Training the Next Generation of Neuro Specialists
Medicine is advancing every day, but unfortunately, many innovations are slow to make their way around the globe and improve treatment options for all who need care. The doctors we work with are driven to share knowledge and make scientific advancements accessible everywhere. In partnership with such committed doctors and donors, our Neurosurgery & Neurology Institute (NNI) is bringing the latest innovations in the field of microsurgery to hospitals in Paraguay eager to advance care for patients from across the country.
The roots of microsurgery go back a century. A microscope was first used in modern surgery in 1921 when Swedish Otologist Carl-Oloff Nylén started to employ it in aural surgeries. But expansion of microsurgery required a way to safely train surgeons in the precise skills needed to perform intricate procedures at microscopic scale. In 1958, Dr. Julius Jacobson and Dr. Raymond M.P. Donaghy established the world’s first microsurgery research and training laboratory at the University of Vermont. For the next two decades, Dr. Donaghy trained over 700 physicians in microsurgical techniques. One of the most notable was a young Turkish neurosurgeon named Mahmut Gazi Yaşargil.¹ Yasargil is credited with establishing the principles of microneurosurgery, and in 1999 was named Neurosurgery’s Man of the Century by the Congress of Neurological Surgeons.² Recently, another young Turkish physician, Dr. Abdullah Keles has been instrumental in helping to make microsurgical training accessible for neurosurgeons and neurosurgical residents around the world.
“Many trainees in developing countries don’t have access to a practice space for advanced techniques. This drives motivated doctors to move abroad for their educational advancement and contributes to a drain on the medical workforce in low-income countries.”
Hands-on practice is essential for neurosurgical advancement.
Our NNI efforts in this area are a prime example of how multinational exchange and mentorship can improve equity in access to healthcare around the world. The idea for our microsurgical training lab originated with Dr. José Kuzli, director of the neurosurgery service at the largest public hospital in Paraguay. Although microsurgery skills are a requisite for minute vascular and neural structures, many trainees in developing countries don’t have access to a practice space for these techniques. This drives motivated doctors to move abroad for their educational advancement and contributes to a drain on the medical workforce in low-income countries. Dr. Kuzli had long dreamed of bringing this type of training to Paraguay, and by partnering with Dr. Abdullah Keles through the NNI, this dream has come to fruition.
Dr. Keles works at the renowned Mustafa K. Baskaya Laboratory of the University of Wisconsin School of Medicine and Public Health. Before starting his current position in the Baskaya Laboratory in 2019, Dr. Keles spent two and half years at Yeditepe University Department of Neurosurgery in Istanbul, Turkey, under the supervision of chairman Dr. Uğur Türe. During his time at Yeditepe University he also had the chance to meet Professor Yaşargil, the father of modern neurosurgery, and complete his micro anastomosis course.
Dr. Keles learned about the needs in Paraguay through his UW Madison School of Medicine colleague, Dr. Robert Dempsy, member of the NNI Leadership Council. Dr. Keles then spent over a year gathering all of the microscopes, instruments, and supplies needed to constitute a basic microsurgery laboratory, purchasing many of the items at auction with his personal funds.
Dr. Kuzli (center) poses with residents in the microsurgery lab.
In April 2022, an NNI team formally presented Dr. Kuzli with the equipment and supplies to establish the first microsurgery laboratory of its kind in Paraguay. From there, Dr. Kuzli hit the ground running to establish workstations in the National Hospital of Itauguá. Coordinating with Dr. Keles, they organized a series of workshops introducing basic anastomosis and micro-suture skills followed by hands-on lab training. Dr. Kuzli reports that these courses have been a monumental success, with over 20 residents and new doctors participating week-to-week.
“We’ve changed the chip in our residents,” Dr. Kuzli shared. “They are now hungry to continue to learn and master microsurgical skills.” The laboratory provides a unique space for residents to improve their understanding of the three-dimensional structure of human anatomy and to train in spatial appreciation and hand-eye coordination.
The development of this laboratory has an exponential benefit as Dr. Kuzli is taking the training on the road for residents and doctors at other hospitals in Asunción. This is the long-term, sustainable impact that we strive to create through our mission. Learning from the success of this project in Paraguay, we are now preparing to replicate it with partner hospitals in Bolivia.
Dr. Kuzli and Dr. Patel prepare for a complicated AVM surgery.
The benefits of this project came full-circle when the NNI sent a neurosurgical team to collaborate with Dr. Kuzli and others on complex arteriovenous malformation (AVM) cases in August. Our team was led by Dr. Nirav Patel, a brain AVM expert from the Brigham and Women’s Hospital in Boston. Dr. Patel credits some of his success as a leader in AVM surgery to the many hours of practice he spent in the Baskaya Microsurgery Laboratory during his residency, the same lab that is now helping to train and equip up-and-coming neurosurgeons in Paraguay. In his closing lecture on AVM surgery, Dr. Patel encouraged the residents to “practice, practice, practice” in the microsurgery laboratory in order to become excellent neurosurgeons.
Solidarity Bridge and the NNI are honored to play a role in this beautiful example of the circle of solidarity and professional generosity that is at the core of our mission. Working together toward the common good, we are creating a healthier future for all.
Through partnerships and collaborative actions that are measurable and sustainable, the Neurosurgery & Neurology Institute works to build capacity and expertise in Bolivia and Paraguay in order to increase access to safe, affordable and timely health care. As a program of Solidarity Bridge, 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.