The global burden of neurologic disease disproportionately impacts low- and middle-income countries. Nearly half the neurological burden from disability can be found in low-income countries alone. Despite the need for neurologic care, there is a paucity of available neurologists to provide it. For instance, in Africa, there is 1 neurologist for every 300,000 inhabitants. In 2011, the American Academy of Neurology (AAN) created a Global Health Section in order to provide better leadership and training to respond to this global challenge.
Neurologists from The Children’s Hospital of Philadelphia have been providing much needed neurology care to children living in world regions where such care would otherwise be nonexistent. Since 2006, the Division of Neurology has participated in the Botswana-UPenn Partnership, sending its physicians to the emerging southern African country. David Bearden, MD, attending physician at Children’s Hospital, had the opportunity to see this work firsthand when he visited there as a trainee. Now, he teaches medical students and residents in Botswana’s first and only medical school, provides clinical care, and conducts research focused on neurologic complications of HIV.
“There have been tremendous advances in medical care in Botswana over the last 10 years, thanks in part to the establishment of a medical school and residency training programs,” notes Bearden. “One of the great things about working in Botswana has been being a part of that change and helping to train the next generation of physicians who will care for children with neurologic disorders.”
Research studies in Africa
The collaboration has already started to produce significant results. Bearden and his local Botswana collaborators recently published one of the first studies of epilepsy in patients with HIV, and just completed one of the first studies of cerebral palsy outcomes in Africa. Their work highlights the novel challenges facing providers treating children with neurologic disorders in sub-Saharan Africa. Notably, children in Botswana with cerebral palsy had dramatically higher rates of cognitive impairment, epilepsy, and visual impairment relative to children with cerebral palsy in higher resource countries. The study simultaneously highlighted the need for physical therapy, adaptive medical equipment, and nutrition in this population.
This work also serves as inspiration for CHOP trainees. Current child neurology fellow Payal Patel, MD, has worked with Bearden in completing a qualitative study of health beliefs around cerebral palsy in Botswana. Current epilepsy and clinical neurophysiology fellow Douglas Smith, MD, has also had the opportunity to travel to Botswana and see firsthand the challenges facing the local medical community.
“The experience is transformative,” says Smith. “Without the technological barriers of modern medicine, treating a patient becomes a far more personal, humanistic experience.” With support from the division, both Smith and Patel later traveled to Karatu, Tanzania, to work in a remote, rural clinic. Another CHOP neurologist, Michael Rubenstein, MD, has worked for years with the Foundation for African Medicine and Education (FAME), a charitable medical clinic founded by an American anesthesiologist and his wife. For these trips, CHOP neurology trainees traveled to a location hours away from the nearest city to bring advanced neurologic care to the children who need it most.
Global high-quality neurologic care
Other CHOP neurologists have extended their reach internationally without leaving Philadelphia. Every other week, neurology fellow Ingo Helbig, MD, Smith, and pediatric neurologist Dennis Dlugos, MD, conference with geneticists and physicians in Germany, Israel, and Palestine to help diagnose hereditary forms of epilepsy in families from the West Bank.
None of this would be possible without support from the division. CHOP neurologists have worked to deliver high-quality neurologic care to all reaches of the globe, answering the call from third-world countries and from the AAN. For trainees in particular, the opportunity is incomparable.
“You wake up every day with the feeling that you will have the opportunity to make a profound difference in someone’s life,” says Smith. “It is the feeling I think everyone who goes to medical school hopes to one day experience.”