Global Neurosurgery: The Pakistani Perspective

To the Editor:

Lack of access to basic surgical care poses a challenge on resource-constrain health care delivery in Pakistan. The delay between onset of symptoms and seeking health care, lack of knowledge regarding treatment options, and financial constraints limit access to surgical care in Pakistan. This lack of accessibility poses a threat 3 times greater than AIDS, malaria, and tuberculosis combined.¹ The incidence of trauma and maternal mortality ratio are staggeringly high. The burden of trauma-related deaths is significantly high in Pakistan causing 42 deaths per 100 000 and contributing to 6% of all deaths.² There is a severe dearth of surgical and anesthesia-related epidemiological data. The Lancet Commission on Global Surgery puts the figure around 5 billion, which is the number of people around the world who are unable to receive timely and safe surgical care. Globally in 2016, 276 million neurosurgical cases were reported and was the second leading cause of death with 9 million deaths.³ Most of these people reside in low- and middle-income countries (LMICs) such as Pakistan where health care does not have the same resources as in high-income countries. In Pakistan, there is an annual deficit of 17 million surgeries because of a dearth of health care professionals and an overrun health system that has led to inaccessibility of surgical services, especially for the poor and those in rural areas.²

The main hurdles in the path of achieving optimal neurosurgical health care in LMICs are lack of specialized neurosurgeons (1 neurosurgeon being available for 720 000 people in Pakistan), insufficient equipment, poor research culture, high cost of neurosurgical care, disparity in public and private hospitals care, and lack of interest by health officials to establish new and improve pre-existing neurosurgical departments.^2,4,5 Nine years after the seminal paper by Zafar and McQueen, the situation is still dire with a total of 177 in training residents, 43 approved supervisors, and in total 274 neurosurgeons and significant efforts are needed to improve access to safe, effective, equitable, and affordable neurosurgical care in Pakistan.²