Thomas Pieters, MD (left)
Neurosurgical Resident at University of Rochester Medical Center
Tyler Martin Schmidt, DO (right)
Neurosurgical Resident at University of Rochester Medical Center
Leland Albright, MD, FAANS(L), remembers the moment when he began considering the challenge of starting a pediatric neurosurgery program in Kijabe, Kenya. It’s an experience many of us in the neurosurgical field are familiar with following his publication in the Journal of Neurosurgery: Pediatrics, “Reflections on developing pediatric neurosurgery in Sub-Saharan Africa.” He was driving with his wife, Susan Ferson, a pediatric neurosurgery nurse practitioner, in October 2009 when he had what he describes as a loud thought, “Go to Kijabe, Kenya to teach and to do pediatric neurosurgery.” After all, he had visited there nine times in the previous seven years. Although this undertaking represented a significant deviation from their practice at the University of Wisconsin Medical Center, he and Susan decided to move. They believed it would be, “where they should be, doing what God wanted them to do.” In the following months, Dr. Albright collected donated medical supplies and equipment that would be needed for neurosurgery, including an operating table, a (rudimentary) operating microscope and microinstruments, a Midas Rex drill, and a Storz endoscope and monitor.
His resultant experience not only honors the spirit of neurosurgical excellence and service started by Dr. Harvey Cushing, but also exemplifies these selfless ideals to inspire the next generation of neurosurgeons to follow in his footsteps. The man who flew to Kijabe in 2010 had come a long way from his humble beginnings in medicine, through a transition to pediatric neurosurgery, to a career of innovation; all of these experiences collectively supporting his new adventure in Kenya.
Dr. Albright’s career began at Louisiana State University School of Medicine. Not unlike many neurosurgeons, he was at first interested in another specialty, in his case hematology/oncology. He made his decision to pursue neurosurgery during a six-week rotation with Peter J. Jannetta, MD, who had come from UCLA to develop a neurosurgery department at LSU. He was further bolstered in his decision to enter the field of neurosurgery during his three years as a clinical associate in neurosurgery at the National Institutes of Health (NIH). He finished his residency at University of Pittsburgh Medical Center and worked with children for the first time at the Children’s Hospital of Pittsburgh. Dr. Albright states that “more than anything, I fell in love with the children and their conditions.” They seemed to “click” for him internally. After residency, he was an attending neurosurgeon and pediatric neurosurgeon at the University of Louisville for two years, then had his first experience in global neurosurgery — at the Baptist Hospital in Pusan, South Korea, where he spent six months developing a neurosurgery program that remains functioning to this day. From there he returned to UPMC and the Children’s Hospital of Pittsburgh.
Dr. Albright’s interest in improving childhood spasticity began in 1995 when he heard Warwick J. Peacock, MD, present a paper at a pediatric section meeting about the selective eradication of certain specific nerves to treat children with increased muscle tone (spasticity). He developed a multi-disciplinary clinic which used these “rhizotomies” to treat spastic paraparesis effectively. At that time, however, as rhizotomies were not used for children with spasticity in all four extremities, he obtained permission from the U.S. Food and Drug Administration (FDA) to evaluate intrathecal baclofen (ITB) for these children. Some years later, he evaluated a 35-year old woman who had developed extreme writhing movements as a side effect of extensive medication usage (secondary dystonia) who had failed multiple oral treatments. At the request of her neurologist, Dr. Albright evaluated ITB in her with a series of lumbar punctures, injecting either placebo or increasing doses of baclofen in a double-blinded manner over six days. Although he did not observe improvement, the patient was able to correctly identify the days she received placebo and the days she received baclofen. Dr. Albright implanted a baclofen pump, and within two days, her excess movements were almost eliminated. He realized that ITB could be utilized as a new treatment for children with severe secondary dystonia. He developed an extremely successful multi-disciplinary spasticity and movement disorder clinic in Pittsburgh and later in Madison, Wisconsin.
In addition to his work in South Korea, Dr. Albright went twice for two weeks to the Baptist Hospital in Ogbomosho, Nigeria to teach and operate. He began going to Kenya in 2001 after an American missionary surgeon contacted him regarding the endemic nature of hydrocephalus and spina bifida there.
On August 31, 2010, Dr. Albright and Susan made the move to Kenya. Throughout his four-plus years there, he taught fellow Dr. Humphrey Okechi to be a pediatric neurosurgeon and taught multiple other residents from Kenya and the U.S. the principles and techniques of pediatric neurosurgery in a developing country. He, Dr. Okechi and visiting pediatric neurosurgeons from the U.S. and Canada did over 5000 cases. With or without visitors, 25 cases were done each week, 100 a month. Patient interactions were difficult given social and language barriers. Full patient education was not always possible, which necessitated a lot of patient trust. Susan worked with neurosurgery nurses to describe the procedures and the major risks to the patients, but sometimes it was impossible to obtain a patient’s history because no one in the hospital spoke that tribal language. Dr. Albright reflects that even for patients with complications, families usually went home grateful for the care they had been given and the way their children had been valued.
Throughout his time in Africa, he and his team were faced with many challenges, and they drew support from the experiences of other missionaries. He remembers that before his first medical mission trip to Pusan, a retiring missionary advised him, “to have low expectations, be flexible and have a sense of humor.” He found all of these to be true, but notes that the most important quality needed was that of patience. Through multiple setbacks, including microscope failures, power failures or discouraged staff experiences, his ability to maintain patience allowed the delivery of the best possible care.
Dr. Albright recognizes that the relative pediatric neurosurgical needs in Africa are a fraction of those when compared to endemic AIDS, malaria, and tuberculosis. He believes it is unreasonable to try to develop pediatric neurosurgery centers throughout all sub-Saharan African countries and favors pediatric neurosurgery in academic centers with a particular focus on treatment of diseases that have the potential for better outcomes. That model maximizes value to the community in the setting of limited resources and social customs.
When asked what we as neurosurgeons can do to contribute to the neurosurgery in Africa and to help create a sustainable practice, Dr. Albright recommends:
- Be a resource for supplies and equipment (even small items we take for granted such as Bovie pads and cauteries);
- Be a resource for consultation via email about difficult cases, but remaining aware of limited resources; and
- Be a resource for education by making weekly teaching conferences available by Skype.
In discussing his time in Kijabe, Dr. Albright remembers some particularly difficult patient outcomes, “stuff that could break your heart…those are the cases you remember.” However, he drew support from his wife, Susan, from prayer and from a weekly meeting with missionaries experiencing their own troubles. Despite the challenges of his four-year experience, he has no hesitation in saying that if he could, he would do it again and wouldn’t change a thing.
The lessons learned from Dr. Albright’s selfless experience and earned wisdom can help to solve our own challenges in not only neurosurgical practice, but also our daily personal lives. We salute Dr. Albright for his efforts to improve the treatment of pediatric patients.
Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #PedsNeurosurgery