Pediatric neurosurgery in Africa--present and future

There is no doubt that the development of neurosurgery in general and paediatric neurosurgery in particular has lagged behind in many African countries, and in some unfortunate areas there is not even one single neurosurgeon. In contrast to this alarming situation, there are some excellent neurosurgical centres in northern and southern Africa, which developed fairly rapidly in the 1960s. To date, there are still striking contrasts in Africa where, of the neurosurgeons who are present there at all, some work in extremely difficult conditions while others have better facilities comparable to those in some of the best centres in the world. There is a general strong desire for neurosurgery in Africa to be developed using first what is available locally, then what is available in Africa and only then to turn to the world at large, and there is also consensus that this is the way to proceed. This paper will analyse the current status of paediatric neurosurgery in Africa and the problems that are hampering its development, and suggestions will be made about its future development. It is obvious that Africa is a huge continent and it might sound rather presumptuous to pretend to speak for it in detail. Taking account of this limitation, I will speak mostly about what is accepted nowadays as fact and reality common to most African countries, and for illustrative purposes some details will be given from Zimbabwe, which is where I practice.