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Evolution of Neurosurgery in Bangladesh Original Article

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Evolution of Neurosurgery in Bangladesh Original Article Original Article Evolution of Neurosurgery in Bangladesh Khan AH1, Hossain ATMM2, Shalike N3, Barua KK4 Abstract: The beginning of Neurosurgery is not very new in Bangladesh. Prof.Rashiduddin Ahmed established the first Neurosurgery unit in the then Institute of Postgraduate Medical Research (IPGMR) with only six beds in 1970. The first generation neurosurgeons left the field of neurosurgery in the safe hands of their disciples. There was a rapid progression of neurosurgery further both in private and in government level after 2000.In 1997 the first MS (Neurosurgery) course was started in IPGMR which was replaced by a 5-year residency course under Bangabandhu Sheikh Mujib Medical University (BSMMU) in 2010. Till now over 154 candidates are the active members of Bangaldesh Society of Neurosurgeons and are practicing independent neurosurgery. It is a very popular course and at present there are about 89 residents in various phases of the course in 4 institutions under BSMMU. With the available investigations, diagnostic facilities, operative facilities and good neuroanesthesia; now neurosurgeons also developed their skills in vascular neurosurgery, pediatric neurosurgery, endoscopic neurosurgery, spinal stabilization procedures, stereotactic neurosurgery and stem cell therapy. We are also hopeful that, very soon we would be able to achieve and develop our standard of neurosurgery to an international level by our determination and continuous effort, and by suitable and update learning, teaching and training. Key words: Neurosurgery, Bangladesh, BSMMU. Bang. J Neurosurgery 2019; 8(2): 57-62 Introduction: the world’s eighth most populous country. The per Bangladesh is a country in South Asia sharing its capita income of the country as of 2018 estimate is land border with India and Myanmar (Burma). The $4,561. The country has a low literacy rate, which total area of the country is 147,570 km2. It became was estimated at 66.5 percent for males and 63.1 independent on 16th December, 1971 from Pakistan percent for females in 2014. Health and education by liberation war. Agriculture is the largest sector of levels remain relatively low, although they have the economy, making up 18.6 percent of Bangladesh’s improved as poverty levels have decreased.1 Gross Domestic Product (GDP) in November 2010 Bangladesh has an average life expectancy of and employing about 45 percent of the workforce. It approximately 70 years. The chances of dying is one of the largest textile exporters in the world. between the ages of 15 and 60 years are more than Estimates of the Bangladeshi population vary, but 1 in 4. Health remains an important goal and 2016 UN data suggests 163 million. Bangladesh is instrument of development in this evergrowing nation.The beginning of neurosurgery is not very new 1. Prof. Akhlaque Hossain Khan, Professor and Course in Bangladesh.2 Coordinator, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka1000, Bangladesh. During the Pakistan period Professor Omar ValiJooma 2. Prof. A.T.M. Mosharef Hossain, Professor and Chairman, (AKA Jooma Khan) used to come from Karachi to Department of Neurosurgery, Bangabandhu Sheikh Mujib provide consultancy primarily for head injury patients. Medical University, Dhaka1000, Bangladesh. It was a very limited and expensive facility.3 3. Dr. Narendra Shalike, MS Neurosurgery, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Professor Rashiduddin Ahmad (1937 – Dhaka1000, Bangladesh. 2016)returned to East Pakistan in 1970 after having 4. Prof. Kanak Kanti Barua, Professor and Former Chairman, completed his Fellowship of the Royal Colleges of Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka1000, Bangladesh. Surgeons (FRCS) & five years Neurosurgery training Address of Correspondence: Prof. Akhlaque Hossain Khan, under Professor F. John Gillingham in Edinburg and Professor and Course Coordinator, Department of Neurosurgery, established the first Neurosurgery unit in the then Bangabandhu Sheikh Mujib Medical University, Dhaka1000, Bangladesh. Email: [email protected] Cell No.: Institute of Postgraduate Medical Research(IPGMR) +8801711471153 (now Bangabandhu Sheikh Mujib Medical University Bangladesh Journal of Neurosurgery Vol. 8, No. 2, January 2019 BSMMU) with only six beds.He took part in the About 68 (44.2%) neurosurgeons graduated with liberation war and went back to UK for fear of his Master in Surgery (MS) Neurosurgery nonresidency life. He again joined in 1976 in the Department of and nonresidency course and Fellowship of College Neurosurgery, IPGMR. He is considered to be the of Physicians and Surgeons (FCPS) Neurosurgery Founder of Neurosurgery of Bangladesh.3,4 course from 20102018 and 61 (39.6%) neurosurgeons graduated at the first decade of 2000 Professor A H M Ahsanullah (1937–2014), a while there was only 4 first generation neurosurgeons neurosurgeon that time, started Neurosurgery in in the 70s decade (Fig. 1 and Table 1). IPGMR in 1972 in independent Bangladesh.Professor Ata Alahi Khan (19392016) started Neurosurgery in Currently we have approximately 1 neurosurgeon per Dhaka Medical College Hospital(DMCH) in 1975. million population of Bangladesh (Table 1). As pipeline Professor Lutful Anwar Quaderystarted Neurosurgery neurosurgeons, 89 residents are expected to be in Chittagong Medical College Hospital(CMCH) in graduated from four of the institutions with MS residency 1978.They were the first generation neurosurgeons course under BSMMU from 20192023 (Table 2). of Bangladesh.3,5 It was observed that, till now out of 154 members of The first generation neurosurgeons left the field of BSNS, only 4 (2.6%) female neurosurgeons have neurosurgery in the safe hands of their disciples, been graduated and 6 (4.5%) out of 89 residents are notably Prof. Mohammad Afzal Hossain, Prof. Kanak currently in MS residency course under BSMMU. Kanti Barua, Prof. Shafique Uddin Ahamed, Prof. From 2002 to 2018, 13 foreign residents (all Nepalese) Waheed Uz Zaman, Brig. Gen. Mohammad have been graduated with MS Neurosurgery Non Nuruzzaman, Prof. Nausher Alam, Prof. Abul Khair residency and Residency course from BSMMU and and others. Since then they had been working hard currently there are 7 foreign residents (6 from Nepal together to establish neurosurgical centres all over and 1 from Bhutan) undergoing MS residency course the country to increase the number of beds in at BSMMU (Table 3). neurosurgery wards, and to motivate, inspire and train new doctors to consider neurosurgery as career path. Among four of the institutions currently with MS Neurosurgery residency course, DMCH has majority Methods and Materials: of beds distributed for neurosurgical patient (290 This retrospective study has reviewed the computer beds) followed by NINS with 175 beds, BSMMU with database with details of neurosurgeons from 95 beds and CMCH with 88 beds excluding cabin Department of Neurosurgery of BSMMU, DMCH, bed facilities (Table 4). National Institute of Neurosciences and Hospital Table-I (NINS), CMCH and Bangladesh Society of Total No. of Neurosurgeons in Bangladesh per Neurosurgeons (BSNS), Dhaka, Bangladesh from total population8,9 January 2017 to September 2018. The data regarding the total no. of neurosurgeons in Bangladesh, total no. Year No. of Population of female neurosurgeons in Bangladesh (graduated (in decades) Neurosurgeons (in millions)1 and currently undergoing residency program), total in Bangladesh no. of current residents in four of the colleges/institute 19701979 *4 70 80 under BSMMU, foreign students with MS Neurosurgery 19801989 9 80 105 course from BSMMU, and bed distribution and statistics 19901999 12 105 130 of the patients in four of the above mentioned institutes 20002009 61 130 150 are compiled and analyzed. 20102018 68 160 Results: Total 154 From the establishment of Neurosurgery unit in then 1 neurosurgeon per 1 million population (approximate) IPGMR in 1970 to June 2018, about 154 Pipeline 180 neurosurgeons are documented as members of Neurosurgeons (estimated) Bangladesh Society of Neurosurgeons. Following year (Expected) 2000, there was a rapid progression of in the field 20192023 89 ofneurosurgery further both in private and in 1 neurosurgeon per 750,000 population (approximate) government level. At the same time postgraduation *Note: Out of 4 first generation neurosurgeons (197079), only one courses also expanded much more ever than the past. is alive now. 58 Evolution of Neurosurgery in Bangladesh Khan AH et al. (Total = 154) 80 68 70 61 60 50 40 30 20 9 12 10 4 0 1970-1979 1980-1989 1990-1999 2000-2009 2010-2018 Fig.-1: Total No. of Neurosurgeons in Bangladesh8,9 Table-II Total No. Current Residents in various institutes/medical colleges of Bangladesh7 Session year BSMMU DMCH NINS CMCH Total residents 2011 1 2012 2 2013 4 2014 7 3 89 2015 7 6 3 (on pipeline 2016 5 6 3 neurosurgeons) 2017 6 6 5 3 2018 8 6 5 3 Total 40 24 10 15 Table-III Foreign students with MS Neurosurgery course from BSMMU (From Nepal and Bhutan)7,9 Year Name of the Neurosurgeons Total 20022011 Graduated from BSMMU 4 (Nonresidency course) 20112018 Graduated from BSMMU 9 (Residency course) 20192023 Pipeline Neurosurgeons (Expected) 7 Table-IV Bed distribution at Department of Neurosurgery of various instituitions10 Ward BSMMU DMCH NINS CMCH Bed Total Bed Total Bed Total Bed Total Male ward 38 95 140 290 80 175 35 95 Female Ward 29 110 67 30 Emergency Ward 28 40 28 30 59 Bangladesh Journal of Neurosurgery Vol. 8, No. 2, January
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