International Issues: Expanding neurologic education to resource- poor countries Lessons from Moi Teaching Hospital

It is well-recognized that there is a disparity in health care resources and availability in low- and middle-income countries, often due to a combination of poverty, lack of clean water and adequate nutrition, and political conflict. Yet it seems less attention is given to challenges specific to the provision of medical education in such developing nations. Besides war, famine, drought, and the AIDS epidemic, eastern African nations carry a heavy burden of neurologic disease(1) and insufficient infectious disease programs,(2) coupled with a paucity of subspecialty-trained providers. Over the past decade, there has been increasing concern over the so-called brain drainthe ongoing relocation of African doctors to more profitable parts of the world,(3) perceivably due to the challenges inherent to practicing in resource-limited settings. This is exemplified by the estimated 0.03 neurologists per 100,000 people in low-income African countries (compared to 1 to 10 per 100,000 in Western countries), and further by the lack of neurologists in all of sub-Saharan Africa.(4) Similar estimates in sub-Saharan Africa suggest that there is only 1 neurosurgeon for every 4,000,000 people, with dedicated neurologic and neurosurgical services available only in a few private centersinstitutions that are financially inaccessible to 90% of the population due to the nonexistence of health insurance systems.(5