General state of neurosurgical care in Uzbekistan
G.M. Kariev, D.M.Mamadaliev .
Pic 1: Recent photo of Republican specialized scientific-practical medical center of neurosurgery in Tashkent.
Brief historical aspects
A recent report based on the latest data from statistics of Republican scientific-practical medical center of neurosurgery in Tashkent, Uzbekistan. The “birth” of Uzbekistan's neurosurgery dated back to 1943, when Tashkent Medical Institute neurology department was just established and leaded by prof. L.Y. Shargarodski (1896-1959), then by initiatives by surgeon, professor I.I.Orlov (1888-1952) was founded first neurosurgical department. In 1946 at the basis of Research institute of traumatology opened neurosurgical department for 20 beds, Chief – Tishin А.G. Later on, in this department worked Prof. Kariev M.H., prof. Mirsadikov А.S.
Eventually prof. M.H.Kariev has made a great effort and contribution in foundation of recent Republican neurosurgical center, which serves as one of the chief clinical centers for all neurosurgeons who is going to take a neurosurgical specialization.
Pic 2: 1946-1950years. During operation.
Overall number of neurosurgical beds in the Republic – 963. (2019) For 2019y patient admission rate per year was 72 594. Overall number of operations (including emergency) are 10470 for 2019. From them 7370 planned cases (70.4%), 3100 (29,6%) are emergency cases. By type of pathology- mostly treated neurotraumatological cases (24 917) then oncological (3880) and congenital pathologies- (1016). Mortality rate in 2019 in hospital was 853 patients from overall treated 49120 (1.73%) a little more in contrast to 2010y (it was 469 death from 34938 patients-1,34%) which can be explained by increased number of patient admission and complexity of surgeries.
Our neurosurgical treatment and needs
Mostly treated neurosurgical disorders which include cerebral aneurysms, AVMs, cavernous malformations, (both endovascular and open) brain tumors, (including skull base and craniocervical junction tumors) epilepsy, hemorrhagic stroke, all types of spinal trauma and disc herniations, spinal canal stenosis, spinal tumors, pediatric neurosurgery, traumatic brain injuries with a higher proportion of diseases in rural area as compared to urban centers.
Unfortunately due to lack of experience and equipments, functional neurosurgery is poor developed. Only pharmacologically refractory epilepsy can be surgically treated. Neither Republican neurosurgical center nor private institutions have facilities for deep brain stimulation, stereotactic instruments, for Parkinson’s disease and other movement disorders.
We have some positive aspects regarding pain surgery. Recently we have started using of high frequency ablation for different pain syndromes. Same can be stated for endoscopy. Newly installed Karl Storz systems are mostly being used for pituitary surgeries. But spinal cases are exclusion due to lack of experiences.
Last two years, thanks to better diagnostic instrument supplementation by the government, Uzbekistan had to face new challenges in neurosurgical care due to better diagnostics of vascular pathologies, cerebral aneurysms, AVMs, and other rare entities. This led to preparation of new neurosurgeons for vascular departments of many hospitals. So we can say that vascular neurosurgery is the youngest branch and yet needs more support in this regard. It is also noteworthy to emphasize the fact that in rural areas of the republic, basic diagnostic equipments like CT are in need. People with intracerebral hemorrhage are often being misdiagnosed as ischemic stroke and treated by neurologists. This indirectly causes increases the number of mortality. Another problematic scene with pediatric population which have poor organized neurosurgical screening for in utero CNS anomalies, resulting in stable numbers of spina bifida and other CNS defects in outpatient diagnostic departments.
Neurosurgeons, Education, and Societies
Uzbekistan has approximately 291 neurosurgeons (including about 8 women) for 34,03 million people. Of the 6 approved medical universities (Tashkent medical academy, Tashkent pediatric medical institute, Bukhara medical institute, Andijan medical institute, Urganch medical institute), all 6 have neurosurgical departments.
The duration of the neurosurgery residency program changed from 3 years to 4 years. But for master's degree is not changed (3 years). Most of the government hospitals and medical universities across Uzbekistan still lack basic neurosurgical infrastructure, and hence incapable of providing neurosurgical training. That’s why as basic training centers considered Republican neurosurgical center and Republican center of emergency medicine where residents can train basic neurosurgical skills.
Moreover, some private hospitals with extensive infrastructure have been started some neurosurgical cases which are not too complex and feasible. Nevertheless, there is still no cadaveric laboratories which can provide hands-on-exposure and “cutting and stitching” for neurosurgery residents.
Started from 1991, Uzbek Neurosurgical Society established and began actively involving in international neurosurgical societies including WFNS and ACNS. By active cooperation with World arena of colleagues, plenty of surgeries has been done and master classes by experienced neurosurgeons from Japan, Turkey, Russia, India and many other countries was organized.
Pic 3: September 2018. Second Congress of Neurosurgeons of Uzbekistan. Mentors (left-to- right:Prof. Yoko Kato, Prof. Gayrat Kariev (chief neurosurgeon of Uzbekistan) and young neurosurgeons.
Pic 4: Teaching, sharing knowledge and experience are the motto of ACNS. Thanks prof. Y.Kato and her international team made it possible some dreams of YNS to come true.
Pic 5: Prof. Yoko Kato and young neurosurgeon from Uzbekistan Dilshod Mamadaliev.
Note:By: Prof. Bajamal, Indonesia
Since early March 2019, the C-19 case was detected in Indonesia, so the
government has made various security policy efforts. Now vaccinations are
running well and 2 million have been implemented out of the target population
of 188 million that need to be vaccinated. The most encouraging thing is that all
of the health workers are currently vaccinated. We have 402 neurosurgeons in
Indonesia serving a population of 370 million. Indeed, neurosurgery services
since the beginning have been quite severely affected, so it is clear that
neurosurgery services have decreased. Besides that, what is more disturbing is
the impact on training residency. Because the residency training is under the
responsibility of the Dean of the Medical Faculty. In this case, the dean was more
concerned about the dangers of exposure to the resident, so there was a
reduction in resident activity related to the C-19 case. Other things that are quite
important in this training process include the cancellation of fellowships to
several countries abroad
What was very touched was that there were quite a lot of victims of health workers, 240 doctors who died and three of them were neurosurgeons who were victims of C-19, namely Dr. Sianne Winaktu, Dr. Mahmud, Dr. Andrianto Purnawan. We are deeply saddened by their loss.
Since the end of February 2021, there appear to be signs of a decrease in the number of cases hospitalized and also a decrease in the number of cases who die, which gives us significant hope. Now with strict and fast screening, more surgeries are being performed and outpatient visits are getting better. What is quite encouraging is that the hectic activities of transferring knowledge and experience can be seen with the zoom webinar activity held by various neurosurgery education centers in Indonesia. We all hope that this pandemic will be resolved well and in the future, neurosurgical services and training will develop further.