From the time Roger Hartl, MD, a neurosurgeon and director of neurosurgery spine for New York City-based Weill Cornell Medicine and co-director for New York Presbyterian Och Spine, completed his medical school rotations in the country of Malawi, he knew he wanted to treat patients in Africa.
However, upon moving to the United States after medical school, Dr. Hartl got caught up in his training and personal life. He sought out ways to return to Africa through Doctors Without Borders and the Bill Gates Foundation but was told they had no need for spine and neurosurgeons; only infectious disease specialists.
Dr. Hartl continued to face roadblocks in his goal to practice overseas, until 15 years ago when he received a personal invitation to treat a patient in Tanzania.
Dr. Hartl jumped at the opportunity to travel back to Africa, making visits to several hospitals in Dar es Salaam, Tanzania.
"As soon as I walked into these hospitals in Tanzania, it was evident that they needed neurosurgeons and spine surgeons," Dr. Hartl told Becker's. "From then on, I started going back on a yearly basis."
This visit to the country inspired Dr. Hartl to launch the Global Neurosurgery Course through Weill Cornell Medicine. Every year, Dr. Hartl takes a team of surgeons and fellows to a partner hospital in Dar es Salaam, where they spend 10 days engaging with local surgeons, taking over new equipment and operating on patients.
Additionally, the program brings surgeons from Tanzania to the U.S. for training programs as well. Through a weekly Zoom call with Dar es Salaam spine surgeons, neurosurgeons and nurses, Dr. Hartl keeps up to date with the country's progress.
Fifteen years ago when he began traveling to Tanzania, the country had three neurosurgeons for a population of 30 million. All three surgeons were practicing in Dar es Salaam, meaning patients in rural parts of the country had limited access to care.
Now, thanks in part to Dr. Hartl's training program, Tanzania has over 15 neurosurgeons spread out all over the country.
"Once while I was there, we had a patient come in who was bitten by a crocodile and had multiple injuries to his arms and legs, along with sustaining head trauma from the injuries. The family had to put him on a bus and drive him three days on a bus to the hospital to seek treatment. Of course, by the time he arrived there were already all kinds of infectious issues from the wound," Dr. Hartl said.
While the patient survived thanks to Dr. Hartl and his team, as well as several surgeons in Dar es Salaam, improving access to care in all parts of the country remained a priority for the global neurosurgery program.
This year, thanks to a donation from Brainlab, Dr. Hartl and his team performed the first spine case using 3D navigation in sub-Saharan Africa.
"We used the machine from Brainlab for the first 3D-guided TLIF fusion in the country, which went very, very well. Now, since I left, the hospital has been doing a bunch of navigated cases. They've really continued to use the technology," Dr. Hartl said. "Over the years, I have been really shying away from bringing a lot of equipment over because a lot of it breaks down very quickly. This was the first time in a number of years we've brought technology. Given our long relationship and the trust built, it now makes a lot of sense."
Dr. Hartl emphasized how important that long-term relationship has been when it comes to building trust with local physicians and residents. He has no plans to start a similar operation in other parts of the world, because he believes that the best way to make a lasting impact is by focusing your time and resources on one single facility.
"If you're a spine surgeon or orthopedic surgeon looking to make global change, my advice would be to stay focused. Make a commitment to one particular institution, try to build relationships, and try to always go back to the same institution. Don't expect too much when you go the first time," he said. "Don't expect too much in terms of what you can do and how happy they are going to be that you're coming. If you really want to make an impact, you have to commit long term. There are microsteps in the right direction. It can be frustrating to go back every year. There are setbacks, and things don't always happen the way we expect them to happen. Stay focused and stay humble."
Dr. Hartl's course has continued to grow over 15 years, with 122 local surgeons, emergency room physicians and nurses in attendance at his most recent virtual reality teaching seminar in Tanzania.
The program also launched a follow-up study on spine trauma patients in the area, tracking the cost and effectiveness of instrumentation surgery.
"A lot of patients in the area are now being treated in ways they would not be treated if this course did not happen," Dr. Hartl said. "Our goal is to continue long-term collaboration to help teach and train the most capable surgeons possible."