GLOBAL NEUROLOGY REPORT: THE PERILS OF FETAL MONITORING IN AFRICA

Dr. James C Johnston

Maclean’s news recently interviewed neurologist and attorney Dr. James C. Johnston, his Ethiopian colleague and neurology Professor Dr. Mehila Zebenigus and Rwandan neurologist Dr. Jules Nshimiyimana for an editorial discussing the perils of using electronic fetal monitoring (EFM) in Africa.

Western medical advances exported to developing nations are supposed to improve healthcare and save lives.  However, “The West sometimes exports not just its medical advances, but its medical mistakes.”  This is unquestionably the case with EFM, a procedure that causes more harm than good.

EFM has been a birth myth for fifty years.  It is the standard of care in the West despite overwhelming evidence that it is ineffectual, rife with interpretive errors, has a 99% false positive rate, and has completely failed to reduce the incidence of cerebral palsy or any other neonatal neurological disorder.  EFM has, however, dramatically increased the caesarean section rate.  And C-sections create needless dangers to mothers and babies, increase risks in future pregnancies, and may account for an increased risk of future chronic diseases and neuropsychiatric disorders in children.

Why is this sham procedure being used against all scientific evidence?  To protect physicians and hospitals from lawsuits, as well as generate significant revenue.  And doing the procedure is not only medically harmful, but it completely neglects patient autonomy and informed consent.

Drs. Zebenigus and Johnston, along with renown medical ethicist Professor Berna Arda and leading medical malpractice attorney Thomas P. Sartwelle have discussed these concerns in the peer reviewed literature with publications in the Journal of Child Neurology, British Medical Journal, Journal of Maternal Fetal and Neonatal Medicine, Journal of Childhood and Developmental Disorders, Surgery Journal, Medical Law International, Neurologic Clinics and several other publications including the Legal Medicine and Medical Ethics textbook of the American College of Legal Medicine.  Many of these articles are freely available at ResearchGate.net:  https://www.researchgate.net/profile/James_Johnston6.

The more serious problem is that EFM is now being pushed in Africa, where the potential damage from a useless procedure is compounded by the utter waste of very limited resources.  The global fetal monitoring market is a multi-billion dollar business, and most of the growth in the next decade is projected to be in developing regions such as sub-Saharan Africa.  Drs. Zebenigus and Johnston have already seen the use of EFM machines increasing in Ethiopia, and Dr. Jules and other physicians report the same in Kenya, Rwanda, Tanzania, Uganda and other countries.

The cost of the EFM machines, training staff to read a useless test, and the resulting unnecessary C-sections all drain valuable resources that would be better used to care for children who have cerebral palsy.

“EFM has made birth less safe in the United States – and now, through a kind of medical imperialism, it is poised to potentially make birth less safe throughout the world.”

Read the Maclean’s news article at:

https://www.macleans.ca/society/health/the-use-of-electronic-fetal-monitoring-is-expanding-into-africa-and-thats-a-problem/

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Global Neurology Report: Access to healthcare in Africa

Gondar Outpatient Waiting

Gondar Outpatient Waiting

The Economist Intelligence Unit recently published a report on access to healthcare in Africa and the Middle East. (www.accesstohealthcare.eiu.com). The report recognized the complex challenges of improving access to healthcare in sub-Saharan Africa, a region plagued by the ‘double burden’ of ongoing communicable diseases and rapidly increasing non-communicable disorders. These problems are compounded by a severe shortage of healthcare workers, poor infrastructure, limited transportation, and a dearth of supplies, equipment and medications.

The Economist Intelligence Unit Index ranked the countries on both (1) accessibility for most disease categories and access to medications, and (2) the healthcare system including coverage, infrastructure, efficiency and innovation. The Index evaluated progress considering current global policy agendas, such as the UN Sustainable Development Goals. It also adopted a forward-looking approach, asking whether each country is implementing the right mechanisms today for optimal access in the future.

Ethiopia ranked at the bottom in a cluster of other sub-Saharan countries. These least developed countries struggle with additional challenges such as underdeveloped supply chains for medications, a significant urban-rural gap in access and, most importantly, a continuing shortage of healthcare workers.

The increasing incidence of non-communicable diseases including neurological disorders is exacerbating poverty and significantly adding to the disease burden. The EIU reports that financial expenses of healthcare drive 11 million Africans into poverty every year. But, as Drs. James C. Johnston and Mehila Zebenigus discussed at the July 2017 United Nations High Level Political Forum, the situation is magnified by neurological disorders which afflict tens of millions of people, typically the young, causing cognitive impairment and physical disability, leading to loss of employment, marginalization, increased vulnerability and exclusion, contributing to a profound impact on the economy.

This EIU Report raises several suggestions for improvement including national health insurance, mobile technology applications, artificial intelligence platforms and focusing on specific disease threats. However, while these proposals may be beneficial if enacted, they do not address the key problem – a shortage of healthcare workers.

Drs. James C. Johnston and Mehila Zebenigus discussed these concerns at the 2017 World Association for Medical Law (WAML) conference and, while recognizing the many overwhelming challenges, recommended focusing on the root of the problem – the shortage of physicians and other healthcare workers. Africa has one-quarter of the global burden of disease but less than 3% of the world’s healthcare workers. The only way to ensure sustainable improvement if to ethically advance collaborative partnerships between developed countries and the least developed regions, with clearly defined goals, focusing on the needs of the South to establish self-sustaining programs that incorporate training, patient care and research, and provide triangular cooperation to improve South-South relations.

This focus on collaborative partnerships is the approach Global NeuroCare has adopted in working with the Addis Ababa University Department of Neurology, and that autonomous program has been extraordinarily successful, soon entering the 12 th year, having graduated 32 board certified neurologists, with 21 more physicians in the three-year training program.

Drs. Zebenigus and Johnston serve as Directors of the non-profit organization GlobalNeuroCare.org and will discuss guidelines for developing sustainable collaborative partnerships at future meetings with the UN, WAML and other organizations.