A Model for Neurosurgical Outreach to International Charity Hospitals: Lessons from Maria Auxiliadora Hospital, Lima, Peru

INTRODUCTION: Modern neurosurgery has failed to reach many citizens of the developing world as the result of a myriad of geopolitical and financial obstacles. One method to efficiently and cost effectively improve care provided by international charity hospitals in a sustainable way is through targeted neurosurgical outreach, equipping operating theaters, and educating local neurosurgeons. The International Neurosurgical Children's Association (INCA) effectively improved the available neurosurgical care in the Maria Auxiliadora Hospital of Lima, Peru through the advancement of local specialist education and training. METHODS: A mission team provided neurosurgical equipment and training for the local neurosurgeons of Maria Auxiliadora Hospital of Lima, Peru. A standard letter introduced the program to select international neurosurgical societies. An initial site evaluation visit assessed the faculty skill level, host site facilities, political influence in hospital, and equipment. A series of intensive 1-week trips per year over 3 years were used to teach techniques such as neuroendoscopy, microsurgical tumor resection, and minimally invasive neurosurgery. RESULTS: The INCA mission to the Maria Auxiliadora Hospital in Lima, Peru, involved three visits with costs totaling $40,000 for travel and equipment. Two senior host faculty were trained, both of whom currently function independently with basic neuroendoscopy. This was accomplished during 41 total cases. The number of endoscopy cases performed by the host team each year in between visits successively increased. At the end of 3 years, the host neurosurgeons added microsurgical techniques to previously performed operations and were proficiently and independently performing neuroendoscopy and minimally invasive neurosurgery. CONCLUSION: The purpose of targeted neurosurgery outreach is to create sustainable programs serving indigent patients in an area with demonstrated need, yet sufficient infrastructure to sustain the new resources and surgical skills. Our experiences may serve as a successful template for the execution of other cost efficient and sustainable neurosurgery missions worldwide.