Specialised medical services
Several foreign experts have made significant contributions to the development of specialised medical services in Mauritius. One of them, Dr Suresh Asopa, is due to leave the country shortly after spending 25 years here and establishing a full-fledged Neurosurgery service.
In fact it was following a report submitted by Prof A K Banerjee, head of Neurosurgery at the All India Institute of Medical Sciences, New Delhi, who was commissioned to make a situation analysis and propose recommendations about Neurosurgery in Mauritius, that Dr Asopa was selected by him to come and set up a Neurosurgical Service in the public health sector in Mauritius.
He was then practicing at Bombay Hospital, and left his post there for the purpose of the mission in Mauritius. He arrived in this country in March 1989, and has thus completed 25 years of service to the population of Mauritius as a neurosurgeon.
It may be noted that at that time there were two neurosurgeons practicing in the private sector, and none in the public sector. There was therefore no neurosurgery to speak of in any government hospital, and he was tasked to start from scratch and set up Neurosurgery Services in the Ministry of Health.
Dr Asopa was posted at the SSRN Hospital with a mandate to set up the first Neurosurgery Unit there. This is now in place, and Dr Asopa gave us an outline of the current status of the Unit and the service in the island, as follows:
– Neurosurgery Ward of 24 beds, accommodating both male and female patients.
– Operation Theatre: Shared with Cardiac Surgery Service.
Equipment: The Operation Theatre is equipped with sophisticated gadgets such as CUSA (Cavitron Ultrasonic Aspirator), operating microscope, Mekay’s table, etc.
– Two Neurosurgeons posted at SSRHH.
– Nursing staff in ward and ICU.
Training: The nursing staff for ward, Operation Theatre and ICU have received special training in handling Neurosurgery cases.
Coverage: The two neurosurgeons at SSRNH cover Flacq and Jeetoo Hospitals as well, that is, all cases from Flacq and Jeetoo Hospitals requiring Neurosurgical advice or interventions are referred to them at SSRN Hospital.
Operations performed: Both the range and the number of operations performed have increased.
– From 39 in 1989, at present about 225 operations are done every year at SSRNH.
– Types of operations: cases include victims of head injuries (road accident, industrial, etc), brain heamorrhage, tumours of the brain, etc.
Island-wide Neurosurgery Service in Public Sector:
There are 3 neurosurgeons based at Victoria Hospital and they cover JNH as well. In total there are now 5 neurosurgeons and two 2 junior neurosurgeons in the Ministry of Health.
Further, there are currently 2 neurosurgical trainees in Switzerland and Kenya respectively.
Patients sent abroad:
A certain number of patients still have to be sent abroad for various technical reasons, amongst others the lack of certain sophisticated equipment locally, for example DSA (Digital Subtraction Angiography). There are arrangements that have been made between MOH and specialised institutions in India e.g. VIMHANS in New Delhi.
It can be seen that the Neurosurgery services have come a long way from the initial start in 1989, such that the majority of Mauritians needing Neurosurgery can now be managed locally.
Like any other medical speciality, the field of Neurosurgery is continually developing, and at a rapid pace. Industrialisation, vehicular traffic expansion with more road accidents, lifestyle factors are all contributing towards increasing the load of neurosurgical work. In order to keep pace with this increased volume and the advances taking place in the field, both the Neurosurgery Services in MOH have to be revisited in terms of organization, infrastructure, staffing with a focus on training, equipment and continuing medical education of the health professionals.
For example, it is now essential to have the DSA equipment, which will allow cases of subarachnoid haemorrhage to be treated locally instead of being sent abroad.
From the organization point of view, for a population of the size of Mauritius, Dr Asopa felt that the department should ideally be situated at one place, with attached neurologists, neuro-radiologists, neuro-anaesthetists and so on. He added that the idea mooted at the MOH to set up this department at VH is now several years old, and should be pursued to completion at the earliest.
Despite constraints and obstacles to set up a Neurosurgical Unit and develop an island-wide Neurosurgery Service starting from zero in 1989, this is now a reality for Mauritius. It is now up to the new generation to make further developments, and Dr Asopa was confident that there will soon come a time when most of the neurosurgical problems will be dealt with in Mauritius itself, with a diminishing number of patients having to be sent abroad.
After spending almost half of his working career in this country, naturally he will be leaving the country with mixed feelings. He carries with him pleasant memories of his professional and social life, and wishes the best for the people of Mauritius. We too wish him all the best in his future life, and extend our wishes to his wife, and to his son Jayam, who recently completed his medical internship. we pray for a fruitful career as – future Neurosurgeon too perhaps?
* Published in print edition on 11 July 2014