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Zachary S. Hubbard, Ashish H. Shah, Michael Ragheb, Shelly Wang, Sarah Jernigan and John Ragheb

S urgical intervention has the potential to significantly reduce the global burden of disease; however, in developing areas of the world such as Haiti, access to surgical treatment is limited. Surgically treatable diseases remain a major cause of worldwide mortality with approximately 17 million deaths per year. Additionally, lack of access to affordable and appropriate surgical care affects over 80% of the world’s population, with the most severe disparity evident in low- and middle-income countries (LMICs). 15 , 20 Left untreated, the natural course of

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Ashish H. Shah, Ernest Barthélemy, Yudy Lafortune, Joanna Gernsback, Ariel Henry, Barth Green and John Ragheb

T he global burden of neurosurgical disease has been vastly underestimated as a major contributor to public health morbidity. In 2010, surgically treatable conditions contributed to nearly one-third of all deaths worldwide (16.9 million), with more than 5 billion people lacking access to timely, safe, affordable surgical care. 8 , 10 The inequity is especially pronounced in low- and middle-income countries (LMICs), where the vast majority of patients cannot afford access to surgical or anesthesia care. In LMICs such as Haiti, Uganda, Sierra Leone, etc

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Michael Ragheb, Ashish H. Shah, Sarah Jernigan, Tulay Koru-Sengul and John Ragheb

the development of subsequent hydrocephalus. 6 Further studies by Schiff et al. in sub-Saharan Africa demonstrated that rainfall may drive bacterial exposure and the ensuing infections that lead to PIH. 8 Lack of access to neurosurgical care, coupled with the expense of surgical equipment, limits treatment options for children born in developing countries with hydrocephalus, which inevitably results in poor overall outcomes. In response to the lack of pediatric neurosurgery care and high rates of untreated children with hydrocephalus in Haiti, Project Medishare

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Robert M. Levy, Vincent G. Pons and Mark L. Rosenblum

S everal investigators have recently identified a clinical syndrome affecting primarily homosexual males and Haitians. 6, 8, 13 With no known cause of diminished resistance, these patients present with diseases suggestive of a defect in cell-mediated immunity, including Kaposi's sarcoma, Pneumocystis carinii pneumonia, and other serious opportunistic infections. The syndrome has been designated the “acquired immunodeficiency syndrome” (AIDS) because of the presumed etiological immune deficiency. Patient groups at high risk of contracting AIDS include

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Ryan T. Muir, Shelly Wang and Benjamin C. Warf

32% of congenital neurosurgical conditions; 4 in Kenya, hydrocephalus represents the highest surgical burden of disease in male children; 78 and in Uganda, hydrocephalus accounts for 59% of neurosurgical conditions. 67 With more than half of Africa's population younger than 18 years, it is remarkable that fewer than 10% of neurosurgeons have subspecialty training in pediatric neurosurgery. 5 In Haiti, with a population of 10 million, one-third of whom are younger than 14 years of age living in poverty, access to neurosurgical care is also sparse. 76 In many

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Lizardo Cerezo, Marcelino Alvarez and George Price

, persistent unexplained lymphadenopathy, and diarrhea. Although no single reliable test has yet been found for the diagnosis of AIDS, the immunological defect is characterized by a depression of the ratio of helper T lymphocytes to suppressor T lymphocytes (H/S ratio). In 1979, the first five cases of AIDS were recognized. As of July, 1984, over 5000 AIDS patients were identified in the United States. 3 The high-risk individuals who have developed AIDS fall into the following categories: 1) homosexual or bisexual men; 2) intravenous drug abusers; 3) Haitians; 4

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many extended visits to Africa, Haiti, and Thailand. On examination, a lowered T cell helper/suppressor ratio (0.08:1) was found, but previously obtained biopsies from skin and rectal mucosa were negative. He became lethargic, incontinent, febrile, and aphasic, with a right-sided hemiparesis. Peripheral blood and cerebrospinal fluid examinations were unrevealing, 3 except for a leukopenia of 1600/ µ l. Computerized tomography examination showed many nondiagnostic hyperdense areas in the cerebral hemispheres. Following recommendations in the literature, we performed

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Jacquelyn A. Corley and Gail Rosseau

specialized epilepsy care. 12 Haglund et al. 7 describe their twinning program at Duke University Medical Center with New Mulago Hospital in Uganda. In addition to donating useable surplus supplies, the Duke teams facilitate surgical camps several times a year to provide a platform for training all providers, including anesthesiologists and perioperative nurses. In the first 2 years since implementation, an increase in neurosurgical cases, as well as cases from other surgical specialties, was observed at New Mulago Hospital. 7 In Haiti, the first-ever neurosurgical

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Robert M. Levy, Dale E. Bredesen and Mark L. Rosenblum

, several other groups at risk have subsequently been identified. Reports of AIDS in recent Haitian immigrants to the United States without other known risk factors have appeared. 103, 118 Additional cases of AIDS in Haitians still residing in Haiti have recently been confirmed. 109 Of 61 Haitian AIDS patients, 15 had Kaposi's sarcoma and 45 had opportunistic infections. Other risk factors were identified in only approximately 20% of patients. Pneumocystis carinii pneumonia was initially documented in three patients with hemophilia A in 1982. 28 Since then, several

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James T. Rutka

Neurosurgery (ISPN) to name just a few. I had the pleasure of attending a recent conference at Weill Cornell Medical College in New York City, on January 19, 2019, entitled “Global Neurosurgery 2019: A Practical Symposium.” Participants from around the world gathered to discuss their efforts and models in countries such as Haiti, Tanzania, Vietnam, Cambodia, and Bolivia. Specific challenges, solutions and successful projects, key failures, and lessons learned were all discussed. At the symposium, I had the great privilege of discussing our global neurosurgery effort over the