Bank report emphasises primary and preventive health care to the exclusion of specialist services.1 It is a fallacy to argue that these services are unaffordable luxuries. Many lives can be saved and much crippling morbidity prevented by the provision of surgicalservices. This no less applies to neurosurgery. Unfortunately, this is not the intention or priority of many of the governments of the developing world, the World Bank or the World Health Organization. Papua New Guinea (PNG) is a developing country of 4 000 000 people to which Australia contributes significant aid. The medical and surgical diseases encountered are similar in type and distribution to other developing countries in the tropics. 2 However, as the Western lifestyle is adopted, standards of living improve, rapid urban development ensues and life expectancy increases, the i n c i d e n c e of cancer, 3'4 diabetes, 5 h y p e r t e n s i o n , 6 cardiovascular and cerebrovascular disease, 7 urban violence and road trauma, s will increase significantly, and with these trends the need for neurosurgical services will become overwhelming. There is no neurosurgeon or computerised tomographic scanner (CT) in PNG. This is clearly an unacceptable situation, when it is recognised that the ratio of neurosurgeons per head of population is one or more per 200 000 in many developed countries. W h a t needs to be d o n e - - b y w h o m ? The c o m m o n neurosurgical problems encountered in PNG are trauma to the head and spine, infections of the CNS, particularly tuberculosis (TB) and cryptococcosis, cerebral mass lesions, and congenital problems such as h y d r o c e p h a l u s , sincipital e n c e p h a l o c e l e , spinal dysraphism and tethered cord. Over 2 two-week periods in 1992 and 1993, a visiting n e u r o s u r g e o n (JVR) e n c o u n t e r e d 82 neurosurgical patients. 55 (67.1%) were consultations, 23 (28%) had elective surgery, 4 (4.8%) had emergency surgery and 16 (19.5%) cases were awaiting surgery. The cases consisted of 9 major groupings: neurotrauma 18 (7 severe), spine 18, congenital 13, hydrocephalus 4, scalp, skull, orbit 6, vascular 2, peripheral nerve 3, and neurology 5. Thus, there is plenty of potential work for a neurosurgeon in PNG. The general surgeons are able to cope with many acute neurosurgical problems provided they have received at least some relevant training and experience which is provided in the four year general surgical training p r o g r a m m e (MMed). T h e m a n a g e m e n t of raised intracranial pressure is difficult without the benefit of CT, but it is still possible to adequately diagnose and treat these patients in PNG and other developing countries. 9 At present, clinical localisation of cerebral mass lesions supplemented with ventriculography, encephalography or cerebral angiography p e r f o r m e d with cut films and a manual changer must suffice. However, these investiga- tions are not usually performed because of the general unavailability of craniotomy. The successful management of head injury by general surgeons has recently been reported from Malaysia 1° and in Central Africa. 11 The isolated general surgeon may repair selected ethmoidal encephaloceles transfacially and avoid craniotomy. 19 The general surgeon may also be technically competent to correct extradural spinal cord c o m p r e s s i o n , spinal TB, h y d r o c e p h a l u s , myelo- meningocele, or drain an intracranial epidural abscess secondary to sinus infection, but will require extensive experience and judgement to comprehensively manage these more challenging problems. 118 J. Clin. Neuroscience Volume 2 Number 2 April 1995