Oral presentation: Ellianne dos Santos Rubio

Background

13 million people lack timely access to neurosurgical care in the Caribbean.  The World Health Organization (WHO) and Centers for Disease Control (CDC) see neurosurgical task-sharing as a promising strategy to address specialist scarcity and delayed emergency care. In task-sharing, medical tasks are performed collaboratively between specialists and non-specialists with shared responsibility.

Healthcare workforce scarcity is seen across the Caribbean Islands of the Dutch Kingdom. Curaçao serves as a neurosurgical tertiary hub for referrals from Bonaire, Sint Maarten, Saba, and Sint Eustatius, while Sint Maarten serves as a secondary care center for the northern islands. The consequent air-ambulance-dependent pathways negatively impacts neurosurgical emergencies, resulting in preventable morbidity and mortality.

Methods

This research aims to: (1) analyze workflow, quality, and equity in emergency air-ambulance transfers using mixed qualitative and quantitative methods; (2) explore the potential and limits of neurosurgical task-sharing in underserved island settings; (3) survey Caribbean physicians and communities on the need, acceptability, and perceived impact of neurosurgical task-sharing; and (4) develop and implement an initial simulation-based training hub in Curaçao for non-neurosurgeons to systematically train for emergency procedures.  These procedures will be supported by structured curricula, standardized assessments, cost-effective analysis, and real-time tele-monitoring via Vuzix smart glasses, to strengthen islands without resident neurosurgeons, focusing on the Caribbean islands of the Dutch Kingdom.

Ultimately, this work aims to co-create a collaborative model that improves timely access, safety, and resilience of neurosurgical emergency care, with hopes of building a reproducible model for analogous geographically constrained settings.