Dear friends and dear colleagues, we are undoubtedly living through a global health history and we hope this weekly forum allows us to stay connected and remember that we are not in the same boat, but we are weathering the same storm. Together, we can continue to strive for our goal to treat our neurosurgical patients anywhere or at any time and provide an educational program to our young neurosurgeons around the world. It gives me a great pleasure to participate to this practical course and to share with you the situation of neurosurgery in the Arab world. My deep thanks and congratulations to our friend and colleague, Professor Isabel Germano, to manage this session and of course to all the staff who did a huge job for this meeting. I will focus my talk on the role which was played by Arab medicine and especially neurosurgery and therefore give some data about Arab neurosurgery as a number of neurosurgeons, a kind of pathologies and needed indeed by perspectives and challenges facing Arab neurosurgeons. So first of all, let me show you my city of Rabat, capital of Morocco, and I hope that you can come numerous to visit us early, nearly after the end of this crisis, inshallah. Oh, sorry. So Arab world is composed by 22 countries and it contains today a little bit more than 430 million inhabitants. The Pan-Arab Neurosurgical Society is the official representative of all the Arab world to the WFNS since 1997. Let's talk about the history of medicine. What about this history? I think before talking about neurosurgery, we need to recall the role played by Arab medicine and the first seed of medicine as a profession has begun to grow till 500 years more or more than in Iraq and Baghdad, and the first prescriptions for sickness, the first medical library, and the reign of Ashurbanipal, the last great king of Assyria. So in the Nile Valley, on Ebers and Edwin Smith's papyrus rolls, the anatomy of human bodies, a list of 700 drugs, 250 different illnesses. It was considered that it is a religious responsibility to pass down the knowledge they had accumulated from one generation to another. And Herodotus, five hundred before Cretaceous, Greek historian, father of history of medicine, the art of medicine in Egypt was distributed, thus each physician is a physician of one disease. But in Greece, Asclepius and Hippocrates were the masters, Galen, physician of gladiator, dissected the spinal cord and also studied the nerves in Alexandria in medical school. Odamus' story, this story is very amazing because Odamus has been thrown from a chariot, couldn't move the third and the fourth fingers, and all the physicians in Rome city fell to treat him. So Galen treats the neck but not the finger. At that time, can you imagine, a physician needs to study anatomy as an architect, needs to follow a plan. He was deeply religious and he believed that every part of human body was designed by the creator for a special purpose. And we believe that it's true till now. So Nestorius in Greece took some of Galen's scrolls and Arabic was the language for learning Europeans sought refuge development of medical translators at that time and moved from Djandhi Chakour to Baghdad with the building of the first paper factory. So here there is many Arab doctors, physicians, Razi between 965 to 800 to 900, Abul Qasas, Abdel Avicen, etc. They encouraged the Caliph to build hospitals in Persia, in Morocco, in North Syria, Baghdad, Spain and Cairo. One of the biggest is still in Cairo, was still in Cairo. All were hospitals and medical school at the same time. And each patient when leaving hospital was given a sum of money so that he might start his life afresh. There is Abul Qasas al-Zahrawi in Cordoba, he is the master of surgery and the creator of several surgical instruments. And of course he wrote many books like Kitab al-Tasarif and diseases. It's Abul Qasas diseases called at that time. There is also Abu Marwan ibn Zuhair in Seville who was described cervical dislocation and many many others. So just to remain outstanding of our community, Arab community about the achievement of outstanding scientists and inventors of a lot of surgical instruments, which some are similar to those of our time. And we are proud to give his name to my university in Rabat. So let me just share with you this document found recently in the archive of Moroccan Ministry of Higher Education and Research. It's consecration, young doctor, his name was Abdullah al-Katami in 1207 at the oldest Al-Qarawiyyin University in the world, which was built by a woman Fatima bint Mohamed al-Fahri in 855. The Arab world is composed, as I already said, by 22 countries and neurosurgical care should be provided to about 430 million citizens. The PUNS was created in 1996. Our society is a member of WFNS since 1997. According to World Banking, it's composed by variable economical level countries. According to the World Bank, four different level, low income countries like Mauritania, Somalia, etc. Low middle income like Morocco, Tunisia, upper middle income as Algeria, Lebanon, and high income countries like Saudi Arabia, Qatar, Kuwait, etc. So in 1974, the first meeting of the Pan-Arab Neurosciences Society, it was started by Neurosciences Society and the last Professor Ahmed al-Banhawy was one of the earliest members of the Egyptian Society of Neurological Surgeons and a foundation fellow of the Pan-African Association of Neurological Society, which was named PUNS at that time. And he had his neurosurgical training in Oxford, England, continental Europe, and the Montreal Neurological Institute in Canada. So the real history of the Pan-Arab Society has really begun and was being marked by several eminent neurosurgeons as Professor Sherif Izzat, Professor Khamnishi, and all of those in this slide, but Professor Khalaf al-Mutairi was the organizer of the first meeting conducted by the Kingdom of Saudi Arabia with many mentors, 26 Arab neurosurgeons, the list of their names is here on the left of this slide. So we started a survey which was sent to 20 countries more than 10 months ago, and there is the result of this survey. We found 1,840 neurosurgeons offering care to more than, I said, more than 400 million citizens. And since the last world meeting in Beijing in 2019, we are now 19 Arab societies who are affiliated to the WFNS, three not yet, but in the two countries that not have neurosurgical society yet. Different fields of neurosurgical care is provided in most of countries, and most countries practice those skull bays with all endoscopic approaches as is shown in this slide. And also, most of university teams in Arab hospital countries practice, for example, wake surgery with neuromonitoring in at least more than 10 countries. It is a particular surgery, as you know very well, which needs dedicated tools. It's a challenging surgery, nevertheless, it's a common practice in the Arab world currently. The vascular neurosurgery, despite of the lack of on the vascular neuroradiology in many multidisciplinary teams, we can say today that we are very proud of our neurosurgeons who are dealing with the raptal aneurysm. I hope that in the future, more and more mobilization will be practiced in every center of neurosciences among the Arab world. All pediatric neurosurgery in the Arab world is taken care of by Arab neurosurgeons. And more than that, we created recently the Neurosurgery Arab Pediatric Society, which started, which was organized last year in Tangiers, the first meeting. And neurosurgeons in Arab world are practicing the stereotactic in tumors, biopsy, in functional disease, and also in evacuation of hematoma, abscesses, etc. And there is also a diploma that was created 10 years ago in Morocco, it's called Diploma University of Brain Stereotactics that I lead. I think spine surgery is one of the most practiced in the world. All the colleagues from Middle East to North Africa deal with techniques of spinal pathologies, degenerative, deformity, functional, malformative, and tumoral. I think this is an example for patient who had laminectomy many years ago. He presents a deformity of lumbar spine and low dorsal blocked in these kyphotic attitude of the lumbar spine and you see here after the correction how is he standing. You can see in the post-operative radiography the alignment of the spine three weeks later after operation. Minimally invasive spine surgery as endoscopy, disc herniation, and kyphoplasty and many others many invasive technique is in Morocco at least used for 10 years ago. It's one example of the other Arab countries. Catalogues of the local training program in Arab countries. What's needs to these catalogues? The first is we need to encourage local training so to quickly increase the number of neurosurgeon is very important. To have neurosurgeon adapted to the local conditions, this is crucial. To make a pressure on the healthcare planner to develop neurosurgeon and help neurosurgeon to increase this specialty and requires lower cost of this specialty. The second thing is stimulation of clinical research. This is one of in my opinion leak in this area and accurate statistic on local start with that for example accurate statistic on local pathology presented in medical meetings to show the involvement of neurosurgery in public problem. Best way to convince health planners to develop neurosurgery. And finally the third thing is organization and promotion neurosurgery. We did that for many years ago but we have to continue to create a national society of neurosurgery affiliate to WFNS. Almost all the countries are all members. Organizing national and international meeting and entering meeting of Pan-Arab society was already done for two years ago and courses and workshops we need to organize it more and more. So we should meet more frequently in such courses and workshops. We have among our countries the high competencies in many areas. For example professor Kherdine from Algeria who organized yearly endoscopic workshops, a nice endoscopic workshops. The spine team from Egypt who had developed a high level of mini invasive spine surgery and many others in the Arab world like Arab spine for example in Dubai. And we should encourage our young neurosurgeon to attend these courses with creating more scholarship provided by organizer if it's possible and in the future maybe with the why not by Arab Pan-Arab society with the financial situation permitted. So we have to pay tribute to some pioneers who create such educational program which is today congratulated by all the countries around the world and may create and reinforce some regional exchanges between our countries. Encouraged with this success WFNS launched a second training program in Africa, Africa 100 which was fully supported by professor Majid Sami and created other regional training centers in order to increase the number of training positions for the applicants in Arab world and also in Africa by the way. So this WFNS reference center which was our Arab pride was created in 2002. It was in cooperation between an agreement between the WFNS and Mohamed Sank University in Rabat, Morocco. His mission is organization of basic training in neurosurgery and postgraduate education for sub-saharan African neurosurgeons. It started between 2002 to now and 6-1 neurosurgeons enrolled in this residency program, 25 have been already trained and 13 under training. And there are other training sites not to forget that in Algeria, in East and Central and Southern Africa, Brazil, India, in Egypt it starts also and the total of these young African neurosurgeons it's almost 16 young neurosurgeons. So what is the opportunity for us? We need to take this opportunity of good level of neurosurgery in some centers in the region and a driving force for the rest of the region. Increasing interest of cooperations with the international community but not only in the international and development of international network of training centers and we need better organization of neurosurgery at the level of the region. We need help and provide support for the Arab neurosurgeons. This good example with Professor Amr Shawarbi who modestly animates some workshops about spinal cord stimulation in Morocco. He was, for many of you who knows, the former president of Pan-Arab society and the main actors in developing and promoting neurosurgery locally and in Arab world and Africa. We need to help development of neurosciences in Arab university. Africa 100 program for training young neurosurgeons from Africa country was one of the big opportunities. So you know that disease not knows no border or they cross borders and reach anyone. So we should neurosurgery. Evolution of neurosurgical practice brings a change in the pathologies and we will see that. Look in this slide. Look at in this slide. These changes of the neurosurgical pathology spectrum during the 60s. We know the predominance of infections and traumatic pathologies and this according to Moroccan statistic that resembles to the majority of Arab countries and beyond to see the tumor pathologies appears before moving to the top of the list in the 2000. So what are our challenges and perspectives? For example in this paper published by Professor Osama El-Mefti which noticed that there is a low incidence of cerebral aneurysm. In the same period a group of young neurosurgeons conducted a research about this subject under the supervision of Professor Hamnishi and they conclude the incidence of aneurysm is the same in Morocco and United States of America. So what the future chance of the medical and societal and economic environment? We need more competitive medical context. We need also better education and awareness of the patient and their families regarding medical management. We need a government higher societal expectations regarding quality of patient care and more medical and financial constraints. Medical management more involvement with technology and we need fewer opportunities for a trainee to achieve competency in standard neurosurgery, microsurgery and operative techniques. So the program has to be reviewed to meet the future needs of neurosurgeons and we need to reinforcement of education and training in standard neurosurgical techniques, development of training in subspecialties as I already showed. Pediatric neurosurgery constitutes 20 to 30 percent of neurosurgical activities, neuro-oncology, neuro-endoscopy, spinal surgery etc. We need development of training in minimally invasive techniques. It's very important. Development and implementation of social economic curriculum in neurosurgery residence program, health care management, medical legal issues etc. Development of neurosurgery simulation in residency program. We need that and we are working hard to have that in every university in the Arab world and we need to use more and more electronic media and internet for educational purpose. One line literature review guidelines exchange neurosurgical cases and experiences and etc. So the different subspecialties department are present in different countries especially pediatric neurosurgery, radiosurgery and spinal surgery as I already shown. And what is the issues? The issues is we need to develop exchange between neurosurgical centers of different countries and level countries. We need to create specialized department either private or public dedicated to the neurosurgery. We need also to develop cooperation with not only regional and international societies but to be as one unique organization and create research centers is very important. Develop a strategy to decrease prices and make neurosurgical material accessible for everyone. Encourage medical financial support between different level income countries and maybe why not create Arab foundation for neurosurgery and develop more education and encourage publication in Arab journals as our pan-Arab journal or other national journals. During this unprecedented pandemic health crisis at COVID-19 after a few days of manipulation such as around the world we have decided to continue the training and education of our resident and young neurosurgeon of our society by organizing many webinars by different neurosurgical societies of the Arab countries as you see on this slide that is organized by Moroccan society, Arab-Saudi society, pan-Arab society etc. So Arab surgery has undergone remarkable progress in the last 50 years and it played a major role in the birth of all regional and continent neurosurgical associations. So we end my conference by welcoming all of you to the 13th conference of pan-Arab society in Amman, next Amman. We hope that all these crises will be there behind us. Thank you so much.

neurosurgery

Arab world

training programs

clinical research

statistics

education