Advancing Neurology in Africa

A neurologist and attorney, James C. Johnston, MD, JD, is the founder of Global NeuroCare, a nongovernment organization (NGO). Global NeuroCare was established by Dr. James C. Johnston to improve neurological services in developing regions. Dr. Johnston and one of his Ethiopian colleagues Dr. Mehila Zebenigus, serve as Directors of this organization.

Holding Special Consultative Status with the United Nations ECOSOC, the highest status granted to an NGO by the UN, Global NeuroCare has engaged in a long-term collaborative partnership with Addis Abada University Department of Neurology to advance the training of physicians in Ethiopia. The Neurology Residency Training Program has been an outstanding success, substantially increasing the number of practicing neurologists in the country, leading to the treatment of more patients. These neurologists are also teaching a new generation of doctors to manage common neurological problems which represents the most effective was to improve healthcare in regions with a severe shortage of doctors and other healthcare providers.

On behalf of Global NeuroCare, Dr. Johnston and one of his Ethiopian colleagues Dr. Mehila Zebenigus have discussed the medical, ethical and legal aspects of advancing healthcare in developing regions at several meetings over the recent years including the United Nations High Level Political Forums, World Congresses for Medical Law and American Academy of Neurology conferences. They have highlighted the serious concerns of short term medical missions which fail to provide any substantive benefit to the host nation, and may cause significant harm to the local population. An additional concern is that developing nations have inherently vulnerable populations that may be intentionally or unintentionally exploited by these types of brief self-serving medical missions.

Drs. Zebenigus and Johnston presented the Ethiopian model to demonstrate that effective capacity development requires increasing the recruitment, training and retention of medical staff, which mandates stable long-term collaborative North-South partnerships focused on establishing local training programs, staffed by local physicians, to address the particular local community needs. They recently published a white paper for the UN on this topic, and will be present those recommendations at the 26th Congress Meeting of the World Association for Medical Law.

GLOBALNEUROLOGY® REPORT: TUBERCULOSIS – WHO GLOBAL TB REPORT

Tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis, most often affects the lungs, and is spread through the air from person to person.  TB may involve the brain, spine, kidney, or joints, and less commonly other organs or body systems.  Almost one-quarter of the world’s population harbours latent TB, meaning they have been infected but are not yet ill with the disease.  TB is the leading cause of death from a single infectious agent, and remains one of the top ten causes of death globally.

The most recent WHO Global TB Report confirms that 7 million people were diagnosed and treated for TB in 2018, meeting one of the milestones towards the UN Political Declaration Targets on TB.  Although the number of new cases of TB has recently declined, the burden remains very high in the least developed nations especially in sub-Saharan Africa, and in India, China and Russia.  There are an estimated 3 million people with TB who are not receiving treatment, and progress must be accelerated in order to attain the Sustainable Development Goal (SDG 3.3) of ending TB by 2030.  https://www.who.int/tb/global-report-2019

In the least developed nations, the combination of limited infrastructure, severe shortages of physicians and other healthcare providers, and lack of medications precludes the effective diagnosis and treatment of many diseases including TB.  Drs. James C. Johnston and Mehila Zebenigus have discussed these concerns and provided recommendations to improve care in developing regions at the American Academy of Neurology meetings and World Congress of Medical Law conferences as well as in the peer-reviewed literature.  Comprehensive programs with international support and monitoring are essential, and there must be a focus on children since half of children with TB do not receive quality care and only one-quarter of children under 5 years of age in TB-affected households currently receive preventive treatment.

Another serious impediment to ending TB is drug resistance which affects half a million patients annually, with only one in three of those patients receiving treatment.   WHO recently provided new guidelines for improving treatment of multi-drug resistant TB and is working with civil society organizations (CSO) to address this problem.

Global NeuroCare® is a non-profit CSO in Special Consultative Status with the UN ECOSOC and fully supports the comprehensive efforts to achieve the 2030 SDG 3.3 of ending the TB epidemic.  Directors James C. Johnston, MD, JD and Mehila Zebenigus, MD provided recommendations for addressing TB and other conditions at the UN High Level Political Forum earlier this year, and at the 2018 Commission for Social Development. Article.6.2019.TBimage[1]

Global Neurocare Works with the UN to Combat Neurological Disorders

A prominent neurologist and medical law specialist, Dr. James C. Johnston has been in private practice for nearly 30 years. In addition to his work as a neurologist, James C. Johnston, MD, JD, also serves as a partner with Global Neurology Consultants, where he is mostly concerned with improving health care quality and access in developing regions. To further this vision, Dr. Johnston founded Global Neurocare, a nonprofit organization dedicated to advancing patient care and increasing medical training and research in developing countries such as Ethiopia.

Neurologists are scarce and resources limited in these developing regions, resulting in the needless deaths of those suffering from neurological disorders every day. Global Neurocare was granted Special Consultative Status with the United Nations in 2013, the highest status granted to a non-governmental organization. The Economic and Social Council (ECOSOC) Committee at the United Nations looks at numerous applications to find non-governmental organizations that coincide with the aims and purposes of other United Nations programs.

Members of organizations granted Special Consultative Status are able to serve as UN delegates at sessions in various locations around the world. Global Neurocare’s status with the UN allows it to raise public awareness, implement international trade agreements, and provide expert analysis on relevant issues, among other benefits. Neurological disorders are recognized by the World Health Organization as one of the greatest threats to public health, and organizations such as Global Neurocare are poised to help with the crisis.

“Electronic Fetal Monitoring, Cerebral Palsy, and Medical Ethics”

A Consultant Neurologist in private practice, Dr. James C Johnston holds an MD from the University of Texas Health Science Center, is a Diplomate of the American Board of Psychiatry and Neurology, and an Attorney and Counselor at Law. Dr. James C Johnston is also an accomplished clinical researcher and medical author.

Among Dr. James C Johnston’s numerous peer-reviewed articles on cerebral palsy and electronic fetal monitoring, he published “Electronic Fetal Monitoring, Cerebral Palsy, and Medical Ethics: Nonsense of a High Order” with coauthors Berna Arda and Thomas P Sartwelle. This article appeared on May 2, 1017 in the medical law, health governance, and bioethics journal Medical Law International.

Electronic fetal monitoring (EFM) is employed to monitor the heart activity of unborn babies during the labor process. The inventors of EFM saw great benefits for the prevention of cerebral palsy (CP), believing that the technology could predict CP and allow physicians the time to prevent CP by ordering immediate C-sections.

“Electronic Fetal Monitoring, Cerebral Palsy, and Medical Ethics” demonstrates that EFM has done nothing to combat CP since the technology became the standard of care almost half a century ago. Furthermore, the article describes how EFM harms mothers and babies alike and discusses how physicians relying on EFM violate the fundamental bioethical principles of autonomy, beneficence, and nonmaleficence.

James C. Johnston, MD, JD and his colleagues have also published an article in the 2018 Surgery Journal highlighting the failed arguments of a typical EFM advocate. This article, “Continuous Electronic Fetal Monitoring During Labor: A Critique and Reply to Contemporary Proponents” is freely available in the open access journal or through the following link on Researchgate.net:

https://www.researchgate.net/publication/323614188_Continuous_Electronic_Fetal_Monitoring_during_Labor_A_Critique_and_a_Reply_to_Contemporary_Proponents

The Medical Law International article is also open access and available through Researchgate.net under Dr. James C. Johnston: https://www.researchgate.net/publication/316693326_Electronic_fetal_monitoring_cerebral_palsy_medical_ethics_Nonsense_of_a_high_order.

ELECTRONIC FETAL MONITORING:  A BLATANT DISREGARD OF MEDICAL ETHICS

Prominent medical malpractice attorney Thomas P. Sartwelle and neurologist James C. Johnston, MD, JD, published a new article on cerebral palsy and electronic fetal monitoring (EFM) in the journal Clinical Ethics, co-authored with renowned medical ethicist Professor Berna Arda, and neurologist Dr. Mehila Zebenigus.  

This article represents the latest in an ongoing series by these authors who have related publications in the Journal of Child Neurology; Neurologic Clinics; Surgery Journal; Maternal Health, Neonatology and Perinatology; Journal of Pediatric Care; Journal of Maternal, Fetal and Neonatal Medicine; Medical Law International; Journal of Childhood and Developmental Disorders; and several other journals and book chapters.  These articles may be accessed on ResearchGate.net. In this particular Clinical Ethics article, the authors discuss the use of EFM without informed consent which represents a blatant disregard of patient autonomy.

An abstract summary highlights the content:  A half century ago electronic fetal monitoring was rushed into clinical use with the promise that the secrets of fetal heart rate decelerations had been discovered and that the newly discovered knowledge would prevent cerebral palsy with just in time cesarean sections (C-sections) preventing babies from experiencing asphyxia, which was thought to be the primary cause of cerebral palsy. In the years since electronic fetal monitoring’s debut, it has been discovered that asphyxia is a rare cause of cerebral palsy. At the same time electronic fetal monitoring use increased to 85% of all labors, the C-section rate increased to 33% without an attributable decrease in the rate of cerebral palsy. What went wrong with electronic fetal monitoring?

The answer lies in a new analysis of the physiologic theories concerning fetal heart rate decelerations, demonstrating that the earlier electronic fetal monitoring theories were wrong. This revelation is only the latest evidence that electronic fetal monitoring use today is harming mothers and babies with useless C-sections. Yet electronic fetal monitoring use continues unabated. Why? This article explores the complex answers and bioethical concerns, through a review of the new evidence underlying fetal heart rate decelerations in labor.