Assisted Education for Specialized Medicine: A Sustainable Development Plan for Neurosurgery in Myanmar Philippe Schucht 1 , Irena Zubak 1 , Dominique Kuhlen 2 , Janine Abu-Isa 1 , Michael Murek 1 , Andreas Raabe 1 , Zaw Wai Soe 3 , Kyawzwa Aung 4 , Aung Thu Soe Myint 5 , Myat Thu 6 - BACKGROUND: With only 4 active certified neurosur- geons for a population of 50 million, neurosurgical care was seriously underdeveloped in Myanmar in 2012. Together with the local neurosurgical community, Swiss Neurosurgeons International started a program of assisted education with the aim of increasing the neurosurgical capacity to 60 active neurosurgeons by 2023. - METHODS: Our program included a fully sponsored fellowship at an academic hospital in Switzerland for every Myanmar neurosurgeon in training to observe contemporary neurosurgery and the organization of regular workshops, lectures, and educational surgeries in Myanmar. Halfway through the program, we performed a survey to assess its benefits and shortcomings. - RESULTS: In 2019, the number of active neurosurgeons in Myanmar had increased to 20, with 50 more in training. Intracranial pressure monitoring, cervical spine surgery, transsphenoidal surgery, and intraoperative electrophysi- ology have become established procedures. Our survey showed an increased interest by the residents in tumor and vascular surgery and a new interest in spinal surgery. The overall rating of the fellowship was “very good,” with language barriers, cultural differences, and coping with inclement weather reported as the greatest difficulties. - CONCLUSIONS: Since the start of our project in 2013, a series of contemporary neurosurgical technologies and procedures have been introduced to Myanmar with the help of Swiss Neurosurgeons International. Our survey results have shown the strong points of the ongoing educational program and the weaknesses to be addressed. Midway through our 10-year project, with an expanded and improved education program, our goal of 60 active neuro- surgeons in Myanmar by 2023 seems well within reach. INTRODUCTION E fforts at increasing the healthcare capacity in low- and middle-income countries had long been neglected in the surgical domains, 1 until the Lancet Commission on Surgery estimated, in 2015, that 28%e32% of diseases worldwide will require surgical intervention. 2-4 At present, most of the world’s population has no access to safe and timely sur- gery, 5 and this lack of surgical capacity has been especially grave in neurosurgery. 2 According to the World Health Organization, traumatic brain injury is expected to become the third leading cause of death by 2030. 6,7 Most trauma patients in low- and middle-income countries will be young adults who experience impact injuries during traffic accidents, often involving head trauma. 8 Their lost contribution to their families and to the development of the society and the financial burden in the case of severe disability is great and warrants better prevention measures and improved neurosurgical care. Similarly, hydrocephalus, meningoceles, and benign brain tumors are relatively frequent conditions that can be curable with timely neurosurgical intervention. Recent investigations have shown that specialized surgery, including neurosurgical intervention, is Key words - Developmental help - Myanmar - Neurosurgical education Abbreviations and Acronyms OT : Operating theater SNI: Swiss Neurosurgeons International From the 1 Department of Neurosurgery, University Hospital Bern, Bern, Switzerland; 2 Department of Neurosurgery, Hospitale Cantonale, Lugano, Switzerland; 3 Rector, University of Medicine 1, Yangon, Myanmar; 4 Department of Neurosurgery, University of Medicine, Mandalay, Myanmar; 5 Department of Neurosurgery, Naypyitaw General Hospital, Naypyitaw, Myanmar; and 6 Department of Neurosurgery, Yangon General Hospital, Yangon, Myanmar To whom correspondence should be addressed: Philippe Schucht, M.D. [E-mail: philippe.schucht@insel.ch] Citation: World Neurosurg. (2019) 130:e854-e861. https://doi.org/10.1016/j.wneu.2019.07.018 Journal homepage: www.journals.elsevier.com/world-neurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Elsevier Inc. All rights reserved. e854 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.07.018 Original Article