Upon completion of the five-year program at Hubert Kairuki Memorial University (HKMU) in Dar es Salaam, Tanzania, I embarked on a one-year internship at Muhimbili National Hospital. This period proved pivotal in sparking my keen interest in the field of Neurology. In Tanzania, the pathway to specialization in Neurology entails four years of Internal Medicine training, followed by two additional years of specialized Neurology training to qualify as a certified Neurologist. Notably, Muhimbili National Hospital is the sole institution in the country offering this program.
During my search for educational opportunities, I discovered the MMed course at Stellenbosch University in Cape Town, South Africa. This comprehensive four-year program is exclusively focused on Neurology. As a member of SADC, I was eligible for reduced tuition fees in comparison to international students. The administrative procedures proved to be laborious, involving substantial paperwork and financial arrangements. The process took approximately eight to ten months to finalize before I could commence the program. I was fortunate to secure funding from the Karimjee Jivanjee Foundation, for which I remain profoundly grateful.
Upon commencing my tenure as a Supernumerary registrar in a foreign land, I encountered a myriad of challenges, including cultural disparities, securing accommodation, arranging transportation to and from the medical facility, grappling with homesickness, and acclimating to the new healthcare framework. It was incumbent upon us to sit for our Part 1 examination either before joining the program or within the inaugural year. The preliminary phase of our training was centered on Neuroanatomy, Neuroradiology, and Neuropathology, followed by comprehensive instruction in Neurophysiology, Neuropsychiatry, and Clinical Research.
It was essential to maintain equilibrium within the new environment and healthcare system while also staying updated on the study syllabus and fulfilling on-call responsibilities. Our typical day commenced with an 8 AM morning meeting, followed by OPD clinics from 9 AM to 1 PM, and in- patient rounds from 2 PM to 4 PM. Additionally, we were tasked with managing administrative responsibilities and preparing for the following day. This initially seemed overwhelming, but after the first year, everything began to fall into place. Time passed swiftly, and before we knew it, four years had elapsed, signaling the time to return to Tanzania.
Currently, I am concurrently employed at three institutions, where I work part-time to facilitate coverage across multiple catchment areas. This arrangement allows me to garner experience across diverse healthcare hierarchies. As a neurologist who has practiced in both South Africa and Tanzania, I have had the unique opportunity to observe and understand the challenges and opportunities that exist in both countries.
Practicing neurology in Tanzania presents a unique set of challenges. Like many low- and middle-income countries, the country faces significant barriers in access to care. The high prevalence of neurological diseases, coupled with a lack of specialist doctors, exacerbates the situation. Furthermore, socioeconomic and public health factors contribute to the complexity of providing neurological care.
In contrast, South Africa, while not without its challenges, has a more developed
healthcare infrastructure. However, the burden of neurological diseases is still high, and there is a need for more specialist doctors. The socioeconomic disparities and public health issues are also prevalent in South Africa, similar to Tanzania.
As of June 2020, Tanzania had approximately eight neurologists, whereas South Africa had 145 (1) . Efforts to educate the general populace and healthcare professionals on the scope and significance of neurology were imperative. The unavailability of most medications for neurological disorders, coupled with constraints in conducting both laboratory and radiological investigations due to financial limitations and resource availability, posed significant challenges. Only about 15% of Tanzanians (8% through NHIF), equivalent to 9.1 million had health insurance by the end of 2021 (2) .
Despite these challenges, several strategies can be employed to improve neurological care in both countries. Rehabilitation programs incorporating cognitive, physical, and social aspects of recovery can benefit. Community health programs, outreach services, and telemedicine can also play a crucial role in making neurological care more accessible. In Tanzania, improving government infrastructure is a key strategy for poverty reduction and improving access to healthcare. In South Africa, there is a need for continued investment in healthcare infrastructure and training of specialist doctors.
In conclusion, by implementing targeted strategies and investing in healthcare infrastructure and training, it is possible to make neurological care more accessible and effective in both countries. The journey has been challenging yet ultimately fulfilling. However, substantial efforts are still required to enhance neurological recognition and care across the entirety of the African continent.
References
1. Parkinson's Disease Research on the African Continent: Obstacles and Opportunities. Dekker MCJ,
Coulibaly T, Bardien S, Ross OA, Carr J, Komolafe M. s.l. : Frontiers in Neurology, June 2020. doi:
10.3389/fneur.2020.00512. PMID: 32636796; PMCID: PMC7317302..
2. Mandatory health insurance for the informal sector in Tanzania-has it worked anywhere! AT, Mori.
s.l. : Frontiers in Health Services, October 2023. doi: 10.3389/frhs.2023.1247301. PMID: 37849823;
PMCID: PMC10577424..
ABOUT THE AUTHOR
Dr Vivek Keshani
Completed medicine at Hubert Kairuki Memorial University in Dar es Salaam, Tanzania. Completed
my medical internship at Muhimbili National Hospital and worked as a GP at Shree Hindu Mandal
Hospital. Completed my Masters of Medicine in Neurology at Stellenbosch University/Tygerberg
Hospital. Excited to begin my Clinical Fellowship in Sleep Neurology at the University of Toronto in
July 2024.
My passion for neurology extends beyond clinical practice, encompassing advocacy, research, and
policy. By actively participating in shaping healthcare systems, I hope to contribute to a more
neurologically informed and compassionate world.