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Letters to the Editor


Advocacy and training to improve neurological care in developing regions are greatly needed, as noted by Drs. Ana-Claire Meyer, Gretchen Birbeck, and Nirali Vora in “Countering Global Neurological Burden Will Take Advocacy, Training” (November 17; This is unquestionably a critical issue since neurological diseases and disorders represent one of the greatest threats to public health, and have reached devastating levels in many countries, especially the least developed nations.

The unprecedented growth of global health programs at United States academic medical centers would seemingly set the stage for improving advocacy and training, but many of these programs focus on brief self-serving medical missions, which fail to provide any substantive benefit to the host nation and, in fact, can and do cause actual harm. Additionally, the developing nations have inherently vulnerable populations that are at risk of intentional and unintentional exploitation by these types of missions.

For example, it is imperative to ensure that visiting physicians do not extract research data without local approval or engage in activities that may violate the World Health Organization Constitution or any other applicable statement on health and human rights, including international and national guidelines, proclamations, decrees, and regulations.

The proper approach, as mentioned by Drs. Birbeck and Vora, is to work closely with the local community in the targeted area and focus on educating and training local providers. In fact, the single most effective method of combating the increasing burden of neurological disease is to substantially increase the recruitment, development, training and retention of medical staff in developing regions. This mandates establishing stable, long-term collaborative partnerships with the goal of forming local training programs. This type of capacity development is absolutely essential in order to advance local health care, expand medical services, promote teaching, further research and direct proper management of funding, equipment and medications to meet regional needs.

Global NeuroCare supports this approach in Ethiopia, where I have had the privilege of working with the Addis Ababa University Neurology Residency Training Program over the past decade. This well established autonomous program is an extraordinary success by any measure, having graduated 24 board-certified neurologists that are delivering care to many thousands of patients. More importantly, in a nation of 100 million people, they are teaching general physicians and health extension providers how to diagnose and manage common neurological conditions such as stroke, epilepsy, and dementia.

Several graduates have established neurology sections or departments in outlying university medical schools, spreading neurological care and teaching into rural areas where the majority of people live. In a striking example of cooperation, the program also trains residents from other African nations, thereby expanding neurological services far beyond Ethiopia. This Ethiopian program may serve as a prototype for other developing regions, and is a timely reminder that the only way to ensure sustainable growth of neurological care is to ethically promote collaborative partnership development with the long-term goal of instilling self sufficiency in the developing regions. Dr. Birbeck's description of the Zambian program suggests it is following this same path, and we commend Dr. Siddiqi and his colleagues on their efforts.

James C. Johnston, MD, JD

Director, Global NeuroCare

Seattle, WA, USA