In Reply: The State of Cerebrovascular Care in Africa.

To the Editor: We express our gratitude to Dr Totimeh et al for their letter1 in response to our article on the state of cerebrovascular care in Africa.2 The issues encountered in delivering cerebrovascular care in Ghana are evident, and we appreciate their insights into said issues while being heartened by their acknowledgement of the urgent need to enhance African neurosurgical care. The concerns identified by Dr Totimeh and his collaborators are valid and highlighting the pressing need for a transformation in the health care systems in Ghana and Africa is admirable. Nevertheless, these challenges elucidate the erroneous leadership aims and paucity of preparation. We believe that addressing the said challenges will necessitate a collaborative effort on the part of all stakeholders, including health care providers, policymakers, and communities. As Dr Totimeh deliberated in his topical letter, it is possible to ensure that health insurance covers neurosurgical care, although it may be resource-intensive during the initial stages. We second the idea that neurosurgical coverage should be added to local health insurance to ensure that patients would be able to receive the care they require. The lack of technical expertise1 identified by Dr Totimeh and his team is also concerning. In particular, his team member noted that during surgical preparation in the operating room, nurses were ill-prepared and lacked the technical expertise warranted for critical intraoperative tasks. This observation suggests that not only doctors but also other members of the multidisciplinary surgical team had subpar training, indicating the flawed state of cerebrovascular care and neurosurgery delivery in Ghana and Africa as a whole. We greatly appreciate the authors' contribution to this important topic and hope that this dialog will continue and that a larger community will join us in advocating for our African neurosurgical colleagues.