1433. The Current State of Neurosurgery in Haiti

Authors: Phabinly James Gabriel; Phabinly Gabriel, BA; Ernest Barthélemy MA, MD; Yudy Lafortune, MD; Hélène Clervius, MD; Jordan Pyda, MD; Kee Park, MD (Newark, NJ)

INTRODUCTION:  Neurosurgical need in Haiti, a low-income country (LIC) in the Caribbean, is largely unmet due to limited understanding of local neurosurgical epidemiology and an impoverished healthcare system. This narrative provides an update on the current state of neurosurgery in Haiti, including descriptions of local neurosurgical leaders, an overview of contemporary capacity-building initiatives, and recommendations to guide future global collaborations.

METHODS: We utilized a mixed methods approach to document the current state of neurosurgery in Haiti, including comparative bibliometric analysis of relevant research, data searches utilizing the WFNS Global Neurosurgical Workforce Map and the World Bank database, and informal interviews of local and foreign neurosurgeons practicing in Haiti.

RESULTS: A structured literature search on the topic “Neurosurgery AND Haiti” yielded 14 publications, compared to results ranging from 18 to 211 articles for each of the remaining regional island-nations studied. Articles offer limited data on neurosurgical disease burden and recent initiatives. A total of four formally trained neurosurgeons currently serve a population of 10.5 million inhabitants, yielding a neurosurgeon-per-100,000 population density (NPPD) of 0.038, which ranges from 1/12 to 1/25 the NPPD of neighboring countries. Notable contemporary initiatives include the recent relaunch of the local clinical neuroscience society, continued work of a notable hydrocephalus treatment program, and the recent creation of Haiti’s first neurosurgical fellowship training which was established in collaboration with the Haitian Ministry of Health, the medical school of the State University of Haiti, and the University of Miami. 

CONCLUSIONS: Limited data on Haitian neurosurgical disease burden, and an inadequate workforce as measured by NPPD, contribute to acritically unmet need for neurosurgical care. Solutions will require the collective effort of a culturally competent, multidisciplinary community that includes neurosurgeons, partnering healthcare providers, public health leaders, academics, professional humanitarian organizations, and the engagement of political stakeholders in Haiti’s universal health coverage.