Advancing Excellence in Neurosurgical and Neurological Care
Trauma and stroke are among the leading causes of death in both Bolivia and Paraguay. And a lack of access to neurosurgery contributes to the death toll. Neurosurgeon José Kuzli, our partner in Paraguay, recently shared an illustrative example. Speaking to us through Zoom, he told the story of a young man who suffered a subarachnoid hemorrhage and had to travel many kilometers to the public hospital on the outskirts of Asunción for emergency care. Dr. Kuzli met with the patient and diagnosed the hemorrhage. However, due to limited access to angiogram imaging and aneurysm clips, it took nearly two weeks to prepare the patient for surgery. Sadly, during that two-week delay he suffered a new bleed, went into a coma, and became inoperable. With greater access to supplies and equipment the hospital could have intervened earlier to save the patient’s life.
We are committed to alleviating the suffering, death and disability from neurological disorders and injuries that disproportionately impact patients in the countries where we serve. To advance our efforts in this specialty, we are inaugurating a new Neurosurgery and Neurology Institute (NNI). The NNI, a program of Solidarity Bridge, will house multiple initiatives in research, education, resource mobilization, and service—all for the benefit of patients and practitioners in South America.
In Asunción alone, hundreds of neurosurgical patients are turned away each year because of an inability to access essential supplies. One goal of the NNI is to address these disparities through collaborative strategies for sustainable resource mobilization. Within the past year, Solidarity Bridge coordinated the shipment of two containers of supplies to Dr. Kuzli’s hospital in Paraguay. Through the NNI, we will continue working to open new channels for affordable neurosurgical supplies that contribute to life-saving care.
There is also a clear role for the NNI to help narrow the gaps in subspecialty training. Many of our partners in Bolivia and Paraguay are highly trained in neurosurgery, but are seeking the advanced training and expertise needed to manage certain complex cases. For example, Dr. Kuzli shared stories of patients with brain arteriovenous malformations in need of surgical intervention from a cerebral vascular neurosurgeon. In December of this year, the NNI will respond to this need by sending a small delegation of subspecialists to assist in mentored surgeries with our Paraguayan colleagues. In the coming year, the NNI plans to co-host a formal conference in Paraguay with a focus on cerebral vascular surgery. These advanced training programs aim to enhance surgical competency, enabling local surgeons to perform complex, cerebral vascular procedures.
In the area of research, we are often reminded that “if you don’t measure it, you can’t improve it.” In collaboration with the Global Health Research Group on Neurotrauma, the World Federation of Neurosurgical Societies (WFNS), and Bolivian and Paraguayan Neurosurgical Societies, the NNI will implement neurotrauma registries to map the pre-hospital, acute in-hospital, and post-acute care of patients with traumatic brain injuries (TBI). The data collected will support long-term local and global efforts to improve care for TBI patients.
To contribute to residency education, the NNI seeks to establish surgical skill training centers that will be the first of their kind in either country. Currently, surgical residents must travel to other countries, at great expense, to access micro-surgical training. It is imperative to patient safety that residents demonstrate proficiency in surgical and technical skills prior to operating on a living patient. This initiative will establish much-needed simulation environments for residents to develop, refine, and demonstrate their surgical and technical skills. The NNI will work in partnership with the national Neurosurgical Societies to build the training centers and contribute to the development and implementation of training curricula.
The NNI will also work to advance neurological education. This fall, our efforts focused on training for pediatricians who encounter epileptic patients in their clinics. Close to fifty Bolivian pediatricians and neurologists have logged on each month for trainings led by U.S. pediatric neurologists. The participants are receiving continuing education credit from the Bolivian medical college and will be able to better serve pediatric patients throughout the country.
Finally, a central goal of the institute is to create “pathways to care” for patients with limited resources. Patients face many barriers in accessing the neurosurgical care they need. Through a network of local surgeons and institutions who share our mission, we will provide low-to-no cost operations for a number of patients each year. In this way, the NNI and our partners will strive to serve the neglected surgical patient in the same spirit of solidarity that inspires all the work of Solidarity Bridge.
All NNI activities are developed and implemented with oversight from an international Leadership Council. This new institutional structure marks a significant advancement of our Neurosurgery Program and will provide better-coordinated service, expanded research opportunities, and strengthened international linkages with professional societies and academic institutions—all for the betterment of patients and medical practitioners.
Dr. Kuzli (right) stands with his colleagues, recieving a shipment of supplies earlier this year.
Leadership Council
Martin Aliaga, MD
Hospital Obrero de la Caja Nacional and Clínica CEMES, La Paz
Jared Ament, MD, MPH
Cedars-Sinai Marina Del Rey Hospital, California
Carlos Dabdoub, MD
Universidad Franz Tamayo, Santa Cruz
Robert Dempsey, MD
University of Wisconsin School of Medicine and Public Health
Art DiPatri, MD
Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine
Kurt Florian, JD
Epilepsy Foundation of Greater Chicago (former)
Juan-Lorenzo Hinojosa, Ph.D
Solidarity Bridge/Puente de Solidaridad
Jose Kuzli, MD
Hospital Nacional de Itauguá, Paraguay
Barbara Lazio, MD
Providence, St. Peter Hospital
Jeff Loeb, MD
University of Illinois at Chicago
Pablo Maidana, MD
Hospital Nacional de Itauguá, Paraguay
Ann Rhomberg, MSW
Solidarity Bridge
Gueider Salas, MD
Caja Petrolera de Salud and Clínica Foianini
Patricia Vargas Rojas, M.Ed
Puente de Solidaridad
Ramiro Villavincencio, MD
Caja Petrolera de Salud and Clínica Incor
John Weaver, MD
Penn State Health St. Joseph
Richard Moser, MD
UMass Memorial Medical Center