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Neurology Tackles World Poverty — The Challenges and Opportunities

Valeo, Tom

doi: 10.1097/01.NT.0000298554.03660.da
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  • ✓As part of an international initiative to focus on health-care disparities around the world, Neurology published a special theme issue on the challenges of providing care to patients in Africa.

In sub-Saharan Africa, the health-care gap between rich and poor nations becomes a yawning abyss. Europeans have one specialist per 20,000 people, while sub-Saharan Africans have one per three million people.



Sixty-four percent of the world's new HIV infections occurred in sub-Saharan Africa last year, with neurological complications affecting 39- to 70-percent of patients. But only 9 percent of HIV patients in Africa receive retroviral therapy. And 80 percent of the estimated 10 million patients with epilepsy in sub-Saharan Africa receive no treatment at all.

Johan A. Aarli, MD, president of the World Federation of Neurology, along with his two co-authors, Amadou Gallo Diop, PhD, and Hanns Lochmueller, PhD, cite these and other facts in their introduction to a special section on poverty and health care that appears in the Oct. 23 Neurology.



They also announce that Dr. Aarli and Dr. Diop, of Senegal, will co-chair the Task and Advisory Force for Neurology in Africa (TAFNA). The committee will advise and support the WFN African Committee comprising African neurologists working and residing on the continent.

This special theme section of Neurology was published as part of an international initiative, sponsored by the Council of Science Editors — involving 230 other medical and scientific journals — to highlight the health-care disparities produced by world poverty.

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Why now? “I hope the Neurology initiative will contribute to putting Africa on the agenda,” Dr. Aarli told Neurology Today. “I hope it will systematize the efforts already made, and establish a roadmap for further work.”

He acknowledges that the road ahead is long and hard. “It will take a long time for Africa to reach a neurology service like that of the West,” he said, but that only “illustrates the importance of improving neurology education in Africa and establishing neurology as a public health problem. One purpose of this initiative is to increase professional and public awareness of the frequency, severity, and costs of neurological disorders.”

Neurology Editor-in-chief John H. Noseworthy, MD, acknowledged that the journal's efforts may seem insignificant compared to the enormity of the problem, but when asked to join other publications in this initiative, he didn't hesitate. “We should do this,” he said. “I thought issues like this ought to be brought to the awareness of our readers. I expect to be criticized by those who will say, ‘Why did you waste half your issue on something that doesn't help me understand neuroscience?’ But I believe that reminding our readers of global issues of this magnitude falls under the journal's mission. I thought it was the right thing to do, and I'm glad we did it.”

In his editorial in the issue, Dr. Noseworthy states that the articles selected for publication are intended “to stimulate interest in research leading to the alleviation of poverty and its consequences in the underdeveloped world… where the burden of neurologic disease is heavy.”

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Farrah J. Mateen, MD, puts the problem in focus with her article, “Neurology and Poverty,” which uses hard numbers to describe the depth of desperation in Africa. “Where neurologists are needed most, they are least likely to be found,” she writes. “Although the WHO (World Health Organization) estimates that one neurologist is needed for a population of 100,000 people in Africa, there are an estimated 0.3 neurologists per million. Eleven African countries have no neurologists.”

Not only that, physicians who practice in countries where neurologic care is most needed lack resources, educational opportunities, and health-care workers. And an estimated 20,000 physicians leave Africa each year to emigrate to countries that can provide greater resources and opportunities.



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The AAN could make a contribution to increasing neurological knowledge in less developed countries, according to John W. Henson, MD, and co-authors of “International science at the annual meeting of the American Academy of Neurology.”

They point out that one-third of the attendees at the AAN annual meeting come from outside of the U.S. and Canada, with nearly 75 percent of that contingent coming from Europe. Also, while North American membership in the AAN increased by 15 percent over the past five years, it declined by 3.7 percent among international members.

This, the authors believe, shows that greater efforts should be made to increase attendance from other parts of the world.

“The Academy is looking at increasing international participation in the annual meeting, particularly from Africa and Asian countries where participation relative to number of neurologists is low,” Dr. Henson told Neurology Today. “Fewer than 20 neurologists from India attended the 2007 annual meeting. Attending the convention poses challenges for these colleagues. If you're a neurologist in India you have to travel for a full day to and from the meeting, and the travel and accommodations are expensive. Relatively lower income levels for neurologists in some parts of the world further increase the barriers to attending the annual meeting.”

The AAN already offers 10 scholarships each year for international members to attend. Also, topics of interest to neurologists in other parts of the world might increase attendance. The 2008 annual meeting, for example, will include Tropical Neurology as part of the Integrated Neuroscience program, Dr. Henson noted. “Hopefully this will help attract international participants.”

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Other articles in the issue focus more on the experience of practicing neurology in other parts of the world. For example, Alyx Porter, MD, writes about the month that she and her husband, also a physician, spent working at the Maua Methodist Hospital in northern Kenya. Of the patients she encountered, about one-third had some sort of neurological problem, often unrecognized by the local physicians. She said diagnoses often were made more on the basis of probability than actual examination. A cough probably means tuberculosis, and is treated as such, she said; a headache, fever, stomachache, and diarrhea probably mean malaria. “This approach fared well most of the time due to the prevalence of these disorders,” Dr. Porter writes.

While resources were skimpy and the inability of patients to pay often led to overcrowding — patients are not released until their bill is paid — she found the physicians eager to learn. To bring about changes, “raising some awareness about the lack of resources in countries other than ours would be imperative,” she told Neurology Today. “Readers of this special issue should know that so many hospitals and other institutions in Africa could benefit from their old equipment and textbooks.”

What practical efforts can be made immediately? In his article on the Patient Page titled “The Neurology World is Flat,” David C. Spencer, MD, one of the editors of the poverty section, points out that the AAN, along with the Japan Neurological Society, already donate educational materials and training funds to Africa. Also, new programs are either planned or already in place to promote neurological treatment, for example, by sending U.S. neurologists to Zambia, by providing neurology guidebooks for non-physician health workers, and by organizing “neuro caravans” of neurologists who travel from large cities to remote regions to provide care and training.

Such efforts are desperately needed, according to Dr. Aarli, because neurological care in Africa is so far behind. “Epidemiological research has revealed that the impact of neurological disorders has been underestimated (in Africa),” he said. “Many U.S. and other non-African neurologists are already doing a great and sometimes self-sacrificing job in Africa today, and I hope the neurology world will be aware of their contribution and let it be part of an international campaign to develop neurology in sub-Saharan Africa.”

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• Noseworthy JH. Editor's note: Global issue. Neurology 2007; 69:1644.
    • Henson JW, Cascino GD, Post ME. International science at the annual meeting of the American Academy of Neurology. Neurology 2007; 69:1712–1714.
      • Porter A. A perspective on the practice of neurology in northern Kenya. Neurology 2007; 69:1719–1720.
        • Aarli JH, Diop AG, Lochmueller H. Neurology in sub-Saharan Africa: A challenge for World Federation of Neurology. Neurology 2007; 69:1715–1718.
          • Mateen FJ. Neurology and poverty. Neurology 2007;69:1724–1726.
            • Spencer DC. Patient Page: The neurology world is flat. Neurology 2007;69:E16.
              ©2007 American Academy of Neurology