The burden of neurosurgical emergencies in a tertiary hospital and the need to attract more trainees into Neurosurgery

Background: Neurosurgical coverage for hospital emergencies in sub-Saharan Africa has been a controversy considering the limited number of neurosurgeons and the need to institute prompt and appropriate management to reduce morbidity and mortality.Aim / Objective: The aim of this study is to evaluate the adequacy of available manpower for emergency neurosurgical care, compare it with available manpower in other surgical specialties and suggest ways of maintaining or improving available services.Methodology: A retrospective study of consecutive cases presenting at the Accident and Emergency Unit of our Teaching Hospital, over a twenty-four [24] month period, August 2008 to July 2010, was done.Data was collected from the records of thosetreated in theUnit within the period and analysis was done by simple proportion and percentages.Results: A total of 4,363 cases were treated within the study period in the Accident and Emergency Unit, out of which 2591 were males and the rest were females, giving a male:female ratio of 3:2. The requests for specialist consultations were 4277 for this population of cases, viz. Obstetrics and Gynaecology 227(5.3%), Internal Medicine 1751(40.9%), and Surgery 2299(53.8%). A breakdown of consultations to the Department of Surgery showed that Paediatric Surgery had the least 19 (0.8 %), whereas Neurosurgery received the highest 633 representing 27.5% of total consults in Surgery or 14.8% of emergency consultations to all specialties of the Hospital put together.Conclusion: Many cases presenting to the Accident and Emergency Unit require neurosurgical care, but the available neurosurgical manpower on ground is so thin that they are overworked. There is a very strong need to reduce the burden of work on these specialists, by increasing the number of available doctors in the service and improving on the remunerations for the available manpower, in order to attract more trainees to the specialty and ensure good quality of service.Keywords: Emergencies, neurosurgery, overwork, remuneration, trainee