Neurosurgery began to function as a unit in September 2015 with addition of a full time senior neurosurgeon. The Department of Neurosurgery officially separated from being a unit in the Department of Surgery in January of 2018 to become its own department in the School of Medicine. The Department will perform more than 1000 operations per year, train neurosurgical residents, teach medical students, carry out research and community service for Tigray and Ethiopia.
The Neurosurgery Training Program
The neurosurgery training program which began in January 2018 consists of either a five year residency program for general practitioners or a three year fellowship for general surgeons was initiated. The training program is recognized by the Ethiopian Ministry of Health and participates in the Ethiopian National Matching Program for general practitioners to join post graduate medical training programs. Ayder Comprehensive Specialized Hospital and the Neurosurgery training program are certified to give training programs by the College of Surgery East, Central, and South Africa and their member countries. The program is now beginning its second year. Currently there are a total of 2 fellows and 13 residents in the program.
Besides teaching neurosurgery residents the Department provides rotations and didactic session for General Surgery, Ear Nose and Throat, Oral Maxillofacial, and Orthopedic residency trainees. The Neurosurgery department participates in the teaching of C1, C2, and interns under the General Surgery course offered by the School of Medicine.
Current and Future Enrollment Plans for the Neurosurgery Department Training Program
Estimates of Ethiopia’s future need for neurosurgeons based upon World Health Organization estimates for specialists assume there is a need for one neurosurgeon for every 250,000 population. Ethiopia will need in excess of 400 practicing neurosurgeons for its rapidly growing population reaching over 100 million. Currently there are less than twenty practicing neurosurgeons most of whom are in Addis Ababa. Currently there are three programs ( Addis Ababa University, St. Paul Millenium, and Mekelle University) which are taking in about 21 new trainees per year. Recently about 40% of graduates have left the country to practice in other countries such as Malawi, Uganda, and Somali-land. No new training programs are expected in the new future.
The Neurosurgery Department has agreed to take four PGY1 trainees in the Fall of 2019 to be assigned by the Ministry of Health to be trained at Ayder CSH. We will continue to take four PGY1 each following year.
The Neurosurgery Department plans to expand its clinical services, training, and teaching as the new cancer center, Quiha Trauma Center, and Pediatric Neurosurgery Center of Excellence are established in the future. When these development occur we will increase our resident intake to potentially 6 to 8 per year instead of the 4 per year currently. (This development is further discussed in staffing report below)
The Neurosurgical Department has three total active staff and five recruited staff in training.
Current and Future Staffing Plans
Our perceived need for training requirements, teaching, research, and clinical care at Ayder Comprehensive Specialized Hospital is 8 full time faculty. At the current time the 300 bed cancer center is under construction with planned opening sometime in the next two years.
Additionally we are having discussions with the Tigray Regional Health Bureau about
1. Providing neurosurgical services and extending the training program to the H.E.W.O. Hospital in Quiha which would would function as a Pediatric Neurosurgery Center of Excellence. Mekelle University, Tigray Regional Health Bureau, and the Reach Another Foundation (USA and Netherlands NGO) have signed a Memorandum of Understanding to develop such a center.
2. Providing neurosurgical services and extending the training program at the Quiha Hospital in Quiha. Currently there is a 100 bed trauma building under construction there which will possibly be finished in the Fall of 2019.
Once the cancer center construction is completed and assuming neurosurgical services and training are extended to the cancer center, Quiha Hospital, and the H.E.W.O hospital then our full staffing requirements for senior staff would increase to 12 (twelve). The Tigray Regional Health Bureau has one employee in training (Dr. Assefa) which is assigned to Mekelle upon his finishing in two years. We have discussed sharing this individual jointly with the Tigray Regional Health Bureau.
Professor Tony has consulted with the Department of Anatomy in developing a Ph.D. Program in Neuroanatomy with experience in Neuroscience which has been approved by the University but is awaiting final approval by the Ministry of Science and Higher Education. He will be co-appointed in the Basic Sciences and serve as a graduate sponsor and advisor for the Ph.D. Program.
Professor Tony Magana is the founding member of the multidisciplinary neural tube defects research team consisting also of members from the Departments of Anatomy (Embryology, Teratology), Microbiology Pediatrics, Surgery, Obstetrics/Gynecology, and School of Public Health ( Department of Nutrition). Four peer reviewed publications have been accepted in major internationally recognized journals. Professor Tony and other members of the team served as advisors to the Ethiopian Public Health Institute and the Ministries of Health and Maternal/Child Welfare for recommendations in developing a national policy to deal with neural tube defects. This recommendation was formalized in June 2019.
1. Berihu BA, Welderufael AL, Berhe Y, Magana T, Mulugeta A, Asfaw S. High burden of neural tube defects in Tigray, Northern Ethiopia: Hospital-based study. PloS one. 2018 Nov 14;13(11):e0206212.
2. Berihu BA, Welderufael AL, Berhe Y, Magana T, Mulugeta A, Asfaw S, Gebreselassie K. Maternal risk factors associated with neural tube defects in Tigray regional state of Ethiopia. Brain and Development. 2019 Jan 1;41(1):11-8.
3. Welderufael AL, Berihu BA, Berhe Y, Magana T, Asfaw S, Gebreselassie K, Belay E, Kebede H, Mulugeta A. Nutritional status among women whose pregnancy outcome was afflicted with neural tube defects in Tigray region of Ethiopia. Brain and Development. 2019 May 1;41(5):406-12
4. Dixon M, Kancherla V, Magana T, Mulugeta A, Oakley GP. High Potential for Reducing Folic Acid-Preventable Spina Bifida and Anencephaly, and Related Stillbirth and Child Mortality, in Ethiopia. Ethiopia (May 3, 2019). 2019 May 3.
The Department provides care including consultation and surgery for adult and pediatric patients with disorders of the brain, spine, and peripheral nerves at Ayder Comprehensive Specialized Hospital.
Outpatient at Ayder CSH
The source of patients coming to Ayder CSH includes not only Tigray but also in increasing numbers Eritrea, Afar, and the Amhara regions. Ayder CSH is most advanced hospital outside of Addis Ababa in Ethiopia. Several times a month we even receive referral from Addis Ababa for some unique surgical services we offer including:
1. endoscopic pituitary tumor surgery
2. microsurgical nerve transplant
3. surgery for cranial-facial disorders
4. surgery for cerebrovascular disorders (aneurysm)
5. complicated pediatric brain tumors
Outpatients are seen in a once a who week referral clinic (Thursday) and in the emergency area twenty fours a day seven days a week. Approximately 7 (weekdays) to 10 (weekends) patients are evaluated in the emergency area every 24 hours. The number of outpatients seen in the referral clinic has grown from about 50 in 2016 to 90 per clinic day currently. Many patients wait several months for available appointments. The old clinic facility had most of the clinic day only two available stations as it was shared with general surgery clinic the same day. A new clinic facility is being set up which will be shared with Orthopedics on alternating days wherein the Thursday referral clinic will have four stations with computers instead of only two stations and an additional half day morning clinic will be added on Tuesdays. A small daily clinic attended by a junior resident is being considered when increased manpower in the neurosurgery department comes into being.
Outpatient Clinic and Emergency Room Average Daily or Weekly New Consults
Weekly Neurosurgery Referral Clinic
100 per week/400 per month/4800 per year
Emergency Room Adult
6 per day/42 per week/168 per month/2016 per year
Emergency Room Pediatrics
3 per day/21 per week/84 per month/1008 per year
Inpatient Care at Ayder CSH
Average Daily Neurosurgical Census Data for Neurosurgery at Ayder CSH
Total inpatients visited daily/monthly/yearly
28 to 34 daily/960monthly /11,520 yearly
Three operating room days during the working week are alloted to neurosurgery for elective surgery. Emergency care is given 24 hours a day dependent on the availability of beds in the hospital, availabile operating room, anesthestists, and nursing staff.
Neurosurgical Operations at Ayder CSH
9 per week /36 per month/432 per year
2.5 per day/17.5 per week/70 per month/840 per year
Collaboration and Donation
Emory University, Atlanta, Georgia USA
Child Help-International (Belgium) and the International Federation for Hydrocephalus and Spina Bifida (Belgium)
Reach Another Foundation (USA and Netherlands)
Hearts Helping Hands(USA)
Yves Meyers, Aesculap Corporation, and Dallas Memorial Hospital(USA)Quest Medical Supply(USA)
Quiha Hospital (Tigray Regional Health Bureau)