Hopkins doctor sets up neurology department and training programs in Zambia


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On September 8, Dr Deanna Saylor, a specialist from the School of Medicine in Neuro-infectious Diseases and Neuroimmunology, gave a presentation on the establishment of inpatient services and training programs in Zambia.

“Neurological disorders are the leading cause of disability-adjusted life years worldwide and the second leading cause of death worldwide,” she said.

Saylor stressed that it is important to consider that this burden is not evenly distributed.

“75% of the global burden of neurological diseases is in low- and middle-income countries, but those same countries have the smallest neurological workforce to work on these disorders,” she said. “While in high-income countries there are more than five neurologists per 100,000 people, in low-income countries like Zambia that number drops to 0.1 per 100,000 people.”

Further exacerbating this disparity, the neurological burden of disease is expected to increase exponentially over the next decade, and more so in low- and middle-income countries. Additionally, Saylor explained that there are very few neurological training programs in places like sub-Saharan Africa. As a result, there is no significant increase in the number of neurologists per population.

In 2018, Saylor joined the University Hospital (UTH) in Lusaka, Zambia. It is a large hospital, with 1,655 beds compared to 1,162 at Hopkins Hospital. It is the main teaching hospital in Zambia and the national referral hospital in Zambia. However, by the time Saylor joined the hospital, the hospital did not have a designated neurology unit and all neurological cases were being treated in the internal medicine department.

While at UTH, Saylor met Dr. Aparna Nutakki, then a fourth-year medical student at Rush University in Chicago, who spent a year and a half working with Saylor in the Neurological Patient Registry. hospitalized. There, they conducted a comprehensive clinical registry, carried out over six months.

In the clinical study, they found that their department had recorded 749 admissions, or about 125 admissions per month, and that 43% of their admissions were stroke cases. They also found that patients admitted to hospital were generally near the end of stroke.

“Almost a quarter of stroke patients die in hospital, almost 20% of non-stroke patients die, and the most common non-stroke patients were seizures,” Saylor said. “Not only do we have a high stroke burden, but we have a higher percentage of patients with hemorrhagic stroke … so their outcomes are significantly worse.”

There are two main types of stroke to consider when a patient is admitted for a stroke: hemorrhagic or ischemic. Generally, patients with hemorrhagic stroke are more likely to face mortality. Because uncontrolled hypertension is one of the major risk factors for hemorrhagic stroke and is more prevalent among low-income populations, patients in Zambia were much more likely to have hemorrhagic stroke than ‘ischemic stroke.

While in 2018, the UTH did not have a designated neurology unit, it had all the basic tools needed to care for patients, including computed tomography (CT), magnetic resonance imaging (MRI). , electroencephalography (EEG), electromyography (EMG) and lumbar punctures. Since 2018, Saylor has spent his time building a neurology training in Zambia.

At UTH, Saylor managed eight wards and took responsibility for training new residents. She designed her own program from scratch without any preconceived notions. His hope was to blend traditional Zambian training with training that is more prevalent in the United States.

As Saylor describes, didactic training in Zambia is generally heavily protected. However, in the United States, she found that her didactic training was often interrupted and unprotected. On the other hand, the American medical program places more emphasis on clinical care.

In addition to providing training, Saylor also hoped to create an academic and research focus within his program.

“I wanted our residents to have the resources to develop their own locally relevant data that would inform how they care for patients, their policies and advocacy with the Department of Health and… enable [them] to develop an evidence-based care system, ”she said.

Saylor’s proudest moment in his career was when the first group of interns graduated a year ago. She aspires to become obsolete by training other people to take over the program and lean on themselves locally.

Although Saylor has accomplished a lot since 2018, she still has many future aspirations, including the development of teleneurology services, a developing tele-EEG service in provincial hospitals, and the development of a suitable stroke center. in low-resource settings.

In addition to clinical innovations, Saylor hopes to inspire various training innovations, including a virtual curriculum offered throughout the region, objective structured clinical exams recorded on video, formal program evaluations and a curriculum of study. neurology overhauled.

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Norma A. Roth