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| LETTER TO EDITOR |
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| Year : 2018 | Volume
: 4
| Issue : 1 | Page : 89-90 |
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Neurosurgery in India: Success and challenges
Ankit Raj1, Amit Agrawal2
1 Medicine, Kasturba Medical College, Manipal, Karnataka, India
2 Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| Date of Web Publication | 23-Apr-2018 |
Correspondence Address:
Dr. Ankit Raj
Kasturba Medical College, Manipal, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/IJAM.IJAM_67_17
How to cite this article:
Raj A, Agrawal A. Neurosurgery in India: Success and challenges. Int J Acad Med 2018;4:89-90 |
| Neuroepidemiology in India | |  |
A recent report published by the World Health Organization, “Neurological disorders, public health challenges,” states that about one billion people worldwide suffer from neurological disorders including epilepsy, stroke, headache, Alzheimer's disease, Parkinson's disease, multiple sclerosis, brain injuries, and neuroinfections and that 6.8 million people die annually from these disorders.[1] Another study from India estimates that for the current population of 1.27 billion, approximately 30 million people suffer from neurological disorders including epilepsy, stroke, Parkinson's disease, traumatic brain injuries, and neuroinfections with a higher proportion of diseases in rural area as compared to urban centers.[2] Subsequently, India also has to face new challenges in neurosurgical care due to paradigm shift in disease burden. There is an epidemiological transition from infectious diseases such as tuberculosis, neurocysticercosis, and Japanese encephalitis to noncommunicable diseases such as strokes, cerebral trauma, epilepsy, cerebrovascular diseases, and neuromuscular disorders. India is also a witness to noteworthy proportion of poliomyelitis, developmental disorders, birth trauma, and nutritional deficiencies, resulting in a significant risk of mortality and morbidity attributed to preventable or curable neurological disorders.[1]
| Neurosurgeons, Education, and Societies | | |
India has approximately 1800 neurosurgeons (including about 25 women) for 1.27 billion people. Of the 330 approved medical colleges, only 59 have neurosurgical departments recognized for an MCh Neurosurgery training program, with an approved intake of 190/year. The duration of the course varies from 3 years for candidates who have a master's degree in general surgery to 5 or 6 years for those with an MBBS degree (basic medical degree).[3] Although some of the national institutes such as All India Institute of Medical Sciences (AIIMS), New Delhi; National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru; and Postgraduate Institute of Medical Education and Research, Chandigarh, have extremely well-established infrastructure and commendable system of training, most of the government hospitals and medical colleges across India still lack basic neurosurgical infrastructure, and hence incapable of providing neurosurgical training. However, multiple state-of-the-art corporate hospitals with extensive infrastructure and indisputable reputation have been accredited for residency programs by the National Board of Examinations, and have no dearth of clinical and research material, there is still a lack of actual hands-on-exposure and “cutting and stitching” for residents at these places.[3]
Started in 1951, by four young, visionary neurologists, the Neurological Society of India was India's first ever neurological society to bring all the disciplines associated with neurology under one roof. Gradually, several other subspecialty societies such as the Society for Paediatric Neurosurgery, Indian Society for Stereotactic and Functional Neurosurgery (SFNS), Skull Base Surgery Society, Neurotraumatology Society of India, and Cerebrovascular Society of India have evolved to cater to the specific needs of each subspecialty.[4] In 1992, sensing the greater domination of neurosurgeons in the Neurological Society of India, a separate society for neurologists was formed, known as the Indian Academy of Neurology, with its own publication and memberships.[5] Subsequently, several other societies were started, including, but not limited to, Neuro-Oncology Society, Neurosurgical Society of India, Neuro Spine Society of India, Association of Neuroradiologists, Society of Indian Neuro Nurses, and the Indian Society for Study of Pain. However, the Neurological Society of India continues to be the leader, indicating a necessity for an integrative approach to neurological sciences.
| Unmatched Needs | | |
Neurosurgeons of India are nationally and internationally renowned experts in the diagnosis and surgical treatment of innumerous brain and spine disorders including brain tumors, epilepsy, and trigeminal neuralgia. Globally, acclaimed hospitals from India like Fortis Healthcare Hospital, Apollo Hospitals, NIMHANS, and AIIMS provide world-class facilities for stereotactic radiosurgery, radiation oncology, SFNS, deep brain stimulation, skull base surgery, endovascular neurosurgery, and spinal surgery at a fraction of cost compared to treatment centers across Western nations, without any compromise on quality or success rate.[3]
While Indian neurosurgeons are highly acclaimed across the world with reputed positions across professional societies and universities, the majority of Indian population still has limited access to and knowledge about neurological disorders and neurosurgical diagnosis and treatment. A study in 2015 by Krishnan Ganapathy noted that neurological expertise is not distributed equivocally across India. While 80% of India's specialist doctors live in urban India, >700 million people living in rural India still have to travel a distance of 75–100 km for a tertiary consultation.[6]
Owing to its unique and diverse culture pattern and conservative ideology, most of the neurological disorders in India still face stringent social stigma resulting in reduced surgical access and care. In addition to this, most of the infrastructure-proof neurosurgical centers are established in tier-I and tier-II cities, whereas the majority of the Indian population still resides in rural areas and small towns, thus limiting timely access to the diagnosis and treatment.[2] Most of the primary health-care centers, which are the backbone of rural health care in India, have limited communication with specialty centers. Poor awareness and financial hardships also restrain patients from accessing facilities at tertiary care centers.
| Intervention | | |
To sustain long-term development of neurosurgical training and facilities, India needs to create policies and reforms catering to the current needs and challenges. There is an urgent requirement to increase residency seats for the neurosurgical training. It is unacceptable that the current number of trainees entering neurosurgical residencies in India is less than that of the US. Providing financial support through grants and interest-free loans will encourage hospitals to install high-end infrastructure and technology, which in turn, can raise the standard of care for patients. Continuous monitoring of neurosurgery departments across accredited hospitals and recognizing new centers with potential to establish neurosurgery departments will increase neurosurgery graduates and also raise availability and affordability of diagnostic and therapeutic services for patients. Applying advance technologies such as telemedicine, teleneuroradiology, and teleconsultation can supplement neurosurgical facilities at remote locations, thus providing a cost- and time-efficient alternative to patients from these regions.
| Conclusion | | |
Over the past few years, Indian neurosurgeons and hospitals have made huge strides in neurosurgical diagnosis and treatment. However, a large proportion of India, especially patients from lower socioeconomic strata or rural areas, still has limited access to these facilities. Indian government and professional societies need to urgently and dramatically increase the number of neurosurgical residencies and at the same time invest in infrastructure and use technology to make neurosurgery more accessible and affordable.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | World Health Organization. Neurological Disorders: Public Health Challenges. Geneva World Health Organization: 2006.  |
| 2. | Gourie-Devi M. Epidemiology of neurological disorders in india: Review of background, prevalence and incidence of epilepsy, stroke, Parkinson's disease and tremors. Neurol India 2014;62:588-98. [ PUBMED] [Full text] |
| 3. | Ganapathy K. Neurosurgery in India: An overview. World Neurosurg 2013;79:621-8. [ PUBMED] |
| 4. | |
| 5. | |
| 6. | Ganapathy K. Distribution of neurologists and neurosurgeons in India and its relevance to the adoption of telemedicine. Neurol India 2015;63:142-54. [ PUBMED] [Full text] |
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