Once, when Dr. Mark Bernstein was removing a brain tumor from a young boy in Ghana, the electricity failed and the operating room went dark.
“We had to complete the surgery using flashlights,” says Bernstein, a neurosurgeon at Toronto Western Hospital and holder of the Greg Wilkins-Barrick Chair in International Surgery.
Power failures are a common occurrence in hospitals in developing countries, Bernstein says. So when he embarks on teaching missions to resource-poor countries, he often provides battery-powered, LED (light-emitting diode) lights that surgeons can wear on their foreheads as a contingency against blackouts. He also brings his vast knowledge and experience in neurosurgery, including awake craniotomy, brain surgery performed when a patient is awake.
For the past two and a half years, Bernstein’s teaching missions have been supported by a $5.5 million gift from Barrick and the family of former Barrick CEO, Greg Wilkins. Wilkins passed away in December 2009 after a courageous battle with brain cancer. He was treated at Toronto Western Hospital, where he underwent brain surgery performed by Bernstein. The gift in his name was provided in 2011 and established the Greg Wilkins-Barrick Chair in International Surgery, which oversees research and training programs for doctors in developing countries. It also established the Greg Wilkins-Barrick Fellowship, which provides annual funding for a neurosurgeon from a developing country to train at Toronto Western Hospital.
James Balogun, a neurosurgeon from Nigeria, was the second recipient of the Wilkins-Barrick Fellowship. “I had the opportunity to train with people who are masters in their field, including my mentor, Mark Bernstein,” Balogun says. “I had a chance to use equipment that I had only read about in text books. I saw how patients are cared for in a systematic way by multidisciplinary teams, and how this can extend someone’s life for years. I’ve learned so much in the past year, and it has put me in a very good position to advance patient care when I go back home.”
Since the establishment of the Wilkins-Barrick Chair, Bernstein has led teaching missions to Ethiopia, Nigeria, the Ukraine and Zambia. These countries lack the resources that most Canadians take for granted, Bernstein says. They don’t have high-end surgical drills and are chronically short of CT and MRI scanners. Post-operative care is also lacking and brain tumor patients often wait months for a pathology diagnosis, which may turn out to be wrong because most hospitals lack dedicated neurosurgeons.
Zambia, for instance, has just three neurosurgeons in a country of 15 million, Bernstein says. That’s one for every five million people. By comparison, Canada has 180 neurosurgeons for a country of 35 million, or roughly one per 195,000.
During teaching missions, which last about two weeks, Bernstein conducts lectures, and performs and supervises surgeries. He says awake brain surgery is a practical option in resource-poor countries because it doesn’t require general anesthetic, still a high-risk proposition in the developing world. It’s also relatively inexpensive and safe, and doesn’t take a lot of time – important considerations in countries where the health-care systems are usually underfunded and overburdened.
In addition, neurosurgeons can communicate with patients during awake brain surgery, which helps them determine areas to avoid when excising tumors, minimizing potential damage to critical functions such as speech and hearing.
Before starting his fellowship in Toronto, Balogun performed two awake craniotomies in Nigeria under Bernstein’s supervision. Then, he was able to observe Bernstein for an extended period in Toronto. “I had the privilege to watch him up close and learn exactly how he does his thing,” Balogun says. “In that way, my understanding was consolidated. I am now armed with this knowledge that I can use and transfer to my colleagues.”
For Bernstein, this knowledge transfer is at the heart of what he does, and what the Wilkins-Barrick gift is helping to facilitate. “I have no illusions about changing the face of neurosurgery across the planet, but most things in life happen in baby steps,” he says. “If we can teach doctors in developing countries how to do awake brain surgery, how to work better as a team and think critically, then those little things can stack up to produce better doctors who want to share what they learn. And, make no mistake, we learn a lot from the doctors and nurses we meet on teaching missions, including how to cope with dignity in very difficult working conditions. It’s a lesson you don’t forget.”
Read more about the Greg Wilkins-Barrick Chair in International Surgery.