RESUMO
BACKGROUND: Surgical conditions account for as much as one third of the global burden of disease, yet 5 billion people worldwide do not have access to timely, affordable surgical care. These disparities in access to timely surgical care are most pronounced in low- and middle-income countries, where the availability of specialty surgical services such as neurosurgery are severely limited or completely absent. The African autonomous region of Somaliland, in the Horn of Africa, is one such region. METHODS: Discussions were conducted with key individuals in Somaliland to ascertain the current state of neurosurgery in Somaliland. RESULTS: The current state of neurosurgery in Somaliland was characterized. First, a background on the recent history of the republic and the surrounding region was furnished, which provides context for the challenging socioeconomic conditions in Somaliland. Brief biographical sketches were presented of local leaders and general surgeons who are actively working to improve economic and health conditions and who welcome opportunities to improve all health services, including neurosurgery. In addition, an overview was presented of new initiatives in capacity building in neurosurgery and sources of directed training and care in neurosurgery. CONCLUSIONS: This article provides the first-ever assessment of current neurosurgery-related activity in Somaliland. The article provides recommendations to guide the international neurosurgery community in future contributions.
Assuntos
Países em Desenvolvimento , Neurocirurgia , Djibuti , HumanosRESUMO
Dr. Joseph Murray has inspired me, among many others, to develop medical and surgical care through thoughtful research and to see that the benefits achieved are applied to human needs in a greater global perspective. In active encouragement of his protégées, he has stimulated innovation not only in academic centers and in specialty fields such as transplantation and craniofacial reconstruction, but also in wide-scale benefit to all peoples in need, passing hope along through transformational learning and indigenizing health care skills. In an example from one such protégée, a career in academic surgical pursuit of learning beyond boundaries is illustrated in going from the Brigham to the bush, learning from those who may never have been in a schoolroom, and from our "mission to heal" carrying back "Gifts From the Poor."
Assuntos
Pesquisa Biomédica/história , Anormalidades Craniofaciais/cirurgia , Saúde Global , Transplante de Órgãos/história , Cirurgia Plástica/história , Boston , História do Século XX , História do Século XXI , Humanos , Prêmio Nobel , Estados UnidosAssuntos
Doença das Coronárias/etiologia , Distúrbios Nutricionais/epidemiologia , África Subsaariana/epidemiologia , Comorbidade , Doença das Coronárias/genética , Humanos , Distúrbios Nutricionais/complicações , Distúrbios Nutricionais/mortalidade , Fatores de Risco , Fatores Socioeconômicos , InaniçãoRESUMO
A fossa da supra-renal tem sido alvo de poucos estudos clinicos e e uma area onde, quando nao ha disturbios nas funçoes dos orgaos adjacentes, lesoes de grande tamanho podem ficar muito tempo sem serem detectadas. A menos que haja suspeita de um tumor da supra-renal, devido a informaçoes bioquimicas ou por um exama clinico, seu diagnostico prematuro era, ate ha pouco tempo, uma exceçao, e sua localizaçao requeria tecnicas invasivas. Com o advento das tecnicas radiologicas e sonagraficas computadorizadas nao-invasivas, os cirurgioes tem, agora, o problema inverso, ou seja, um diagnostico prematuro de uma massa assintomatica da supra-renal. Para que os incidentalomas da supra-renal sejam considerados neoplasias, tecnicas semelhantes as que sao empregadas para as massas tiroideanas devem ser empregadas, ao inves de uma indicaçao rotineira de cirurgia. Uma correlaçao direta entrwe o estudo das imagens e o estudo clinico de alteraçoes anteriormente descobertas no paciente e necessario antes que uma operaçao seja indicada para os casos de incidentalomas da supra-renal
