By Hanna Grimm
For Alvan Ukachukwu, his career as a neurosurgeon was a natural extension of a love of working with his hands and a passion to care for people. Yet, as one of only 80 neurosurgeons in his home country of Nigeria, Ukachukwu habitually faced obstacles to getting his patients the care they needed.
“Things like lack of funds, late presentation with disease or sickness, long surgical waitlist, the waitlist for the equipment and the facilities in the hospital limit the provision of neurosurgical care to a lot of patients,” said Ukachukwu, a first-year student in the Master of Science in Global Health program at the Duke Global Health Institute. “We have patients that present very late and then there are several issues that prevent them from getting to the hospital on time and accessing care as quickly as they ought to.”
Nigeria, with a population of around 200 million, has one neurosurgeon per 2.5 million people, compared to about one per 84,000 people in the United States. Also, most of Nigeria’s surgeons are concentrated in the urban areas, leaving vast rural areas without access to neurological care, Ukachukwu said.
Working under those conditions made it clear to Ukachukwu that improving care in resource-limited environments is critical to minimizing global disparities in healthcare. Countries like South Africa and Egypt have overcome similar resource-related obstacles, and Ukachukwu wants to understand how they did it. That brought him to Duke.
“The best way to understand this is to do research on the global inequalities or disparities in the distribution of neurosurgical resources, neurosurgical manpower, and access to neurosurgical care — and the Duke Global Health Institute came highly recommended,” he said.
Ukachukwu’s efforts have received recognition. He was inducted as a Fellow of the American College of Surgeons on October 27. Also, in September he was named the recipient of the MPOWER Global Citizens Scholar for the African Region. In addition, he is the recipient of the Jack and Caroline Leslie Family Global Health Fellowship Fund at the Duke Global Health Institute.
“I was honored to have been announced as one of the winners of the MPOWER scholarship,” he said. “It is going to be a great incentive in my studies at Duke to really help to lessen the financial burden.”
Through his work with the Division of Global Neurosurgery and Neurology, Ukachukwu has begun research that he hopes will yield results he can bring home to Nigeria to improve neurosurgical care. He is considering an investigation into the continuum of care and the issues that limit the efficiency of care. Specifically, he is interested in devices that can quicken physician decision-making in patient care.
One such device is the Infrascanner, a hand-held near infra-red spectroscopy device that can detect bleeding in the intracranial space around the brain. Ukachukwu said the Division of Global Neurosurgery and Neurology is already doing intensive research into potential uses for the device—specifically in areas with limited medical resources like Uganda.
The device can help physicians prioritize which patients need a cranial CT scan or emergency cranial surgery. In many parts of Africa, access to cranial CT scans is considered a luxury due to the limited number of CT machines spread across vast distances, Ukachukwu said. If the doctor determines that a patient needs a CT scan, waitlists, machine breakdowns, and transportation issues can stall patients from getting critical care.
“I’ve personally lost patients in the process of trying to get a CT scan done in another center where it is available,” Ukachukwu said. “If I have this Infrascanner device, it is possible that it could help me make a decision in treating the patient as quickly as possible.”