The Global Neurosurgery and the WFNS

In 2015, the Lancet Commission on Global Surgery highlighted surgical care disparities worldwide [1]. No one could ever imagine that Global Neurosurgery would become a real movement, a source of inspiration for others surgical specialties [2]. Over the years, Global Neurosurgery allowed the realization of a collective awareness of surgery as a global health priority. The Neurosurgical community accepted the challenge of delivering timely, safe, and affordable neurosurgical care to all who need it. Multiple efforts have been made to address this need to promote national surgical policies, improve surgical education and training, build quality research, and advocate for the surgical workforce. The critical factor has been the relationship between the World Health Organization (WHO) and the World Federation of Neurosurgical Societies (WFNS). Since 1955, the WFNS has promoted global improvement in neurosurgical care, building neurosurgical capacity through education, training, technology, and research. The goals are ambitious. By creating international partnerships, the WFNS has established multiple training programs in neurosurgical centers in Africa and other countries with limited facilities, allowing residents to work first in the host countries to learn and improve their skills and return to their country of origin [3,4,5]. Furthermore, the WFNS is working on sustainable surgical programs within Low-and Middle-income countries (LMICs) using digital technology [6]. Internet availability allows fast and easy access to digital resources, and digital education has become an emerging tool to bridge the gap between surgeons from High-Income Countries (HICs) and LMICs.

The Journal of Global Neurosurgery

1 | WHAT IS GLOBAL NEUROSURGERY? The Global Neurosurgery Committee of the World Federation of Neurosurgical Societies defines Global Neurosurgery as “the clinical and public health practice of neurosurgery with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to all who need it”(1). The definition weaves the values of equity, social justice, and inclusivity through the fabric of the traditional characteristics that define modern neurosurgery, such as excellence, technical mastery, integrity, and compassion. The recent addition of the global health dimension and the accompanying scientific and systems approach to address the unmet neurosurgical needs in the world has galvanized our profession, stimulated academic inquiry, and inspired many who wish to enter it. One only needs to see the explosive number of publications using the terms “global neurosurgery” over the last few years as a proxy of academic interest (2) (figure 1).

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Neurosurgery made a fascinating advancement in the last century. However, its historical development was somewhat slower than that of other surgical specialties due to the complexity of the central nervous system. Initial attempts to treat brain disease surgically have been related to high morbidity and mortality. Only the better understanding of brain structure and function localization and the introduction of antisepsis, anesthesia, and hemostasis at the end of the 19th century led to increased interest and rapid advancement in the field. The other development of neurosurgery was distributing the acquired knowledge and making this highly specialized care available to all patients around the world. Among all other surgical disciplines, global neurosurgery was the foundation of neurosurgical organizations around the world, and their close cooperation, few countries founded the WFNS in 1955. The first president was Jefferson, and the first WFNS congress was held in 1957 in Brussels (congress president professor A. Walder). WFNS initiated a world congress every four years to gather neurosurgeons for scientific exchange.

Do We Really Need Another Journal?

A new Journal sees dawn – but didn't we already have too many journals and too many articles published to go to oblivion rapidly? Publishers take advantage of the move towards open access. The need to attract an audience and select papers for high-quality decreases with the move towards business models where journals charge article processing fees to cover expenses and create margins. The Journal of Global Neurosurgery (JGNS) is not a business project: it is far more altruistic and intends to fill a real need. The long-term prospects will not depend on revenue but on the sustainability of the publication model, which by necessity must be low cost and non-profit – other ways, the new journal will not be able to fill the need. "Global Neurosurgery" is becoming increasingly vogue. Individual neurosurgeons and the World Federation of Neurosurgical Societies have fostered projects to develop our specialty in low- and middle-income countries (LMIC), where single neurosurgeons have catered to many millions of patients. We see a worldwide quiet revolution of expanding surgical infrastructure and dissemination of knowledge in countries previously deprived. The stakeholders of this revolution have soon identified a veritable glass ceiling when it comes to publication. Submissions have frequently been seen as relevant or generalizable for the audiences of existing journals. Clinical neuroscience in LMICs is, much to the surprise of many practitioners and editors in previously established structures, different. Fundamental issues such as study population and external validity were rediscovered when population data, research findings, and practice guidelines from affluent, relatively elderly western people with access to smooth infrastructure and exquisitely equipped hospitals were applied with little meaning in LMICs with different demographics and epidemiology. Yet, many clinical studies from LMICs were adapted to previous literature's format and style, without detecting the unique qualities, "the cracks in the wall" of existing paradigms, that would bring the progress of knowledge and change. I believe that a research community with a thorough understanding of the specific qualities of infrastructure and epidemiology in LMICs is being established, and it needs dedicated platforms. A journal is one such platform that can serve to define and direct the subspecialty.

Global Neurosurgery: Its Time Has Come

The world is shrinking. We, as neurosurgeons, are enjoying an ever-increasing opportunity to communicate with each other via email, WhatsApp, webinars, virtual visiting professorships, and on and on. This ‘movement’ provides much-needed augmented access to experts and each other worldwide. This, simply put, is the essence of the term ‘Global Neurosurgery.’ ‘Global neurosurgery’ is increasingly referenced in manuscripts and social media. Of course, neurosurgeons have traveled the world for educational purposes for over 100 years. However, in those days gone by, only the elite few were afforded the opportunity for such travel and education. Accompanying the marked increase in opportunities to communicate and educate, the term ‘global neurosurgery’ now takes on a new meaning. In a sense, it is a banner phrase that heralds the introduction and implementation of the latest communication and education access to all neurosurgeons. Global neurosurgery has become the words on the banner of a new and exciting movement – i.e., disseminating neurosurgery knowledge, skills, and hopefully, resources to all neurosurgical world reaches.

The Inaugural Issue of the Journal of Global Neurosurgery

Over the last decade, the field of Global Surgery, which some of us had termed the “neglected stepchild of Global Public Health,” has expanded to bridge the gap in surgical care. Evidence of a burgeoning field of research, practice, and cooperation abounds: the 16 countries of the Southern Africa Development Community, for example, are working together to strengthen surgical care in the region. During the most recent meeting of the World Health Organization’s Western Pacific Regional Committee, the 37 member states unanimously agreed to a regional action framework for safe and affordable surgery. A global coalition is forming to meet the need for 143 million surgical procedures in low- and middle-income countries (LMICs) by the end of the decade. Academic institutions have an essential role and responsibility in the quest for global access to safe and affordable surgical services. In response to pressing material disparities faced by district hospitals, academic institutions can partner with the public sector and bolster access to services by helping provide the staff, space, systems, and social supports required for quality care. By conducting relevant and timely research, investigators inform the planning, financing, and implementation of surgical care delivery programs. Furthermore, specialists are well placed to bring their expertise to bear on disparities in access and outcome, and neurosurgeons are advancing research to link their area of clinical practice to broader efforts for global health equity; this includes, of course, an emphasis on forging fruitful and equitable research collaborations across the globe. To that end, I congratulate all involved in launching the inaugural issue of the Journal of Global Neurosurgery (JGNS).

Neurosurgery in the Dutch Antilles: A minireview of recent developments

Curaçao is an island in the Southern Caribbean Sea, which formed part of the Dutch Antilles and Aruba, Bonaire, part of Saint Martin, Saba, and Statia. Aruba was the first country of the Dutch Antilles to dissolute in 1986 (1). On October 10th of 2010, Curaçao and Saint Martin also became constituent countries within the Dutch kingdom. Bonaire, Saba, and Statia became “special municipalities,” also known as administrative divisions, within the Dutch state (2). Curaçao is the biggest of the six islands, with an area of 444 km2/ 171.4 sq.mi, situated 65 km (40mi) north of the Venezuelan coast (3). Curaçao is of multi-cultural composition (mainly Afro-Caribbean) and has three official languages; Papiamentu, Dutch, and English. Spanish is widely spoken on the island as well.3 It has a little less the 160,000 inhabitants (4).