A qualitative assessment of the benefits and challenges of international neurosurgical teaching collaboration in Ethiopia.

OBJECTIVE: To explore the perspectives of Ethiopian and international neurosurgeons on the development of a sustainable academic neurosurgery teaching unit in Addis Ababa, Ethiopia. METHODS: A qualitative case study methodology was employed. RESULTS: Ethiopian and international surgeons describe a rewarding cross-cultural experience. Areas in need of improvement include communication, educational infrastructure, and structured morbidity and mortality discussions. Data collection that aims to understand better the burden of neurosurgical disease in Ethiopia along with rapidly expanding Ethiopian government initiatives to improve the health care system will lead to improved patient care. CONCLUSIONS: Genuine partnerships between surgeons who have trained and worked in well-developed neurosurgical centers and those that are working within the confines of limited resources have the mutual desire to improve neurosurgical care. Understanding each other's perspective is an important aspect of program development.

Attitudes toward neurosurgery in a low-income country: a qualitative study.

OBJECTIVE: To adapt a study exploring the needs of neurosurgery patients in a tertiary care hospital in Canada to examine, for the first time, the perspectives of neurosurgery patients in a low-income country with limited health care resources. METHODS: Semistructured interviews were conducted with 25 neurosurgery patients at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia. Interviews were conducted in Amharic or Oromo, translated into English, and subjected to modified thematic analysis. RESULTS: The following 5 themes emerged: 1) With limited resources, many patients did not seek information outside of that obtained during the clinical encounter. 2) Patients valued direct verbal communication and deferred to the surgeon's authority. 3) Religion played an instrumental role in patient attitudes toward surgery. 4) Most patients did not feel anxious about surgery. 5) A few patients did not inform family members about their medical condition. CONCLUSIONS: Qualitative research methodology in neurosurgery can be successfully adapted from resource-abundant to resource-poor contexts. In low-income countries, patients are faced with limited options for self-education and self-empowerment, and fatalistic and paternalistic attitudes may be prevalent. Local cultural values and expectations can influence practice differently than they do in resource-rich countries.