Supporting modern neurosurgery in developing countries
            
Current Mission: Department of Neurosurgery, Hue Medical College
   
Hue Medical College and the neurosurgical postoperative recovery area
After four years of engagement and three site visits, our March, 2008, mission to the Department of Neurosurgery of Hue Medical College in Hue, Vietnam, significant results were achieved. The Department's capabilities have expanded to enable them subsequently to treat:
  • 118 brain gliomas
  • 22 vestibular schwannomas
  • 47 posterior fossa tumors
  • 33 skull base meningiomas
  • 11 craniopharyngiomas
  • 3 pituitary adenomas
Prior to this mission, in a typical year, the Department was achieving 150 cases including 100 to 110 spine surgeries and 30 to 40 simple craniotomies (done with Gigli Saw). Now the Department can perform microneurosurgeries; previously, when performed at all, these procedures had required transporting the patient to Hanoi or to Ho Chi Minh City, both of which are approximately 1200 km away, and where the patient would be without family support (overworked floor nurses only). The volume and complexity of the Department's activities has grown substantially.

We also gave a series of presentations on interventional neuroradiology. AMCANI's support has also helped to grow the Department's physical resources. Pre-AMCANI, the Department had:
  • six operating rooms
  • no microneurosurgery
  • no drills or bipolar
  • a home-made Mayfield head rest
  • a two-bed ICU
  • a Chinese-donated stereotactic radiosurgery system (Gamma knife)
  • a 0.5 T Chinese MRI
  • a single-array Chinese CT
Perhaps most valuable of all has been the hands-on, on-site, state-of-the-art training that AMCANI has provided to Hue Medical College's neurosurgeons. This has supplemented fellowship training for junior faculty. AMCANI equipment donations enabled them to hone their skills while conducting highly technical, life-saving procedures. Some of these trainees have been able to continue their professional growth at major medical centers in the West, including:
  • Than Duc Tri MD. PhD., with a cerebrovascular fellowship at the University of Antwerp, Belgium
  • Nguyen Thai Minh MD. PhD., with an endoscopic/skull-based fellowship at The Centre for Minimally Invasive Surgery, Sydney, Australia

Drs. Thai and Tre preparing a patient for a microsurgical
procedure using the newly arrived Zeiss OPM1 scope.

The primary purpose of AMCANI is the delivery of neurosurgical training and durable medical supplies to local neurosurgeons. This lack of advanced equipment and training leads to significant morbidity and mortality in the patients they serve. Unlike that of most most NGO medical groups, our strategy is not primarily to provide surgical service during our brief stay in our host country. Instead, we support the recipient medical group in augmenting their neurosurgical services with a coherent plan for local sustainability.

The Department of Neurosurgery at the University of Hue has four neurosurgical faculty, and six residents (all working on M.D. Ph.D. degrees) as well as rotations of general surgery residents. The department is headed by Tran Duc Thai, MD, Head of the Neurosurgery section and Gamma Knife Center, Hue University Hospital. The department is responsible for providing neurosurgical care and training for all of central Vietnam with its population of 20 million people. They are one of three centers of excellence for neurosurgery in the entire country.

In its first mission to Hue (in 2007), AMCANI completed the installation of a Midas Rex and a MedNext craniotome, a Mayfield cranial support system, a Zeiss OPM1 microscope, and microsurgical instruments. The department now has the equipment to perform spinal surgery, stereotactic radiosurgery (Gamma Knife), and simple intracranial surgery.

However, much legwork is needed prior to any such mission. First, we visit the site, familiarize ourselves with its capabilities and aspirations, and begin the planning process. This was done in June of 2006. At that time, Prof. Tran clearly identified the lack of capital equipment as his Department's most pressing problem and the primary limitation of their capacity.

Prior to arrival of AMCANI's surgical team, the microscope, craniotomes, and accessory supplies were delivered (in November, 2006) and the team arrived in Hue in April of 2007. Over 10 days, the Zeiss microscope, craniotomes, and bipolar cautery were integrated into the operating room environment. Instruction in the use of the donated equipment was during the course of nine surgical cases.

The goal over the next several months is to maximize the resources (fiscal and otherwise) to ensure the maximum benefit for the Vietnamese people. To this end we seek financial as well as logistical support to complete the mission. We also seek neurosurgical teaching volunteers. Board-eligible or certified neurosurgeons, OR nurses, neurointensives, BE or BC neurologists interested in participating please contact us at contact@amcani.org
Still needed: Ultrasonic Cavitron (CUSA), transsphenoidal instrument set, C-arm, volunteer clinical training staff, and financing for transportation of equipment and staff to Hue.
2009 © Americare Neurosurgery International
All Rights Reserved / All Visuals Copyrighted