No, it's just terrific. Congratulations on that effort. We talked about it in some of the section meetings and different societies. It's just even knowing what's out there was the biggest question, the gap of what are people doing and what are the gaps. So when I first met Jim Johnson, he was telling us about his work in Vietnam, and I said, oh, you must know Michel Zahra then. And he said, no, who's he? And I said, well, he's been working in Vietnam for the last 20 years, and they didn't know it. You know, there are situations where people have been working in the same hospital and they've not known that somebody else has been and has been doing things there. So, you know, it's really just trying to get people to network and understand what's going on. Dr. Booke, yes. William, thank you for this effort. I think it's great. We heard in Istanbul that with raised awareness there are numbers of countries, numbers of groups that are interested in becoming involved, but like you say, the coordination is poor. We heard of one country in sub-Saharan Africa that had American teams, Belgian teams, and French teams all working in the country trying to set up training programs, but none of them knew that the others were there. It was completely disorganized. And we have some people in the audience here who have spent their whole lives trying to work on this problem. I'd love to hear from Professor El-Kamlichi your thoughts on do we need pediatric neurosurgeons or do we just need neurosurgeons, or do we need neurosurgeons or do we just need general surgeons that can take out an epidural hematoma and repair a myelomeningocele? What would you say? Thank you for asking me to comment on that. I think that I see that in all these statistics of today and those I have seen many time, I mean African continent is just shown with black or white or uniform color without any distinction. I must tell you that it doesn't make us happy as neurosurgeon of this continent to see that. The reason for that is that many survey are done in small groups and these people are not asking on the right way to get the statistics which is not easy. There are individuals who wrote a lot about that, many papers on African neurosurgery which were published. There are today quite good number of national societies, either neurosurgeon or neurosurgeon neurologist. There are Continental African Association which is existing since now some years. So I think there are ways to get better statistics. This is in general, as comment in general. Now coming to the pediatric specialty, general neurosurgeons or general neurosurgeon to make the emergency surgery. I think that this question was raised more than 20 years for African colleagues to ask them about what they need for their countries. And I remember in 1997, 98, majority, and this was also published, majority of African colleagues answered that what they want is training in neurosurgery. No more asking general surgeons to do the emergency because this can be done for some years but it's not the way to improve neurosurgery in the continent. Regarding the specialty between pediatric and general neurosurgery, today I think that the majority of neurosurgeons in Africa are doing at the same time adult and children. Except in maybe very few countries. I know that in North Africa, Dr. Bakhti just mentioned that they have 30, I heard, or 20 pediatric neurosurgeons. No? You don't have? You don't have. Yes, yes, yes. The same situation maybe we have also in Morocco. Not because there is no people who are doing pediatric neurosurgery. There are a lot who are doing very good pediatric neurosurgery, I must say. And who were dedicated to that since maybe more than 20 years or 25 years sent abroad to be trained especially in pediatric neurosurgery. But the activity of adult and pediatric is still mixed. It's some kind of public health politics not to make this distinction. Maybe we will go there in future. But again, it doesn't mean that there are not very good pediatric neurosurgery practices in the country. It should be the same in many other places. In South Africa, in Egypt, in some sub-Saharan Africa because now neurosurgery is developing in this area. So I think that if we want to, I mean, if in this global network and statistics you want to get the really, the point of view of the situation in African continent, it should be discussed with the national societies and with the continental society. To give you really the point of view of the colleagues in this area and also the taking in consideration the socio-economical development and the healthcare planning in the continent. So if I can comment on your comment. I take your point completely. I think the one thing I hope I made clear right from the beginning, our survey was directed, it was purely talking about pediatric neurosurgical care. And it was limited to the number, we did circulate this to African societies, we did to Asian societies, we did to the Indian society. So we approached a large brush, but naturally it is a small survey. I think that the point that we're trying to make though is that what we're trying to do is establish partnerships. And as you've said, there are many good and emerging neurosurgical centers and training programs in Africa. Let's take Africa as an example. And a lot of that is intra-African. I'm sure Femi will agree that a lot of this is coming from African countries working with African countries. And if I can take it as an example that you've just mentioned Egypt and you've mentioned South Africa. We have members over the last six weeks, but we have already got members in Egypt, Ethiopia, Malawi, Nigeria, Democratic Republic of Congo, Rwanda, South Africa, Cote d'Ivoire. So we're already developing this network. And this network isn't intended to be just from the trans-continental. It can be intra-continental as well. And so we're really trying to encourage people to go to what are called South-South fellowships. Don't go and do a fellowship. One of the most impassioned speeches at our meeting was from a young man who trained in the United States but had gone home to no facilities. And he said, I'm at a loss as to know what to do. And so really, although he'd done a fellowship in a very respected neurosurgical institution, he hadn't really learned anything that was going to be practical to him back home. And that's why we're encouraging these relationships between intra-continental, intra rather than inter-continental. Sorry, but I think it's okay what you have said, but this methodology, I think, should be stated at the beginning. And the results should be also commented, taken in consideration, the methodology. And not just mention one continent with one color. Even if maybe you have four or five or six members, it doesn't matter. I mean, these colleagues maybe didn't make enough work because the national societies, the continental societies, were not asked to do such work. I mean, if we want, there is, for example, I can give you the example of the work done in the WFNS. Sometimes they make a survey, and I mean, I experienced that for more than 25 years. In general, when the WFNS wants to have a survey about any issue, they try to get through by making the continental societies and the national societies doing the work and giving the official statistics about the country and about the continent. Then together, it make it a global survey or global statistics. This is the way I think we should do things. And the statistics I am speaking on regarding the end of the 90s was done through the WFNS. Yes, unfortunately, though, it hasn't been updated by the WFNS since 1998, I think. And I think that is an issue because we are dealing, and as I tried to say at the beginning, this was not an exhaustive survey. It was to try and get a feel. It was led by meeting here in the WNS last year, and it was out of a desire to try and work out what was going on. And the questionnaire was merely one part of it, and I really would like to concentrate more on the concept of trying to get people to liaise through an organization such as InterSurgeon, which is completely independent of WFNS, ISPN, any of the other organizations, because I think it's really important that we stay independent and that we aren't seen to be under the control of any global body. And that's what we're really just trying to achieve. Well, thanks to you for your comment. I think we should close. It's 1.30, but we appreciate your attention. It's been a very engaging audience, and I'm sorry we couldn't get to some case discussions, but I thought this panel was an excellent discussion. Thanks, everyone. Thank you, Mark, for co-moderating.

pediatric neurosurgery

Africa

coordination

networking

InterSurgeon