Enhancing Neurosurgical Care in Antigua and Barbuda

The World Health Organization (WHO) estimates that 90% of deaths from traumatic brain injury occur in middle to low-income countries such as the ones in the Caribbean. The Caribbean is a chain of islands and cays that currently does not have the capacity to provide each citizen with equitable access to timely neurosurgical care. Currently, there are 3.5 million Caribbean residents living outside the recommended 4-hour access zone to a facility with neurosurgical capacity. Furthermore, there is estimated 1 neurosurgeon per 600,000 persons. For comparison, there is 1 neurosurgeon for every 27,000 persons in Boston, MA. This disparity in the Caribbean means that many urgent or emergent neurosurgery cases in the region will not make it to a hospital in time or, if they do, there may not be treatment available. Unfortunately, these common scenarios result in permanent neurological damage or death. 

In collaboration with the Global Health community in Boston and the Caribbean Neurosurgical Foundation (CNSF), a team of neurosurgical providers has been working to improve care in the Caribbean. In 2023, Global Nursing Fellow Carly Campbell, BSN, RN, participated in an outreach trip to Antigua and Barbuda whose goal was to support CNSF's mission to enhance neurosurgical care in Antigua. The trip involved conducting a needs assessment, addressing patient consults collected by Mount St. Johns Medical Centre (MSJMC) surgical team, performing urgent neurosurgical cases, educating local nurses and surgeons on neurosurgical interventions and care, and assessing resources in Antigua for ongoing sustainable support.

The outreach strengthened connections between CNSF and MSJMC surgeons, successfully connecting patients with essential neurosurgical operations. Completed surgeries included laminectomy discectomies, ventricular shunt placements, and various other critical procedures. Post-operative care was monitored through online communication with the MSJMC surgical team. The challenges identified as part of the needs assessment included:

• High nurse turnover at MSJMC leading to knowledge gaps.
• Requests for additional training on topics such as triage, neonatal care, and post-anesthesia management.
• The need for education on managing post-emergent procedures like drain care.

As a result, future goals include:

• Creating an informative video for nurses to address these training needs.
• Exploring sustainable ways to build necessary equipment for community organizations, such as patient lifts and strollers, using locally available materials.
• Improving access to medications and training for hospital nurses on managing complex neurological and mental health needs.

Efforts are underway to find sustainable solutions for the identified needs and improve care quality. Due to traumatic brain injuries related to motor vehicle accidents being overwhelmingly identified as the community's highest neurosurgical need, plans also include developing motor vehicle safety education programs and advocating for helmet and seatbelt laws to reduce the incidence of traumatic brain injuries.