Ethical Challeneges of Emergency Neurosurgery in Remote Ruralareas of North-East India

Aim: To evaluate the ethical challenges of emergency neurosurgical services in a resource constrained remote rural area of northeast India. This report details our initial experiences and prole of emergency neurosurgery in our Centre, Jorhat Medical College Hospital. Method and materials:Aretrospective audit of functioning of emergency neurosurgical service was done in Jorhat medical college hospital from June 2015 to May 2018 for a period of 3 years. Patients evaluated and treated in neurosurgery department were included in the study. Data was collected using patients' data sheets and presented in tables and graphs. Simple descriptive data analysis was done with relevant statistical tools. Results and observation: During the study period a single neurosurgeon was operating. There was no dedicated ward and ICU demarcated for neurosurgery. None of the operation theatre nurses had prior neurosurgical exposure. Atotal of 4680 emergency patients were evaluated by a single neurosurgeon during the study period. 668(14.27%; 1in 7) patients were left against medical advice. 1264 (27.12%) patients were transferred out to other hospital. 2748 (58.71%) patients continued treatment in Jorhat medical College hospital. 1716 (62.45%) were males and 1032(37.55%) patients were females. Total 213 patients (7.75%) were undergone operative neurosurgical management. 119(4.33%) patients were died. Most of the patients' autonomy to give consent for surgery were transferred to relatives. Conclusion: The study shows emergency neurosurgery is possible to perform with a limited facility and manpower, even in resource constrained remote rural areas. Sometimes it is ethically challenging whether to keep the critically ill patients or transfer to other far long neuro centers. We need to nd out our own driveways of challenges. These ndings will encourage young neurosurgeons to work in remote areas.