To the Editor: The authors appreciate the comments of Chapman et al1 in response to “Global Neurosurgery: An Overview,”2 the first article in our 7-part series on Global Neurosurgery Essentials. Their comments amplify our two basic messages to the neurosurgical community: (1) that contemporary neurosurgery includes a commitment to the global sharing of neurosurgical knowledge and (2) that global partnerships are essential to progress. The past several decades have been characterized by globalization in nearly every sector of human activity. For neurosurgeons, this has led to a recently acquired, additional professional responsibility. Thus, in addition to taking the best possible care of our patients, we are now called to support those initiatives which are designed to assure that all neurosurgeons can take the best possible care of their patients. As authors Chapman et al write, global neurosurgery encompasses far more than including international speakers at conferences or traveling to distant locations to provide operative support. Key initiatives are often those that require little or no travel but do include a commitment to partnerships that foster clinical excellence in delivery of neurosurgical care everywhere. Such programs include video participation in academic clinical and morbidity/mortality conferences; modeling of high-quality bedside rounding; research training, participation, and publication; and mentorship in clinical and leadership advancement. A recent study of North American neurosurgical training programs showed that two-thirds of programs include global neurosurgery activities in their residencies. Nearly every major neurosurgical meeting now includes global neurosurgery sessions, and this journal has a section devoted to Global Neurosurgery. Our commitment to global sharing of knowledge in pursuit of clinical excellence necessarily includes work toward timely access to neurosurgical care for all who need it. This element of additional, acquired professional responsibility cannot be accomplished by neurosurgeons alone. The creation of infrastructure that provides excellent neurosurgery requires the full participation of what has been called the “neurosurgical ecosystem”: neurosurgeons, neurosurgical organizations, allied health individuals and organizations, academic institutions, public health and government officials, industry, philanthropy, and patients. A newly created organization, the International Society of Global Neurosurgery (www.isgns.org), has been launched to amplify and coordinate these efforts. The G4 Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care (theg4alliance.org) advocates for all disciplines that work in the procedure-heavy fields of Emergency, Critical and Operative Care, sharing the challenges of specialty care which is costly and complex. These organizations are the pathways that connect clinicians to the large multilateral organizations, providing a “seat at the table” when national and regional resources for health system strengthening are being discussed and determined. In addition to the busy clinical practice we each face every day, we now have another professional responsibility: to advocate for quality neurosurgical care everywhere. Despite the United States withdrawal from the World Health Organization, neurosurgeons have multiple avenues to pursue global clinical access and excellence in our specialty. The characteristic passion and perseverance, discipline and determination of our training will provide the needed leadership to maintain, and accelerate, this progress.
G. Rosseau (Fri,) studied this question.