The First National Pediatric Hydrocephalus and Endoscopy Workshop in Bolivia: A Cooperative Journey From Conception to Completion in a Lower-Middle Income Country Setting

BACKGROUND AND OBJECTIVES:Lower-middle income countries in South America have limited pediatric neurosurgery exposure and resources. Hands-on courses are critical in pediatric neurosurgical training, but detailed literature on the requirements and challenges of implementing such courses is lacking. This report describes our experience in conducting the first pediatric hydrocephalus and ventricular endoscopy course in Bolivia.METHODS:Through a partnership with Solidarity Bridge, a nongovernmental organization aimed at enhancing surgical education and training in Bolivia and Paraguay, the Department of Neurological Surgery at the University of Wisconsin organized a 2-day course to highlight all aspects of CSF diversion and endoscopy, using innovative approaches to account for limited country resources. The course preceded the national neurosurgical meeting in La Paz, Bolivia, which made it possible for medical students, residents, and practicing neurosurgeons countrywide to participate.RESULTS:Twenty-seven participants successfully completed the course, which consisted of didactic sessions, hands-on experiences, case discussions, interactive quizzes, and live surgery demonstrations. Course content was guided by multiple discussions with local neurosurgeons to understand priorities and needs. Important preparatory efforts included formal discussions with hospital and governmental leaderships to acquire appropriate course venues and facilitate resident attendance and travel, establishing a team of language interpreters native to Bolivia and Paraguay with insight in the local medical culture, and developing inexpensive endoscopy and CSF access models. Communication challenges were anticipated and addressed creatively, for example using game settings. Lessons learned comprised issues of logistics, funding, attendance, and assessment. Course feedback was overwhelmingly positive, with participants especially appreciating the one-on-one time with instructors at the hand-on stations, and the experiential and interactive format of the lectures.CONCLUSION:The successful execution of a pediatric hydrocephalus and ventricular endoscopy course in a South American lower-middle income country requires innovative approaches to mitigate resource shortage and strategic collaborations to optimize the educational venues.