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.

NON-COMMUNICABLE DISEASES: A GLOBAL HEALTH THREAT

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World Association for Medical Law Congress in Tokyo on 6-8 August 2019.     

Non-communicable diseases (such as heart disease, stroke, cancer, diabetes) are collectively responsible for 7 out of 10 deaths in the world, 41 million people every year.  Many of these people die prematurely and the vast majority of these deaths are in the low income countries.  The World Health Organization considers non-communicable diseases to be one of the top ten global health threats.

The situation is even worse in the least developed nations that are facing a triple burden on ongoing infectious diseases, rapidly increasing non-communicable disease and the effects of globalization including accidents and injuries, compounded by a dearth of healthcare workers.

Neurologist and Attorney James C. Johnston, MD, JD and Neurologist Mehila Zebenigus, MD discussed these concerns at the 2018 United Nations (UN) High Level Political Forum in New York and provided specific recommendations for improving healthcare access in the least developed nations, particularly sub-Saharan Africa.

On behalf of Global NeuroCare® Drs. Johnston and Zebenigus published a written statement on improving healthcare as a strategy for poverty reduction at the UN 56th Commission for Social Development with specific recommendations for Member States to improve healthcare access.  Global NeuroCare® is a non-profit organization holding Special Consultative Status with the United Nations ECOSOC.  This allows Drs. Johnston and Zebenigus, as Directors of the NGO, to provide expert analysis on issues related to global health, make written and oral recommendation statements, and serve as UN Delegates at the United Nations sessions in New York, Geneva and Vienna.

Drs. James C. Johnston and Mehila Zebenigus reviewed their recommendations for improving healthcare in developing regions with leading international experts from over 40 countries at the 24th World Association for Medical Law Congress in Tel Aviv, Israel.  The WAML, in conjunction with the Israeli Ministry of Health and Tel Aviv University honored Dr. Johnston with the Inaugural Davies Award in Public Health.  Dr. Johnston dedicated the award to the Addis Ababa University Department of Neurology and donated the funds to Global NeuroCare.®

Drs. Johnston and Zebenigus have published another statement for the 57th Session of the UN Commission for Social Development addressing inequalities and challenges to social inclusion through advancing healthcare strategies.

They will also present these recommendations to the 25th  World Association for Medical Law Congress in Tokyo on 6-8 August 2019.

Electronic Fetal Monitoring and CP

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Dr. James C. Johnston is the founding partner of Global Neurology and Director of the non-profit organization Global NeuroCare. As a board-certified neurologist with thirty years of experience, Dr. James C. Johnston has authored over one hundred peer reviewed journal articles, papers and book chapters on various topics related to neurology and global health including cerebral palsy (CP).

The high rate of CP in developing nations has led many of these regions to seek electronic fetal monitoring (EFM) as a means of reducing perinatal mortality and morbidity. However, EFM is an ineffective modality with a 99% false positive rate, and does not predict cerebral palsy, acidemia, neonatal neurological injury, stillbirths or neonatal encephalopathy. It does increase the C-section rate and is a significant source of harm to mothers and babies.

Despite 50 years of continuous use of EFM, the cerebral palsy rate and rate of other neurological birth related maladies remains unchanged. Continuous EFM should not be used in normal pregnancies, especially in developing regions where it will waste money that is so desperately needed for prenatal and post-partum care for mothers and babies, and add another layer of undesirable morbidity and mortality to an already critical situation.

Dr. James C. Johnston and his colleagues have published a number of peer reviewed articles concerning EFM and CP. They have discussed CP litigation in the Journal of Child Neurology; ethical concerns related to EFM in Maternal Health, Neonatology and Perinatology; review of the Task Force failure to address this problem in J Maternal Fetal and Neonatal Medicine; the history of EFM and medical training for EFM in separate articles in the Surgery Journal; and some of the legal and ethical concerns in Medical Law International.

J of Child Neurology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431995/

Maternal Health, Neonatology and Perinatology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697350/

J Maternal, Fetal and Neonatal Medicine: https://www.ncbi.nlm.nih.gov/pubmed/26067269

Surgery Journal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530627/

Surgery Journal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553489/

Medical Law International: http://journals.sagepub.com/doi/abs/10.1177/0968533217704883

These and related articles are also available through Researchgate.net at https://www.researchgate.net/profile/James_Johnston6.