The Twinning programs for the Residents in the C – CNS – ECSAR Reference Training Site

The Twinning programs for the Residents in the C CNS ECSAR Reference Training Site

Mahmood Qureshi, Coordinator of the Program in the ECSA region

The Consortium of Collaborative Sites of Neurosurgical Training in the East, Central and Southern African region (C – CNS - ECSAR) has become a very prominent training initiative within the ECSA region. The training Consortium includes Sites accredited by the Regional College of Surgeons of East, Central and Southern Africa (COSECSA).

The Neurosurgical Training program, initiated in 2006, gained accreditation as a WFNS Reference Training Site (Anglophone Region of Africa) in 2012 and “has emerged as a leader in the effort to train neurosurgeons and is anticipated to dramatically improve on the markedly unmet need for neurosurgical care in Sub – Saharan Africa.” (April 2020 issue of World Neurosurgery Vol. 136, pg. 172 - 177).

The Twinning Sites in the regional program have provided the trainees with opportunities to visit institutions in Bergen (for trainees in the Ethiopian part of the program, Addis Ababa University) as well as other international sites.

The Hinduja Teaching Hospital in Mumbai has afforded a valuable academic and hands – on clinical experience during the 3-month rotation in the Trainees senior years, under the supervision of Prof. Basant Misra.

Another very well conducted Twinning rotation in Spain, under Prof Jose Piquer in Valencia and Dr. Pablo Gonzales in Alicante, has provided training through academic sessions, tutorials, clinical hands-on experience as well as vital skills training in the cadaveric labs at these Twinning Sites. Both Prof Jose Piquer and Pablo Gonzales also regularly visit the local Collaborative Site in Zanzibar and hold training sessions during formal teaching symposia, conducted at the Mnazi Mmoja / Neurosurgical Education and Development (NED) Institute, a dedicated neurosurgical hospital in Zanzibar which has evolved into a well-regarded COSECSA accredited training site of the program. The trainees benefit greatly from these associations.

To date at least 15 trainees have spent time in either Bergen, Mumbai, or Valencia/Alicante – typically for 3 months.

However, as would be expected, challenges remain. This is primarily because the Twinning arrangements are largely dependent on the personal initiatives of the faculty involved. A formal arrangement through an Memorandum of Understanding (MOU) between the College and the institutions abroad is lacking. This results in inconsistent rotations at these Twinning Sites. The participating faculty have thus far helped cover the costs of accommodation and meals for the visiting Trainees. Whilst laudable, it is a fragile arrangement without guarantees of continuity. Funding to support the program is currently lacking, and would be critical to ensure its continuity and its success over time. Funding would also enhance a formal Traveling Faculty Program, and enable a diverse group of Faculty to be invited to participate in the program.

The local program organizer, Mahmood Qureshi, is essentially a volunteer, providing direction and promotion of the Twinning exercise, since its inception. A formal MOU, along with a dedicated budget (through support of international organizations such as the G4 Alliance etc), would allow a longer-term structure to be developed. Currently 4 trainees receive a WFNS Foundation scholarship during their training. Several more continue to seek assistance from the Foundation. Hopefully, funding will increase to allow the WFNS Foundation to meet this expectation.

That said, the Twinning experience has provided an excellent opportunity for trainees in the program to benefit and develop during their Fellowship period of training.

In summary: every effort should be made to devise a sustainable Twinning Program in the ECSA region.

August 2022