Letter to the Editor Regarding “What's in a Name? ‘Global Neurosurgery’ in the 21st Century”

Abstract

Andrews, 1 in this interesting article, has presented an overview of concepts in global neurosurgery. The author presented an overview of articles on global neurosurgery that aimed to strengthen neurosurgery in countries with limited resources. Why making a community dedicated to global neurosurgery is beneficial can be understood through the benefits of the Lancet Commission on Global Surgery. 2 , 3 In this context, Ed Benzel 4 had engagingly penned his ideas for global neurosurgery in an editorial in 2018 and focused on methods to resolve the crisis of neurosurgery availability in countries with facility constraints. Similarly, Servadei et al. 5 had also explored and provided a detailed account of the challenges faced by neurosurgery in resource-limited settings. These studies are indicative of comprehensive efforts of the world neurosurgery leadership and community to improve neurosurgical services worldwide. The objective at the core of the article by Andrews 1 was to determined what factors makes global neurosurgery truly global? The specialty will have assumed a truly global role when well-established institutes and centers have adopted methods to help healthcare providers and hospitals in need to develop the specialty for the underserved population. Similar to the United Nations Educational, Scientific, and Cultural Organization, the World Health Organization also plays a global role because of its policies to maintain similar standards across the world and support the needy population. We appreciate the perspective presented in the initial paragraphs of the article by Andrews 1 in which arguments in favor of the presence of global neurosurgery in the early 20th and 21st century were presented. However, the argument presented by the author that neurosurgeons-in-training traveling outside their home country is a form of global neurosurgery is not entirely true. This is because not all in-training neurosurgeons have access to these programs; therefore, the programs are not global in a literal sense. We also do not completely agree with author's perspective that “if it looks like global neurosurgery, acts like global neurosurgery, and calls itself global neurosurgery—then it is global neurosurgery.” 1 The evolution of neurosurgery as a separate specialty would be a perfect analogy to understand the phenomenon of the emergence of global neurosurgery in recent reports. Several studies have been reported on trephination of the skull in the bronze age. 6 Although it was a neurological procedure in terms of the currently accepted definitions of neurosurgery, such a trephination procedure was not considered neurosurgery in that age. 6 Similarly, the development of global neurosurgery is a stage in the evolution of the neurosurgical specialty, such that the focus has shifted from individual learning to collective teaching the skills to the population at large. The work by various dedicated groups such as the Foundation for International Education in Neurological Surgery, Neurosurgery Outreach Foundation, World Federation of Neurosurgical Societies, and so forth, throughout the decades is a commendable, thankful, and highly appreciated effort. However, as stated by Henry Ford, “Coming together is a beginning, staying together is progress, and working together is a success,” the coordination of these organizations will pave the way forward for global neurosurgery and its success in the true sense. The neurosurgical community can progress and succeed by being together, and we hope that global neurosurgery will make a positive contribution to this success. We completely agree with the author that the term “global neurosurgery” is to improve neurosurgery for all on a global scale and that technical developments, high-volume data, and so forth cannot replace the one-to-one communication between a patient and healthcare provider. However, we believe that this will widen the perspective, increase confidence among patient and doctors, and help in delivering safe and improved neurosurgical services. The efforts of global neurosurgery have highlighted the burden of neurological diseases and limited resources in low- and middle-income country groups. 7 , 8 Davis et al. 9 reported a 35.3% response rate in an assessment of the status of global pediatric neurosurgery outreach and concluded that coordinated efforts are essential to identify the barriers of success. More studies on the outcomes of the measures adopted by global neurosurgery from limited-resource countries will help formulate future strategies. Similarly, stakeholders, neurosurgeons, and the community at large will identify key problems and lay forth actionable solutions for the development of neurosurgery in these areas. It is, indeed, a matter of pride that neurosurgeons from developed regions are collaborating to spread the benefits of neurosurgery to their brothers and sisters of underserved areas. We welcome such a move by the neurosurgical community to commit to the growth of global neurosurgery where global developments have preceded regional excellence. We anticipate that this is the time when we can think beyond “global neurosurgery” in the 21st century to further expand the concept to “globalizing neurosurgery” in the 21st century. 1