Leading WFNS to a New Age - Education and Social Responsibility

Interview with Prof. Franco Servadei, new WFNS President, by the occasion of his participation in the 2017 International Meeting of Neurosurgical Societies, in Buenos Aires, Argentina.
By Journalist Federico Wals

What does it mean to lead the world's largest representative body of neurosurgery, with almost 50,000 neurosurgeons?
There are about fifty thousand neurosurgeons in the world. Unfortunately, the distribution of the neurosurgeons is not equal. For instance, we have less than 500 in North Africa, 10,000 in Europe, 5,000 in North America and about 9,000 in South America. So there are not enough neurosurgeons in South/East Asia, or in Africa.

There has been a recent report from the World Health Organization (WHO). Until now, the WHO targeted infectious diseases, such as AIDs or malaria.  Now the WHO has added a new target. The Organization realized that there are millions of surgeries that are not performed in many parts of the world, and that people are dying because of this lack of surgery even more than because of infectious diseases. The new target, then, is to provide surgery in those parts of the world where surgery is not available. Those parts are also some countries of South America and Central America, and neurosurgery is surely involved.  Out of thirty major surgeries - for instance, abdominal surgery, thoracic surgery - three are surgeries for the brain: trauma (brain injury), ischemia/hemorrhage (vascular injury), and hydrocephalus. These are three surgeries – performed by neurosurgeons - are essential priorities  of the WHO.

The worldwide view is that the number of neurosurgeons is uneven: there are countries that have a higher concentration of neurosurgeons (such as Japan, Europe, USA) and there are countries like those in South/East Asia and Africa that do not have enough neurosurgeons. Therefore msny essential neurosurgical procedures are not performed because of this lack of neurosurgeons.

What are the goals which you intend to achieve in your management?
The main problem to solve is education, so the main goals are three. The first goal is to add more centers linked to the World Federation of Neurosurgical Societies (WFNS) for training young neurosurgeons in the countries that need them. The second goal is to offer courses for education in those needed areas, like they are doing in the Latin American Federation of Neurosurgical Societies (FLANC). They are doing courses, for instance, in Bolivia, Ecuador, Venezuela, and the countries of Central America. The third goal is to develop Internet (digital) education.

Are those courses organized by their governments?
Sometimes they are, sometimes they are not. Usually, not. The scientific support is almost always there, but the economic support is not always there, so we have to do it with our resources.

WFNS has recently made some changes to its statements. What was their purpose?
WFNS was founded in 1957 by only thirteen countries, among which was my country, Italy. The structure of the WFNS has now been present for more than sixty years, so changes were obviously needed.

One change was to reduce the mandate of the officers from four years to two years, so now those who are in the committee will be elected only for two years; then, they can be reelected (but not the president). We found that the period of four years was too long.

Another change is that we had a nominating committee, which in the past nominated the official candidates. This system was not democratic even if non official candidates were allowed to run from the floor.  Now, everybody (in regular relation with its society and the WFNS) will be allowed to run and to be voted on. There will be no more official nominations.

We have restructured the foundation, which is the non-profit organization of the WFNS. Some of its activities are to send surgical instruments to countries in need, to pay for young neurosurgeons to be trained, and so on. It is all about how we spend our money. We get some money from our society and some from the congresses, but we spend the money through the foundation for education and for instruments that we donate to countries in need.

What do you expect from continental federations affiliated to WFNS?
The FLANC is an example of very good collaboration with the WFNS. There is very good interaction in education and in having more positions for education in different places, and in a common track of education. So, the continental organizations should help us in education and tell us their specific needs, which are different in every country/continent.

So we can say that the education of young neurosurgeons, especially in the neediest regions, is a priority.
Of course, as I explained, it is a priority in three ways: education in structures (training and so on), education in courses - including cadaver labs - and education via the Internet.

Education is needed, especially in the areas of more poverty.
Yes, and neurosurgeons can also move to be educated in countries with more facilities. Either we go there, or they can come to us.

What is the importance of the digital era, such as virtual communication media, to provide assistance in long-distance neurosurgery?
The Internet is extremely important. We have different methods for Internet education - in the Internet you just have everything. The main education is through videos - because of course, we are surgeons. We also have media support courses, like webinars. Finally, there is a new education method that is coming right now: virtual education via the Internet. By virtual education you have the possibility to access surgical approaches through a telephone. These methods make everything easier. You can go everywhere; they can be used in the middle of nowhere. There is a limit to Internet education, which is the absence of control of the scientific content.

What are the institution's sources of income? How to increase them?
The general finance situation is not entirely good. We receive the money from our societies - they have to pay per neurosurgeon.

So, it is a not a problem of money.
The main sources of income of the World Federation are the fees from the societies and the revenues from the congresses. For instance, two years ago, I organized - together with other colleagues - the World Federation Interim meeting in Rome, and we sent 150,000 euros - at that time, 180,000 dollars - to the World Federation, as revenue of the Congress. So, at the moment, those are the two main sources of income. We need also contributions or donations either from medical companies, other companies, and private persons to support these programs. We have received private donations but we need definitively to increase these revenues.

What message would you give to your fellow neurosurgeons from all over the world?

We are strongly in favor of putting our organization into the future, so we are using new devices such as the Internet. We are moving an organization which was in some ways too bureaucratic into a new era: new faces, new people coming, new people ruling, and new targets.  It does not mean that we do not respect our predecessors and the tremendous work they have done but we simply continue their work in a different and updated way.

We have two scheduled meetings in Beijing (2019) and in Colombia (2021) where we expect massive participation by neurosurgeon members of affiliate societies worldwide.

August 2022