CU Global Neurosurgery

Partnership in Tanzania

Faculty and residents have been traveling from CU Neurosurgery to Tanzania since 2007, first with and then independently. This began as a training mission teaching general surgeons and others basic neurosurgical skills to improve neurosurgical trauma and hydrocephalus support in areas of the country without access to neurosurgery. Beginning in 2013, a Memorandum of Understanding was signed between CU Neurosurgery and the Muhimbili Orthopedic and Neurosurgical Institute (MOI), which represented a transition for CU Neurosurgery from personal mission trips to Sub-Saharan East Africa to an international collaboration and exchange program for sustainable development of neurosurgical specialty care and training in low- and middle-income countries.

MOI Neurosurgery

Faculty neurosurgeons at have trained all over the world—including Japan, Germany, Morocco, South Africa, Australia, etc., and then made personal sacrifices to return home to establish and expand neurosurgical care in their own country. The recent establishment of a neurosurgery residency training program (2017) and a National Center of Excellence in neurosurgery have improved access to neurosurgery services in Tanzania. The additional neurosurgeons trained by MOI have slowly expanded access to neurosurgical services across the country, with neurosurgeons now at additional hospitals in Dar es Salaam, Moshi, Zanzibar, Mwanza, Mbea and Dodoma with more to come.

CU Neurosurgery

CU Neurosurgery is a dynamic, rapidly growing enterprise specializing in clinical, research and educational excellence, representing one of the largest Neurosurgery Departments in the western United States. Within the department are nine Programs of Excellence, offering unrivaled educational opportunities for medical students, residents and fellows in this state-of-the-art Center for education, clinical programs, research and innovation.

CU-MOI Partnership: Improved care through collaboration

International Symposium

Each year, CU Neurosurgery and MOI faculty and residents come together in Dar es Salaam to host an . This conference includes didactic lectures, practical sessions and live OR demonstrations. Breakout sessions for neurosurgery, critical care, oncology, pathology, radiation oncology, radiology, nursing and rehab services make this a unique conference covering all aspects of neurosurgical patient care and clinical practice within these subspecialty areas of neurosurgery. With more countries represented at the Symposium each year, attendance has ballooned to over 150 attendees annually, with overflow participation wired to conference rooms throughout MOI.

International Exchange

Each year, neurosurgery residents and fellows travel to Tanzania along with CU faculty to experience neurosurgical care in Sub-Saharan East Africa. This is a unique opportunity, beloved by residents and fellows, allowing an opportunity to learn about neurosurgical care in resource limited environments. In return, neurosurgery and related specialty trainees and providers come to 麻豆传媒高清 for four-to-six-week observerships in the subspecialty area of their choice, to assist in their development into independently practicing clinicians.

Intraoperative Ultrasound in Neurosurgery

Without access to cost prohibitive navigation technologies including intraoperative MRI, CT, or frameless stereotactic systems or robotics, Tanzanian neurosurgeons previously had no access to intraoperative guidance for cranial and spine surgeries. After discussion, a training program was created to teach intraoperative ultrasound for guidance for brain and spine surgery at MOI. This collaboration began in and was a collaboration between CU Neurosurgery and the Departments of Neurosurgery, Anesthesia and Radiology at MOI. CU Neurosurgery provided basic training and demonstrations with hands-on courses. Following this, neurosurgeons invited radiology into the operating room to assist in normal and abnormal anatomic interpretation while neurosurgeons at MOI developed their own improved understanding of the use and interpretation of ultrasound imaging. Ultrasound units already owned by MOI for use in radiology and anesthesia were used now in neurosurgery, making this an easy transition financially for a LMIC institution. The utility of this training became apparent from the very first case it was used, where a larger craniotomy was required prior to dural opening for adequate access for brain tumor excision. Ultrasound has been shown to be a low-cost and efficacious alternative form of intraoperative guidance and imaging that is quite useful in both the developed and developing world. Further advanced ultrasound teaching occurs now in Tanzania, with other CU courses slowly expanding this technology to other countries and regions across Sub-Saharan East Africa.

Advanced Endoscopy

Many years ago, CURE Children’s Hospital of Uganda () began training surgeons on the use of flexible endoscopy for performing endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC). After a period of formal training, they would then facilitate the donation of a flexible endoscope and monitor tower for the surgeon to return to their home hospital and continue performing surgeries for hydrocephalus across different parts of the developing world. With interest in expanding endoscopic procedures beyond ETV, we began a training program in advanced neurosurgical endoscopy. This has led to the expansion of endoscopic surgery at MOI and now includes endonasal endoscopy (for transsphenoidal surgery), advanced ventriculoscopy (tumors, complex hydrocephalus, etc.), endoscopic assisted surgery and spine endoscopy.

Stereotactic Surgery

Without access to cranial navigation and other advanced stereotactic technologies reliant on expensive machines and disposables, stereotactic and minimally invasive surgeries were previously unavailable in Tanzania. Partnering with industry, we have developed novel ultrasound guided tubular retractors for minimally invasive cranial procedures that require no disposables for use and have also taught and trained MOI neurosurgeons on the use of this device. One benefit of this new technology is the treatment of hypertensive hemorrhagic stroke. Previously, patients presenting with hemorrhagic stroke were largely treated palliatively. Our collaboration in developing novel surgical techniques and improved neurocritical care services is improving the care of these patients that present with double or triple the frequency of high-income countries due to widespread untreated hypertension in the Tanzanian population. These technologies will help improve functional outcomes for these challenging patients. This retractor will also enable smaller craniotomies for tumor resections, abscess surgeries and other pathologies, reducing operative times, shrinking surgical incisions and improving outcomes for countless patients.

In the realm of stereotactic surgery, we have also developed partnerships with Rutgers University and have donated equipment and trained MOI neurosurgeons to use a cranial stereotactic frame. This system allows neurosurgeons to perform precise localization deep in the brain for functional procedures, stereotactic needle biopsies, abscess drainage, etc. These technologies will improve the safety and efficacy of surgery for patients in Tanzania in exciting new ways.

Vascular neurosurgery

Our partnership in vascular neurosurgery includes significant efforts for spontaneous hemorrhagic stroke described above, improved neurocritical care services, nursing and rehabilitation. Additionally, we have expanded lecture topics at our courses related to vascular neurosurgery, have expanded our equipment donation program to include endovascular disposables and have arranged bilateral exchange programs for providers in open and endovascular neurosurgery.

Neurocritical Care

Partnering with Critical Care and Step-Down Staff between CU and MOI, we seek to improve the critical care of neurosurgical patients in Tanzania. In addition to extensive equipment donations, our program has significantly invested in the education of providers and nurses in Tanzania. Multiple monthly virtual didactic sessions occur throughout the year to teach critical care principles. Patient care discussions help improve patient management in real time. Cross country exchanges help solidify knowledge transfer and collaboration. Quality improvement projects help identify areas of improvement and areas of focus, ultimately improving outcomes for patients with neurosurgical diseases despite treatment challenges in a resource limited environment.

Neuroscience Nursing 麻豆传媒高清

Without neuroscience specific nursing training in Tanzania, we strive to improve neuroscience nursing education for nurses caring for critical neurosurgical patients. This training includes virtual and in person didactic sessions, bedside teaching, etc., to help improve nursing education and training across Tanzania.

Neuro-Rehabilitation

A recent addition to our program, we now are working extensively with physiotherapy personnel to improve the education and execution of rehabilitation services to neurosurgical patients both in and outside the hospital. So vital to improving patient outcomes, the Department of Physical Medicine and Rehabilitation at CU has partnered with CU Neurosurgery and MOI to improve neurorehabilitation education and services in Tanzania and is becoming an integral part of our comprehensive plan for improving neuroscience patient care in Tanzania.

Residency Training

Early on in our collaboration with MOI, we assisted with the development of the neurosurgery residency program (2017). Efforts included assistance in curriculum design and application for accreditation. Following full accreditation first for a three-year (after general surgery), and now a six-year residency program (after internship/registrar year), our collaboration includes didactic lectures in person and virtually throughout the year, assistance with research training and research efforts, journal clubs, resident observerships at CU, in person surgical training and assistance, etc. Our goal is to assist MOI to train residents at a level previously only available outside Tanzania.

Neuropathology

Neuropathology is a difficult specialty, with neuropathology representing the longest training program specialty within pathology. With only general pathologists in Tanzania, we have worked to improve efficiency and efficacy of pathological diagnosis for neuro-oncology patients. Our efforts include virtual and in person education and training, international virtual consultation, equipment donations, etc.

Outreach to other communities in Tanzania

Our efforts in Tanzania extend beyond MOI, with previous outreach efforts in Moshi, Haydom, Mwanza and Arusha, with more planned in the future. We strive to help improve neurosurgical training and patient care throughout Tanzania.

Collaborative Research

The CU/Tanzania collaboration has led to a number of publications with continued collaborative research ongoing. Examples follow:

1. Ormond DR, Kahamba J, Lillehei KO, Rutabasibwa N. Overcoming barriers to neurosurgical training in Tanzania: international exchange, curriculum development, and novel methods of resource utilization and subspecialty development. Neurosurgical Focus. 2018; 45(4):E6.
2. Kaale AJ, Rutabasibwa N, Mchome LL, Lillehei KO, Honce JM, Kahamba J, Ormond DR. The use of intraoperative neurosurgical ultrasound for surgical navigation in low and middle income countries: the initial experience in Tanzania. J Neurosurg. 2020 Feb 28:1-8. doi: 10.3171/2019.12.JNS192851.
3. Zerd F, Moore BE, Malango AE, Hosokawa PW, Lillehei KO, Mchome LL, Ormond DR. Photomicrograph-based Neuropathology Consultation in Tanzania: The utility of static-image teleneuropathology in low- and middle-income countries. Journal of Clinical Pathology. 2020 Jul 27;aqaa084. doi: 10.1093/ajcp/aqaa084. PubMed PMID: 32715312.
4. Magwasela FM, Rabiel H, Epidemiology and surgical outcomes of primary brain tumours managed at a tertiary hospital in Arusha, Tanzania. EAJNS. 2024;3(2):43-52.

Partnership in Uganda

Our work in Uganda grew out of our extensive efforts in Tanzania, with Uganda neurosurgeons attending our international conference at MOI and requesting assistance and collaboration. This collaboration is early, but significant efforts are underway.

International Neurosurgery Conference

Since 2024, we have developed an international teaching conference for neurosurgeons, critical care faculty, residents and nursing staff in Mbarara, Uganda. This conference includes didactic lectures, practical sessions and live OR demonstrations. Breakout sessions for neurosurgery and critical care make this a unique conference covering many aspects of neurosurgical patient care and clinical practice. Attendance has increased over the two years of the conference, with the conference expanding to an outside venue due to prior space constraints. Teaching conferences throughout the year continue virtually to increase the impact of these efforts.

Intraoperative Ultrasound in Neurosurgery

Building off our success in Tanzania, efforts are now underway to expand ultrasound guided neurosurgery into Uganda. Case demonstrations and training courses began in 2024, and a machine has been acquired to continue training and practice throughout the year, with access to virtual teaching as necessary to help complete its successful adoption first at Mbarara and ultimately throughout Uganda.

Neurocritical Care

Currently, there is a general ICU, but no neurosurgical ICU in Mbarara, although a Step-Down unit has been started. Efforts to improve the education of critical care providers and nursing staff include bedside teaching and live and virtual didactic sessions. Equipment and textbook donations help increase the success of these efforts and the care of neurosurgical patients in Mbarara.

Our 2025 Global Neurosurgery activities newsletter

Opportunities to Expand Impact

A number of opportunities will help us expand the impact of this program through your help and assistance.

Equipment/Supplies Donations

Prior donations of medical equipment and supplies have made a significant impact on the lives of patients and the efficacy and safety of neurosurgery. We are actively seeking vendor or other industry sponsored donations of new or lightly used (functional) equipment and sterile supplies. Please reach out for additional details of specific needs and regulatory requirements.

Monetary Donations

Your donation can make a great impact on the strength of our program. Thank you so much for considering a monetary donation to assist with increasing our impact in Sub-Saharan East Africa.