East Africa or Eastern Africa is the eastern region of the African continent, variably defined by geography. In the United Nations Statistics Division scheme of geographic regions, 20 territories make up Eastern Africa:
Tanzania, Kenya, Uganda, Rwanda, Burundi and South Sudan are members of the East African Community (EAC). The first five are also included in the African Great Lakes region. Burundi and Rwanda are at times also considered to be part of Central Africa. Djibouti, Eritrea, Ethiopia and Somalia – collectively known as the Horn of Africa.
The area is the easternmost projection of the African continent, and is sometimes considered a separate region from East Africa.
Comoros, Mauritius and Seychelles – small island nations in the Indian Ocean.
Réunion and Mayotte – French overseas territories also in the Indian Ocean.
Mozambique and Madagascar – often considered part of Southern Africa, on the eastern side of the sub-continent.
Madagascar has close cultural ties to Southeast Asia and the islands of the Indian Ocean.
Malawi, Zambia and Zimbabwe – often also included in Southern Africa, and formerly constituted the Central African Federation (also known historically as the Federation of Rhodesia and Nyasaland).
Sudan and South Sudan (newly independent from Sudan) – collectively part of the Nile Valley. Situated in the northeastern portion of the continent, the Sudans are often included in Northern Africa.
Also members of the Common Market for Eastern and Southern Africa (COMESA) free trade area.
In the last 10 years, considerable work has been done to promote and improve neurosurgical care in East Africa with the development of national training programs, expansion of hospitals and creation of new institutions, and the foundation of epidemiologic and cost-effectiveness research. Many of the results have been accomplished through collaboration with partners from abroad. This article is the third in a series of articles that seek to provide readers with an understanding of the development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare in the region (Innovations). In this article, we describe the ongoing programs active in East Africa and their current priorities, and we outline lessons learned and what is required to create self-sustained neurosurgical service 1).
Santos et al., reviewed the major challenges facing health care in East Africa and grouped them into 5 categories: 1) burden of surgical disease and workforce crisis; 2) global health view of surgery as “the neglected stepchild”; 3) need for recognizing the surgical system as an interdependent network and importance of organizational and equipment deficits; 4) lack of education in the community, failure of primary care systems, and net result of overwhelming tertiary care systems; 5) personal and professional burnout as well as brain drain of promising human resources from low- and middle-income countries in East Africa and similar regions across the world. Each major challenge was detailed and analyzed by authors who have worked or are currently working in the region, providing a personal perspective 2).
Mangat et al., reviewed the history and evolution of neurosurgery as a clinical specialty in East Africa. They also reviewed Kenya, Uganda, and Tanzania in some detail and highlight contributions of individuals and local and regional organizations that helped to develop and shape neurosurgical care in East Africa. Neurosurgery has developed steadily as advanced techniques have been adopted by local surgeons who trained abroad, and foreign surgeons who have dedicated part of their careers in local hospitals. New medical schools and surgical training programs have been established through regional and international partnerships, and the era of regional specialty surgical training has just begun. As more surgical specialists complete training, a comprehensive estimation of disease burden facing the neurosurgical field is important.
They present an overview with specific reference to neurotrauma and neural tube defects, both of which are of epidemiologic importance as they gain not only greater recognition, but increased diagnoses and demands for treatment. Neurosurgery in East Africa is poised to blossom as it seeks to address the growing needs of a growing subspecialty 3).