University of Mohammed V Souissi, Rabat.
The high cost of technology is considered to be the determining factor slowing the expansion of modern neurosurgery in many developing countries. The literature dedicated to this topic rarely proposes internal solutions whereby affected countries can overcome this economic impediment. Certain articles cite inevitable obstacles, and the neurosurgeons of these countries can become disheartened when these articles conclude with calls for foreign help as the only approach to the development of neurosurgery. METHODS: Morocco is presented as an example of a developing country in which neurosurgery has become well established in the past 30 years, using a program based on four guidelines, as follows: 1) encouraging the local training of young neurosurgeons, 2) organizing and promoting neurosurgery, 3) integrating the development of neurosurgery into the health care pyramid system, and 4) stimulating research on local pathological conditions. RESULTS: Because of the internal planning efforts stimulated by the first national neurosurgeons, Morocco has progressed from 2 underequipped neurosurgical services and 5 neurosurgeons in 1968 to 12 well-equipped services and 80 neurosurgeons in 1998. The main benefits of this progress are discussed. CONCLUSION: Neurosurgery in developing countries can be promoted if the first working neurosurgeons take up their responsibilities as pioneers. This role requires that they initiate the training of young neurosurgeons as soon as possible and that they find in the local conditions the necessary factors to promote neurosurgery and to integrate it into the health care development of their country 1).