Romanian Neurosurgery (2019) XXXIII (3): pp. 329-331 DOI: 10.33962/roneuro-2019-056 www.journals.lapub.co.uk/index.php/roneurosurgery Overview of neurosurgical capacity in St. Lucia Emil Zhalmukhamedov1, Christopher Magloire2, E. Maidyrov3, Aleric Soans4, Latisha Elijio5, Nikita Nossov6, Shameea Mahbub7 1 Scientissimum Medical Group (Richmond Hill, NY, USA.), New York Chiropractic College (Seneca Falls, NY, USA) 2 Scientissimum Medical Group (Richmond Hill, NY, USA.), SUNY Downstate (Brooklyn, NY, USA) 3 Scientissimum Medical Group (Richmond Hill, NY, USA.), Central Almaty Clinic Department of Interventional Cardiology (Almaty, KAZAKHSTAN) 4 International American University College of Medicine (St. Lucia, WEST INDIES) 5 CUNY City College (Brooklyn, NY, USA) 6 Kent State University (Kent, OH, USA) 7 CUNY Baruch College (New York, NY, USA) ABSTRACT When we talk about the most scenic Caribbean islands, St. Lucia is one of those islands that certainly come into our mind. It is a beautiful tourist destination and the place of post-volcanic paradise on earth. However, just like many remote Caribbean islands, St. Lucians (name for local population) used to have its own difficulties of obtaining on demand basic neurosurgical services in their homeland. This beautiful Caribbean island, socioeconomically falls in the same category as most low-and middle-income countries (LMICs) and unfortunately echoes the same unmet surgical and anaesthesia needs as the rest of them. INTRODUCTION Out of any specialized medical professions, neurosurgery requires diversely prepared physicians and specialized operating rooms and experienced staff, who can handle variety of cranial and spinal cases on demand. In this paper we provided an overview of current neurosurgical capacity in St. Lucia, a Caribbean island that recently defined its neurosurgical scope of work. Our research included a systematic survey, in-person data mining and observation of neurosurgical capacity on the island from 2018 to 2019. THE STATE OF NEUROSURGERY SERVICES ON THE ISLAND As of 2019 population census reported a count of 180,287 St. Lucians living on the island [1]. It’s very hard to imagine that population which is getting closer to 200,000 people didn’t have an adequate access to Keywords Caribbean neurosurgery, neurosurgery capacity in lmics Corresponding author: Emil Zhalmukhamedov Scientissimum Medical Group (Richmond Hill, NY, USA.), New York Chiropractic College (Seneca Falls, NY, USA) scientissimum@hotmail.com Copyright and usage. This is an Open Access article, distributed under the terms of the Creative Commons Attribution Non–Commercial No Derivatives License (https://creativecommons .org/licenses/by-nc-nd/4.0/) which permits non- commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of the Romanian Society of Neurosurgery must be obtained for commercial re-use or in order to create a derivative work. ISSN online 2344-4959 © Romanian Society of Neurosurgery First published September 2019 by London Academic Publishing www.lapub.co.uk http://www.lapub.co.uk/ 330 Emil Zhalmukhamedov, Christopher Magloire, E. Maidyrov et al. the lifesaving specialized surgical procedures. Up until august 2016 St. Lucian’s population who suffered from complex neurosurgical diseases or traumas, had to be evacuated by air to the nearest and more medically developed island such as Barbados, in order to receive a competent neurosurgical care. With this model in mind, it’s not hard to figure out that majority of critical patients who needed an immediate intervention, simply didn’t make pass the receiving hospital’s doors. Presently, St. Lucia has 2 fully functioning board certified neurosurgeons, namely Dr. Curby Dwaine Sydney who is native St. Lucian and Dr. Esteban Roig Fabré – a distinguished professor from Cuba. Both neurosurgeons provide a broad (general) spectrum of adult and paediatric neurosurgical services on the island (Figure 1), which are not limited to [2]: 1. Brain and spine microsurgical procedures 2. Craniotomy and cranioplasty for traumatic brain injuries 3. Cerebrovascular accident treatments. 4. Ventriculostomy and ventriculoperitoneal shunt placements. 5. Spinal procedures include: discectomy, microdiscectomy and laminectomy. On the diagnostic/imaging side, the following equipment is utilized: • Computed Tomography (CT). • Magnetic Resonance Imaging (MRI). • Electroencephalogram (EEG). • Intracranial pressure (ICP) monitoring. • 3D volume rendering and multi-planar reconstruction software. FIGURE 1. Proportion of available neurosurgeons to population of St. Lucia Due to a scarce nature of neurosurgeons on the island, both neurosurgeons also cover neuro-consult services in public Victoria and private Tapion hospitals for referred emergency patients. Both hospitals function as level 1 trauma centres and are equipped with generalist physicians in the emergency room. Additionally the ministry of health of St. Lucia is working with U.S non-profit organization “WPP” which stands for World Paediatric Project. The WPP organization provides volunteer specialized paediatric surgeons from U.S to address the need of surgically sick children in the Caribbean islands. The majority of ongoing WPP surgeries in St. Lucia were addressing congenital scoliosis. Those children with more complex spinal deformities have an opportunity to be flown to U.S for ongoing treatment and monitoring. Prevalence of neurosurgical disease Upon our discovery, St. Lucia along with other LMICs such as Haiti has the same prevalence of neurosurgical disorders [3]. The number one spot takes traumatic brain injury (TBI) followed by cerebrovascular accidents (CVA) [4][5], spinal deformities and congenital pediatric cases (Figure 2). During our research findings it was interesting to note that St. Lucia has low percentage of tumour prevalence in both adult and paediatric patients. FIGURE 2. Graphical representation of neurosurgical cases in St. Lucia The most obvious reason for high incidence of traumatic brain injury prevalence is uncoordinated 331 Overview of neurosurgical capacity in St. Lucia and unstructured road infrastructure. There is no evidence of dedicated traffic police or clear markings on the pavement for traffic to flow on some major highways (figure 3). Therefore every driver and pedestrian is guided according to his/her own intuition. The second largest prevalence of neurosurgical disease is cerebrovascular accidents. The cerebrovascular accidents in St. Lucia directly correlate to lack of primary care screening. Even though shortage of primary care doctors is not evident, citizens are not exposed to ongoing physical check-up or simply neglect doctor’s visits. Our findings showcased that majority of St. Lucian population older than 50 years old are found to have diabetes mellitus or uncontrolled hypertension; which can explain why it contributes to CVA and makes up to 28.6% of all neurosurgery related diseases. FIGURE 3. St. Jude highway in Vieux Fort CONCLUSION This paper showcased an overview of current state of neurological surgery that could be used as a guidance to further neurosurgical development in St. Lucia. As St. Lucian government in collaboration with World Bank continues to invest capital in public healthcare [6], further studies are suggested to assess advancement of neurosurgical care from this point on. Declarations Consent for publication The consent for publication is not applicable for this review article. Competing interests Authors declared no competing interests to declare. Availability of data and material Data sharing is not applicable for this review article. Funding Funding is not applicable to this study. Acknowledgements Author would like to acknowledge the contributing neurosurgeons who are actively involved in improving neurosurgical care worldwide. Ethics approval and consent to participate The approval and consent is not applicable to this study. REFERENCES 1. Saint Lucia Population (LIVE). Worldometers. http://www.worldometers.info/world-population/saint- lucia-population/. Accessed April 17, 2019. 2. Sydney CD. Business Focus. 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