Addressing disparities in neurology by building the workforce in LMICs

Not enough neurologists exist in the world, and disparities are most apparent in low-income countries, where the World Health Organisation reports only three neurologists for every 10 million people. Physicians without extra training in neurology cannot be expected to teach the bedside examination, train others in the field or even recognize neurology as a possible career path. The aim of my work is to address this gap by improving neurology capacity in LMICs to ultimately improve global brain health.I first began my journey in global neurology at an academic hospital in Harare, Zimbabwe. I was lucky to partner with an amazing internist who had apprenticed with a neurologist years before and was essentially the only neurologist in the country. He wanted to improve inpatient stroke mortality, which was 35% (compared with 2% in the USA).Using a design-thinking approach mixed with literature review, we created an evidenced-based stroke management protocol that can guide physicians even if a CT scan is not available to distinguish ischaemic from haemorrhagic stroke. We moved patients around to create a physical stroke unit, which is known to reduce stroke mortality in countries regardless of income level. The stroke unit enabled a more consistent application of protocols (for example, not feeding individuals at risk of aspiration).One unintended consequence — but possibly the most powerful — was that the stroke unit became a concentrated hub for neurology education and clinical care. Physical therapists were able to give more consistent care to patients with stroke and began to send their students to the unit to learn neuro-rehabilitation. Internal medicine trainees also rotated through the stroke unit and found themselves on a neurology rotation and could visualize the specialty as a possible career. With an emphasis on clinical neurology education, the stroke unit enables sustainable neurology capacity building that will continue to improve neurological health in this region.“the stroke unit became a concentrated hub for neurology education and clinical care”