NeuroAccess – Lusaka, Zambia 2016

Dr Michael Bonello, ST7 Neurology

The Walton Centre NHS Foundation Trust, Liverpool, UK

NeuroAccess is a project supported by The Encephalitis Society and run by Drs Benedict Michael and Sam Nightingale which aims to improve the care of patients with Encephalitis and other neurological problems in sub-Saharan Africa through improving education in clinical neurology. The project is funded by courses in neurology for UK undergraduate and postgraduate medics, and by grants from The Encephalitis Society and the Association of British Neurologists.

I would like to thank the ABN for funding my application to travel to Lusaka, Zambia between the 22nd October till the 6th November 2016. I was involved in the provision of neurological teaching as part of NeuroAccess.

NeuroAccess started in 2013, an idea of Dr Benedict Michael and Dr Sam Nightingale, where a yearly two-week course was set up to provide neurological education to general medics in the sub-Saharan African countries of Mozambique and Zambia.

Zambia is a country in southern Africa that is three times the size of the UK with a population of sixteen million people. University Teaching Hospital in Lusaka is the only government specialist referral hospital in the country and is the main centre for training local medical students and nurses.

It has basic facilities to perform blood work and CSF analysis. It has a CT scanner and currently a non-functioning MRI scanner. Work was underway to repair the MRI scanner but unfortunately, this has been ongoing for a few months. Nerve conduction services were provided by Dr Kvalsund a Neurologist who was undergoing research in HIV and B12 neuropathy.

Neurological disease has a huge prevalence causing a significant burden to the healthcare systems. There are three neurologists in the hospital. Our main contact is Dr Omar Siddiqi, who is employed by Harvard University and currently undergoing his research in Zambia. Part of his work involves providing referral services, clinics and training. He managed to set up a functioning neurophysiology lab that provides an EEG service.

The volume of work is so enormous that teaching is spread thin and thus most medics would have had insufficient neurological training. Most neurology training is provided by non-specialists and although the theoretical knowledge is of a good standard the practical application still needs improvement. The ultimate objective is to develop a cadre of local Neurologists that can carry on the work of looking after patients with neurological pathology and so much less reliant on foreign input.

Our objectives during the two-week stint were to provide basic neurological training focusing mostly on concepts of disease and pragmatic approaches to empower medical students and junior doctors currently being trained at UTH to become more versed in neurological conditions.

The course was previously delivered in Zambia in October 2013, November 2015 and Mozambique in 2014, 2015 and 2016 and in all occasions, it was very well received with excellent feedback. This was my second year going having previously travelled to Zambia in November 2015. I was accompanied by a fellow Neurology SPR and a Neurophysiologist from the Walton Centre who helped with EEG provision and further training for the two local EEG neurophysiologists.

Visit

For two weeks the day started at 07:00 with a two-hour morning teaching session delivered to the seventh year (1st week) and fourth year (2nd week) medical students in which we covered a set neurology curriculum trying to build up basic concepts like localisation to explain more complex pathology such as stroke, movement disorders and epilepsy. This was normally followed by a two-hour small group teaching session delivered to fifth-year medical students were a hands-on approach was used to highlight the concepts of the neurological history and examination. An hour session of bedside teaching with the sixth year medical students would follow. Junior Doctor teaching would be next on the agenda and this included a wide variety of teaching styles and topics. This varied from interactive lectures e.g. on neuroradiology, grand round style sessions on cerebellar disorders and spinal cord disorders, to more bedside tutorials presenting patients with Brown-Sequard syndrome and Motor Neurone Disease. A video bank of clinical signs has proved essential in making the sessions as interactive as possible. The afternoons were spent seeing inpatient referrals under the supervision of Dr Siddiqi as well as preparing the sessions for next day.

Wednesdays proved a change from the routine as after the morning 7 am lectures we made our way to the weekly neurology clinic where we would join Dr Siddiqi and Dr Kvalsund seeing patients who could have been waiting for hours and who would have travelled hundreds of miles to seek a neurology opinion. We normally used to be joined by medical students in clinic resulting in it being a teaching clinic. The feedback received for all teaching sessions was very good. Tendon hammers and pen torches were handed out to the most involved students and doctors promoting interaction. A quiz at the end of the two weeks consolidated concepts we covered all week and a diagnostic set was given to the winner.

Future Plans

NeuroAccess aims to slot into a permanent program of post-graduate neurology that is currently being developed by Dr Omar Siddiqi to train a local team of Neurologists that can take forward and improve neurological care in Zambia. Its aim is to build on a strong record of teaching in the UK were faculty, teaching on the successful NeuroPACES course, have the chance to teach on the NeuroAccess course.

The programme is supported by an open access eLearning resource in neurological infection that has been developed (www.braininfectionsuk.org/neuroid_elearning) to allow future reading for junior doctors and consolidation of further knowledge. We aim to return next year to provide continuing neurological education and to build on the previous year’s teaching.