Education & Training

The World Federation of Neurosurgical Societies Rabat Reference Center for Training

African Neurosurgeons: An Experience Worthy of Duplication

Abdeslam El Khamlichi

INTRODUCTION

he Fifth World Federation of Neurosurgical Societies(WFNS) Rabat Reference Center-Mohammed V Univer-

T sity Souissi Conference for African Neurosurgeons, held

on November 8e11, 2012, in Rabat, was the occasion to cele-brate the 10th Anniversary of the WFNS Rabat Reference Center

for Training of African Neurosurgeons. Both events were orga-nized under the High Patronage of His Majesty King Mohammed

VI of Morocco, in collaboration with the ministries of HigherEducation, of Health, and of Foreign Affairs, with the Moroccan

Society of Neurosurgery, the Education and Research Unit inNeurosurgery at the Faculty of Medicine and Pharmacy of Rabat.

That the Moroccan authorities are involved so greatly in thecelebration of the 10th Anniversary of the Center is proof of its

importance, its role as a model in advanced medical training, andits significance in South-South cooperation.

CREATION OF THE WFNS RABAT REFERENCE CENTER

As Second Vice-President of WFNS representing Africa(1997e2001), I approached the WFNS President at that time, M.

Samii, and asked him how the WFNS could help developneurosurgery in Africa. He suggested that before raising the

issue for discussion in the Administrative Council, it would bewise to prepare a report on the situation of neurosurgery in Af-

rica. During 1997e1998, a survey was conducted with a team ofAfrican neurosurgeons across the African continent. The results

of the survey were summarized in a report that was presentedduring the WFNS Administrative Council meeting in Geneva in

1999 (1). The report referred to a severe limitation in the numberof neurosurgeons (Table 1), especially in Sub-Saharan Africa,

where the rate was approximately 1 neurosurgeon to 10 millioninhabitants (1, 2).

After the presentation of this report, the WFNS Administrative

Council decided to create a reference center in Rabat, named

Keywords- African neurosurgery- Rabat Reference Center- Training

Abbreviations and AcronymsWFNS: World Federation of Neurosurgical Societies

Department of Neurosurgery, Hopital des Specialites, Mohammed V UniversitySouissi, Rabat, Morocco

234 www.SCIENCEDIRECT.com WORLD NEU

the WFNS Rabat Reference Center for Training of African

Neurosurgeons, and to create a WFNS Foundation with the aimof providing scholarships to the trainees and basic equipment

for senior neurosurgeons working in countries with limited re-sources. Two people played a key role in the creation of these

two projects: Madjid Samii, who had announced the project of aWFNS Foundation in his first speech after his election as WFNS

President in Amsterdam (1997), and J. G. Martin-Rodriguezwho, along with Madjid Samii, was the first to provide an

amount of US$10,000 each to launch the WFNS Foundation.The first WFNS Foundation scholarship was granted to the late

Didier Mudjir Balanda, who was the first trainee to begin histraining in the WFNS Rabat Reference Center on March 1,

2002.

Our first goal was to create the WFNS Rabat Reference Center

so that a good training facility was available with limited finan-cial resources, and the second was to train young neurosur-

geons in conditions that were as close as possible to theconditions available in their home countries. In the long term,

these trained neurosurgeons will be able to train other youngneurosurgeons so that they can develop neurosurgery programs

and techniques in their respective countries. Although it is adeveloping country, the WFNS chose to set up the center in

Morocco because it has made a great progress in its owndevelopment of neurosurgery. In addition, the project was fully

supported by Moroccan authorities with the aim of enhancingSoutheSouth cooperation.

In 2005, during the 13th World Congress of Neurological Surgery

in Marrakech, a cooperation agreement was signed betweenMohammed V University Souissi (Faculty of Medicine and Phar-

macy of Rabat) and the WFNS (WFNS Foundation for TrainingYoung African Neurosurgeons from Developing Countries).

Mohammed V University Souissi committed itself as the insti-tution to train these young African neurosurgeons in the same

conditions as Moroccan residents, whereas the WFNS was

To whom correspondence should be addressed: Abdeslam El Khamlichi, M.D.[E-mail: fh2nch@menara.ma]

Citation: World Neurosurg. (2014) 81, 2:234-239.http://dx.doi.org/10.1016/j.wneu.2013.10.051

Journal homepage: www.WORLDNEUROSURGERY.org

Available online: www.sciencedirect.com

1878-8750/$ - see front matter ª 2014 Elsevier Inc. All rights reserved.

ROSURGERY, http://dx.doi.org/10.1016/j.wneu.2013.10.051

Table 1. Disparity in the Distribution of Neurosurgeons inAfrica, 1998 (1, 2)

Population(in Millions) Neurosurgeons Ratio (Adjusted)

Africa 676 500 1/1,352,000.00

South Africa 45 65 1/615,000.00

North Africa 119 354 1/338,000.00

Sub-Saharan Africa 515 81 1/6,368,000.000

World 5.479 23.940 1/230,000.00

Figure 2. The National Neurosciences Center at Hopital des Specialites,University Hospital Center of Rabat.

EDUCATION & TRAINING

bound to grant fellowships and to support continuing education

for these residents (Figure 1).

Two duties were assigned to the center in the cooperationagreement signed between the WFNS and Mohammed V

University Souissi in 2005: the organization of basic training inneurosurgery for young African neurosurgeons granted by the

Figure 1. (A) Abdeslam El Khamlichi, Director of the World Federation ofNeurosurgical Societies (WFNS) Rabat Reference Center at MohammedV University Souissi and N. Hajjaj, Dean of the Medical School atMohammed V University Souissi signing the Cooperation Agreement(June 19, 2005). (B) E. Laws, WFNS President and M. Samii, WFNSFoundation President signing the Cooperation Agreement (June 19,2005).

Figure 3. (A) Participants in the First clinical course, Rabat, March 8e11,2007. (B) Participants in the workshop on spinal instrumentation, Rabat,March 8e11, 2007.

WORLD NEUROSURGERY 81 [2]: 234-239, FEBRUARY 2014 www.WORLDNEUROSURGERY.org 235

WFNS or other institutions and the organization of courses

and workshops as postgraduate training to African neurosur-

geons. It was also stated in the Cooperation Agreement thatAfrican neurosurgeons would be selected either after taking an

Figure 4. Picture taken after the 3rd Course that took place at Golden Tulip Farah Hotel Rabat, March 26e28, 2010.

EDUCATION & TRAINING

examination or through study of the applicant’s file. Thosetaking the examination will receive a national diploma of

specialization in neurosurgery after their 5-year training, and theothers will receive a specialization certificate. All have to take

examinations on a yearly basis and are allocated the same tasksas all residents, for instance, managing patients at the depart-

ment and at the emergency department and performing surgeryas required in their training program. They also must present

scientific papers. The resident who has completed his/her 5-year training will then return to his/her home country, where

other neurosurgeons can be trained and come to the RabatReference Center for complementary training.

Figure 5. Lecturers and participants in the 4th

236 www.SCIENCEDIRECT.com WORLD NEU

ACHIEVEMENTS OF THE WFNS RABAT REFERENCE CENTER IN 10YEARS (2002e2012)

Basic TrainingAll African trainees are integrated in the National ResidencyProgram of Neurosurgery; they rotate between the three ser-

vices of neurosurgery in Mohammed V University Souissi ofRabat; they sit for the same examinations as their Moroccan

colleagues; they have access to the medical library and toe-learning; and they share the same activities as their Moroccan

colleagues at the hospital. To help young Moroccan and Africanresidents achieve a neurosurgery training with international

Course Rabat, March 25e27, 2011.

ROSURGERY, http://dx.doi.org/10.1016/j.wneu.2013.10.051

Figure 6. (A) Abdeslam El Khamlichi, Director of the World Federation ofNeurosurgical Societies (WFNS) Rabat Reference Center, making hisspeech during the Opening Ceremony of the 5th Conference Rabat,November 8e11, 2012. (B) Peter Black, WFNS President, making hisspeech during the Opening Ceremony of the 5th Conference Rabat,November 8e11, 2012.

Figure 7. (A) Abdeslam El Khamlichi (director of the WFNS RabatReference Center) receiving a Certificate of Merit from Peter Black(WFNS President), Armando Basso (WFNS Foundation President), andMadjid Samii (WFNS Ambassador for Africa) during the ceremonycelebrating the 10th Anniversary of the WFNS Rabat Reference CenterDecember 10, 2012. (B) WFNS Rabat Reference Center 10th anniversarycelebration. Peter Black, WFNS President, blowing out a candle on oneof the cakes to celebrate the 10th Anniversary of the WFNS RabatReference Center and A. Basso, WFNS Foundation President by his side.

Figure 8. Signature of the cooperation agreement between the WFNSRabat Reference Center and St. Michael’s Hospital, Toronto, Canada.From left to right: Mr. Arthur Labatt (donor), Abdeslam El Khamlichi,Director of the WFNS Rabat Reference Center, and Richard Perrin,representing St. Michael’s Hospital in Toronto.

EDUCATION & TRAINING

standards, Moroccan authorities with the support of Hassan II

Foundation for the Prevention and Cure of Nervous SystemDiseases and the University Hospital Center of Rabat launched a

new neuroscience center with three units: the FunctionalNeurosurgery Unit, the Interventional Radiology Unit, and the

Gamma Knife Radiosurgery Unit (Figure 2). This center was opento patients and residents in June 2008.

Between March 2002 and March 2012 (10 years), 23 African res-

idents registered in the Center; 8 finished their training, and 15 arestill in training. These trainees come from 13 Sub-Saharan African

countries (Benin, Burkina Faso, Cameroon, Congo Brazzaville, theDemocratic Republic of Congo, Guinea Conakry, Mali, Mauritania,

WORLD NEUROSURGERY 81 [2]: 234-239, FEBRUARY 2014 www.WORLDNEUROSURGERY.org 237

EDUCATION & TRAINING

Niger, Nigeria, Republic of Rwanda, Togo, and Uganda). The ratio

of neurosurgeons to population in all these countries varies be-tween one neurosurgeon/2e5 million people (10 countries), and

one neurosurgeon/10e20 million people (three countries).

In accordance with their commitment to return to their homecountry, those who have finished their training (n ¼ 8) are already

back home, taking care of patients, and gathering the practicingneurosurgeons in their country to create a local training program.

One such former resident is Dr. Ismail Nasiru, who returned toSokoto, Nigeria, in 2005, after 3 years of complementary training

in Rabat. He succeeded, with the support of Doctor Bello Bala

Shehu (who was trained in the United Kingdom) in setting up adepartment of neurosurgery at Usmanu Danfodiyo University

Teaching Hospital & Usmanu Danfodiyo University in Sokoto,North Nigeria. This department serves a region with more than

30 million inhabitants. Today, Dr. Nasiru is chief of the depart-ment and oversees three associates and six residents. The

hospital has computed tomography scanning, magnetic reso-nance imaging, an operating microscope, and surgeons are

equipped to perform all neurosurgical procedures, includinganeurysm clipping. Very quickly, their training program is

becoming one of the best in Nigeria.

Another example is Drs. Youssouf Sogoba and Oumar Coulibaly,who finished their 5-year training in Rabat in 2009 and 2011,

respectively, and returned to their country, Mali, with a popula-tion of 14 million inhabitants, as the two first neurosurgeons in

the country. Today, they have been joined by a third youngneurosurgeon, who was trained locally. They have set up a

unique neurosurgical team in Gabriel Toure Hospital, Bamako andreceived sets of instruments and a microscope from the WFNS.

We can easily imagine the importance of the help they providethe population of their home country, which unfortunately is torn

by war and terrorism.

Continuing Medical EducationThe second mission of the WFNS Rabat Reference Center in theCooperation Agreement signed between the WFNS and

Mohammed V University Souissi is to ensure continuing medicaleducation by organizing courses and workshops. Between 2002

and 2012, 5 courses, four workshops and two symposia wereorganized in collaboration with Mohammed V University Souissi,

the Moroccan Society of Neurosurgery, and Hassan II Foundationfor the Prevention and Cure of Nervous System Diseases

(Figures 3e6). In addition to these courses, African residentsattend scientific congresses and meetings inside or outside

Morocco. All residents in Rabat Center are encouraged to attendscientific events. During the year 2012, every resident attended

an average of three congresses, courses, or workshops. HassanII Foundation for the Prevention and Cure of Nervous System

Diseases ensures the main support for organizing this ContinuingMedical Education.

Beside the participants coming from the majority of African

countries, the organizers have always insisted on having WFNSofficers and representatives of various African societies partici-

pate as lecturers in each course to constantly maintain ex-changes either on the activities of the WFNS Rabat Reference

Center or on the evolution of African neurosurgery. In all courses,

238 www.SCIENCEDIRECT.com WORLD NEU

sessions have always been scheduled that address African

neurosurgery, especially a session dedicated to African neuro-surgeons who had been trained in the WFNS Rabat Reference

Center. In this session, those African neurosurgeons had theopportunity to present their experience after going back home.

Also, when presenting their conferences, lecturers have alwaysbeen asked to take into consideration the African context, mainly

the limited resources in the majority of countries.

10TH ANNIVERSARY OF THE WFNS RABAT REFERENCE CENTER

As we have seen, the last course (November 8e11, 2012) wasan occasion to celebrate the 10th Anniversary of the WFNS

Rabat Reference Center for training of African neurosurgeons(2002e2012) and to evaluate its achievements (Figure 7). Thisevaluation was made by the team of Rabat Reference Center,the WFNS officers, and African trainees during a special cere-

mony celebrating this 10th anniversary. The ceremony waschaired by the Moroccan Minister of Higher Education, who

stated in his opening speech, “I am saying it officially, theMoroccan Government fully support the initiative of neurosur-

gical training in Morocco.” In his speech, Peter Black, WFNSPresident, described the Center as “a beacon of light for African

neurosurgery and a model for all continents presently lackingadequate neurosurgical training centers.” Madjid Samii, WFNS

Honorary President and WFNS Ambassador for Africa, stated inhis speech, “We can be proud of the WFNS Rabat Reference

Center,” “The WFNS Rabat Reference Center is the beginningfor the takeoff of Africa in neurosurgery,” and “What was done

by Rabat team for Africa during the 10 years education is unique,

and remains unique in history.” Armando Basso, WFNS HonoraryPresident and WFNS Foundation President, stated in his speech

that “The WFNS Rabat Reference Center became a fantasticexample of what should be done to develop training programs”

and “The WFNS has other reference centers, but the ReferenceCenter in Rabat is an example of what should be done. This is the

superstar in the WFNS education program.”

COOPERATION AND PARTNERSHIP

During its first 10 years, the WFNS Rabat Reference Center hasattracted young residents to the practice of neurosurgery. It has

also been able to attract several institutions with the aim ofsupporting and helping the development of neurosurgery in Af-

rica. Beside the main partners (Mohammed V University Souissiand the WFNS), the Center is supported today by many other

institutions. Therefore, among the 15 African neurosurgeonsundergoing a training in various services of neurosurgery in

Rabat, only three have received grants from the WFNS Founda-tion, seven received a scholarship from their home country

(mainly universities), three received grants from the UniversityHospital Center of Rabat, one from the Moroccan Agency for

International Cooperation, and one from the French-SpeakingSociety of Neurosurgery.

In March 2011, during the 4th WFNS Rabat Reference Center

Course (March 25e27, 2011), a cooperation agreement wassigned between the WFNS Rabat Reference Center and St. Mi-

chael’s Hospital in Toronto, Canada (Figure 8). Thanks to DoctorRichard Perrin, former WFNS Secretary, an amount was donated

by a Canadian sponsor to cover the complementary training (6e12

ROSURGERY, http://dx.doi.org/10.1016/j.wneu.2013.10.051

EDUCATION & TRAINING

months) of African neurosurgeons who have already finished their

basic training at the WFNS Rabat Reference Center.

CONCLUSION

Through its activity and its influence on the promotion of African

neurosurgery, the WFNS Rabat Reference Center can be consid-ered as a model of a regional training center. For such a center to

accomplish its mission, it requires a training program director fullydedicated to the project, complete support from local university

WORLD NEUROSURGERY 81 [2]: 234-239, FEBRUARY 2014

andhospital authorities, and grants and scholarships from local and

international institutions awarded to trainees.

ACKNOWLEDGMENTS

My deep and sincere thanks to those who have helped in giving

birth to this project, to the institutions who have backed theproject financially, and to the members of the team who have

been following the training of the young African neurosurgeons inthis center.

REFERENCES

1. El Khamlichi A: African neurosurgery: current situ-ation, priorities and needs. Report presented to theWFNS Administrative Council, Geneva, February 20,1999.

2. El Khamlichi A: African neurosurgery, Part II: currentstateandfutureprospects.SurgNeurol49:342-347, 1998.

Conflict of interest statement: The authors declare that thearticle content was composed in the absence of anycommercial or financial relationships that could be construedas a potential conflict of interest.

ww

Citation: World Neurosurg. (2014) 81, 2:234-239.http://dx.doi.org/10.1016/j.wneu.2013.10.051

Journal homepage: www.WORLDNEUROSURGERY.org

Available online: www.sciencedirect.com

1878-8750/$ - see front matter ª 2014 Elsevier Inc.All rights reserved.

w.WORLDNEUROSURGERY.org 239