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.

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GLOBAL NEUROCARE IN SPECIAL CONSULTATIVE STATUS WITH THE UNITED NATIONS

Dr. James Christopher Johnston

In 2010, Dr. James C. Johnston established the non-profit Global NeuroCare® to advance healthcare in developing regions.  Global NeuroCare® was formally granted Special Consultative Status with the United Nations as a Non-Government Organization in 2013 and this status has been continually renewed.  It is the highest status granted by the United Nations to NGOs.

The UN ECOSOC Committee on NGOs, which is comprised of 54 Member States, recommended Global NeuroCare® after a lengthy and laborious application process including a review of its statutes, objectives, past and present affiliation, and achievements.  The UN ECOSOC grants Special Consultative Status to NGOs with programs of direct relevance to the aims and purpose of the United Nations.

This position allows Global NeuroCare to provide expert analysis on issues directly from its experience; help monitor and implement international agreements; take an active role in advancing United Nations goals and objectives; serve as an early warning agent; raise public awareness of relevant issues; provide essential information and analysis at organizational events; make written and oral statements at international conferences and events; and organize additional or side events.  Global NeuroCare® members can serve as UN delegates at the UN sessions in New York, Geneva and Vienna.

In accordance with Article 71 of the UN Charter, the Economic and Social Council (ECOSOC) of the United Nations has fully accepted Global NeuroCare in its circle of accredited non-governmental organisations.

This consultative relationship is governed by the UN ECOSOC resolution 1996/31, which outlines the eligibility requirements for consultative status, rights and obligations of NGOs in consultative status.

Based on his experience in Global Health, James C. Johnston, MD, JD has presented multiple statements to the UN with recommendations on improving healthcare in developing regions, and these have been accepted and published by the ECOSOC High Level Political Forum and the Commission for Social Development.

GLOBAL NEUROLOGY REPORT: WORLD ASSOCIATION FOR MEDICAL LAW CONFERENCE

World Association for Medical Law (WAML) Congress

World Association for Medical Law (WAML) Congress

The 50th Anniversary Meeting and 23rd World Association for Medical Law (WAML) Congress was held on 9-14 July 2017 in Baku, Azerbaijan.  Leading international experts from around the globe discussed topics related to GlobalHealth, Medical Law and Bioethics.

Drs. James C. Johnston, Mehila Zebenigus and Guta Zenebe presented recommendations for improving relations between developed and developing countries through guidelines that focus on ethically advancing collaborative partnerships to improve health care. This topic followed Dr. Johnston’s lecture last year at the WAML meeting in Los Angeles, USA discussing the medical, ethical and legal problems that arise when Western countries engage in short term medical missions to resource limited nations, resulting in medical paternalism, doctor tourism and actual harm to the very patients that are most desperate for help.  Specific examples of these problems were presented at both meetings, along with clear guidelines on how to avoid the harmful effects of these self-serving missions.

Drs. James C. Johnston and Mehila Zebenigus also discussed concerns related to neuroimaging for the patient presenting with headache. They recommended deleting the currently used guidelines because those guidelines are outdated, and have been a contributing factor in the continuing misdiagnosis of headache disorders.  Dr. Zebenigus discussed the management of the patient with headache in Ethiopia.

Drs. Thomas P. Sartwelle, James C. Johnston, Berna Arda and Mehila Zebenigus highlighted the concerns related to using electronic fetal monitoring in sub-Saharan Africa, how that procedure causes more harm than good, and wastes scarce resources that would be better used helping children with cerebral palsy.

In terms of disclosure, Drs. Zebenigus and Johnston are Directors of the non-profit organization Global NeuroCare® which focuses on advancing neurological services in sub-Saharan Africa and particularly Ethiopia, and is actively involved in all of these areas.

GLOBAL NEUROLOGY REPORT: TRIANGULAR COOPERATION

Dr. James C Johnston

Triangular Cooperation | Dr. James C Johnston

Global NeuroCare is a non-profit organization dedicated to advancing neurological care in developing regions, especially sub-Saharan Africa and particularly Ethiopia.  It is one of the few non-government organizations to hold Special Consultative Status with the United Nations ECOSOC, which allows Director and Neurologist Dr. James C. Johnston to actively participate with the UN intergovernmental bodies, decision makers and related organizations.  Additionally, Global NeuroCare is accredited by the World Health Organization, and affiliated with the Office of the Special Adviser on Africa.

On behalf of Global NeuroCare, Dr. Johnston presented several statements over the past few years to the UN High Level Political Forum, the Commission for Social Development and the Integration Segment.  Four of these statements have been adopted and published, focusing on advancing collaborative partnerships between the North and South in an effort to improve healthcare in Africa.

Dr. Johnston emphasized the importance of ensuring that relationships between the North or developed countries and the South are based on sustainable, collaborative, ethically congruent partnerships that truly benefit the South, as opposed to the short term medical missions that are so harmful to developing regions.  Successful partnerships will allow sub-Saharan African nations to develop functional capacity building, thereby becoming self-sustainable, further advancing patient care, physician training and medical research.

These types of North-South partnerships can be even more effective by encouraging South-South and triangular cooperation.  South-South cooperation is the process whereby two or more developing countries pursue individual or shared objectives through exchanges of knowledge, skills and resources.  This is not a substitute for, but rather a complement to North-South partnerships.  In triangular cooperation, partnerships between two or more developing nations are supported by a developed country or even multinational organizations.

For example, Global NeuroCare focuses on advancing neurology in Ethiopia where Dr. Johnston serves as an Honorary Professor of Neurology in the Addis Ababa University Department of Neurology Residency Training Program.  This program has graduated 32 board certified neurologists over the past decade.  However, there are no local opportunities for advanced neurophysiology training, so Dr. Johnston arranges for the resident physicians to attend the University of Siena, Italy for 6 month fellowships.  This requires separate funding which has been provided through scholarships sponsored by a Canadian based neurophysiology society.  Thus Global NeuroCare coordinates Ethiopian training through Italy with financial support from Canada and, in turn, as an example of South-South cooperation, the Ethiopian physicians return to train their colleagues as well as physicians from other African nations.

Global NeuroCare plays a crucial role in coordinating this type of triangular coordination, which is the most effective means of ensuring sustainable capacity building leading to self-sufficiency that will truly advance healthcare in sub-Saharan Africa.

Global Neurology Report: The WHO ‘Neurology Atlas’ Second Edition

Emergency Room in Ethiopia

The World Health Organization (WHO) published the first comprehensive report (Neurology Atlas) on the
status of neurological care and services throughout the world over a decade ago. This compilation provided a
unique and invaluable source of data on the rapidly increasing burden of neurological disorders, and the available neurological services in 109 countries. It highlighted the large disparities between neurological care in the developed and developing nations, and provided critical information for medical specialists, healthcare planners, policy makers and national training programs. This Atlas provided the first detailed picture of the global situation for neurology, and the updated second edition was released in September 2017. It may be accessed here (http://apps.who.int/iris/bitstream/10665/258947/1/9789241565509-eng.pdf).

This updated Atlas reviewed 132 countries comprising 94% of the world’s population and the data will continue to be helpful to policy makers, although the findings were not surprising and may be summarized as follows:

(1) Neurological disorders are a significant cause of the global disease burden, which was thoroughly addressed in the Global Burden of Disease studies.

(2) Neurological disorders are disproportionately high in developing regions, which are also plagued by resource limitations and severe shortages of healthcare workers.

(3) Neurological conditions are expected to grow exponentially in the future.

The Atlas report focused on several key areas including legislation for neurological disorders, financing of neurological services, social welfare support, workforce data, available neurological services and informational gathering systems. As expected, sub-Saharan Africa fared the worst, with the lowest proportion of healthcare workers, the most limited services and poorest geographical distribution of those services. There were 0.04 neurologists per 100,000 people in the WHO African region, compared to 4.75 per 100,000 people in high income countries.

In Ethiopia, for example, where Dr. James C. Johnston serves as an Honorary Professor of Neurology with the Addis Ababa University neurology residency training program, there is one neurologist for every 3-4,000,000 people, and most of those neurologists are in the capital city Addis Ababa. This ratio, although exceedingly poor compared to the WHO recommendation of at least one neurologist for every 25,000 – 100,000 people, represents a significant improvement since before inception of the program in 2006 when there was one full time neurologist for the one hundred million people in the country.

Dr. Johnston established the non-profit organization Global NeuroCare (www.GlobalNeuroCare.org) to advance neurological services in developing regions. Global NeuroCare holds Special Consultative Status with the United Nations ECOSOC and fully supports the self-sufficient, sustainable Ethiopian neurology residency program. This program has made a significant and measurable difference in the Horn of Africa, graduating 32 board certified neurologists with 21 more physicians in the three year training, improving the lives of tens of thousands of people.

On behalf of Global NeuroCare, Dr. Johnston discussed the healthcare concerns affecting developing nations at the 2016 and 2017 United Nations High Level Political Forums, the 2017 United Nations Commission for Social Development, and at the World Association for Medical Law conferences in Los Angeles (2016) and Baku (2017). One of the main concerns impeding development stems from academic medical centers with global health programs that engage in short term medical missions which are tantamount to doctor tourism, fail to provide any substantive benefit to the developing nations, and cause more harm than good. He presented guidelines to improve sustainable, ethically congruent, collaborative partnerships focused on capacity building to advance neurological services in sub-Saharan Africa, using Global NeuroCare’s focus on Ethiopia as a model plan.