Achieving women: Making a mark in neurosurgery

"If you are working with brain trauma, be prepared to handle life-or-death decisions every day," a female neurosurgeon says.

It is a conversation that has been described by Cosmopolitan Magazine in a report called 11 Things I Wish I Knew Before I Became a Neurosurgeon.

The female neurosurgeon, Uzma Samadani, PhD, MD, FACS, FAANS, goes on to express just how sensitive the work she does is.

"I work at the largest level-one trauma centre in the Midwest. Level-one centres are hospitals that are equipped to handle the most severe total body emergencies, so as a trauma neurosurgeon, I treat whatever comes in the door, and generally on very short notice. The first question the family asks when someone's had a traumatic incident is, 'Are they going to live?'"

She adds: "For many families, it is the most harrowing experience they will ever have; for neurosurgeons, this is just the daily routine. Nearly every patient is a high-stakes case, which can make this work feel incredibly important but also nerve-wracking."

There is a huge gender gap when it comes to the practice, with only 3200 women (7 per cent) in neurosurgery worldwide. In Kenya, there are only six female neurosurgeons. This is according to a recent report by the East African Journal of Neurological Sciences (EAJNS).

The report says that the current World Health Organisation (WHO) requirement is a ratio of one neurosurgeon to 100,000 persons and 1: 200,000 for low and middle-income countries, and locally, we are far from closing the gap. Kenya has, however, made strides over the years.

"To meet WHO requirements, Kenya requires an additional of about 230 neurosurgeons."

The EAJNS report adds that: Out of the 40 neurosurgery residents currently in training in Kenya, there is one female resident, Dr Marjorie Adagi who is in her senior year of training.

"In addition to four years of medical school, they intern for a year and are a resident for five to seven years. After that, many pursue a fellowship to specialise in areas such as spine. The complexity of the nervous system and its functions require this level of knowledge and mastery of techniques and technology."

The report adds that these professionals do a lot more than brain surgery. "About 70 per cent of a neurosurgeon's time is devoted to your spine, treating back pain, neck pain, herniated discs, degenerative disc disease and even leg pain," the report notes.

It adds that neurosurgeons work with the entire nervous system that starts in your brain, runs through your spine, and branches out to all areas of your body.

"Neurosurgeons treat many painful conditions, such as low back pain, epilepsy, stroke, sciatica, pinched nerves and chronic pain. These conditions may manifest itself in one place, but appear in another."

Back on the experiences of Dr Uzma Samadani, she says that because of the gender gap, it is not easy to find a mentor who looks like herself.

"The best mentors are people who have a vested interest in your success - often the people who hired you - and if you emulate the behaviour of people you admire, you will succeed."

EAJN's report notes that a major challenge female neurosurgeons may encounter is finding a balance between personal and professional demands since women are faced with additional responsibilities like child-bearing and family-rearing.

This is echoed in Cosmopolitan's report, with Dr Uzma saying that: "There is no "good time" to have a kid."

"I had a baby when I was a resident, and it was hard, even with an extraordinarily supportive family. I was working about 140 hours a week during my pregnancy. When I gave birth, I took 12 weeks off and when I returned, I was senior enough to cut down my hours to a very leisurely 90 hours a week," she says.

"I missed out on so many things - my son's first steps, his first day of preschool, his classroom presentations. Now, I work about 70 hours a week, but I still miss a lot, which can be hard as a parent."

One way Kenya can aid these professionals with the challenges they face is by continuing to train more neurosurgeons to meet the current shortage.

"Women constitute a significant proportion of the population as well as in medical schools. Therefore, to meet the shortage of neurosurgeons women will play a key role. It is hoped that these pioneer female neurosurgeons in Kenya will inspire more women to join the challenging but largely fulfilling field of neurosurgery," the EAJN report notes.

Below are Kenya's female neurosurgeons as profiled by EAJNS.

Dr Sylvia Shitsama

Dr. Sylvia Shitsama was the first female neurosurgeon in Kenya after graduating in 2015. She is a consultant neurosurgeon and a lecturer at the School of Medicine, Jomo Kenyatta University of Agriculture and Technology (JKUAT).

Dr Shitsama undertook her neurosurgery training in Kenya (MMed-Neurosurgery, University of Nairobi) and Canada at the St Michael's Hospital, University of Toronto. She has a keen interest in spine and skull base neurosurgery; medical education and research.

She is the Chairperson of the Women in Neurosurgery (WIN) Kenyan chapter; the mentorship lead, JKUAT School of Medicine, and a committee member of WIN, a committee of the World Federation of Neurosurgical Societies (WFNS-WIN).

Dr Susan Karanja

Dr Susan Karanja is a consultant neurosurgeon at the Kenyatta National Hospital. She is also involved in teaching as an adjunct lecturer at the Faculty of Medicine, University of Nairobi. She graduated in 2015 as the second female neurosurgeon in Kenya.

After attaining her medical degree in Kenya, she pursued neurosurgery training in South Africa at, the University of KwaZulu-Natal (MMed-neurosurgery). She is interested in neurovascular neurosurgery. Dr Karanja is the current Treasurer of the Kenya Association of Women Surgeons (KAWS).

She is a Fellow of the College of Neurosurgeons of South Africa. She is a member of neurosurgical and medical societies in Kenya and abroad; including the Society of Neurosurgeons of South Africa and the Kenya Medical Women Association (KEMWA).

Dr Grace Muthoni Thiong'o

Dr Grace Muthoni qualified as a neurosurgeon in 2016 with a Master's degree in Medicine-Neurosurgery from the University of Nairobi. She is currently based at the Sick Children Hospital, University of Toronto. In Canada, Dr.Muthoni is working and pursuing further education. Dr Muthoni has a keen interest in pediatric neurosurgery and neurotechnology.

Dr Trizah Tracey John

Dr. Tracey John is a consultant neurosurgeon and an honorary lecturer. She is based at the Department of Surgery University of Nairobi and Kenyatta National Hospital.

She is a Deputy Director of Medical Services at the Ministry of Health in Kenya. She studied in Kenya and Switzerland. In 2017, she graduated with a Master's Degree in Neurosurgery (MMed-Neurosurgery) from the University of Nairobi.

Dr Beverley Cheserem

Dr Beverley Cheserem is a consultant neurosurgeon and an associate professor at the Aga Khan University Hospital in Nairobi. She undertook her training in the United Kingdom in various University hospitals including South London Hospital.

She has a keen interest in skull base neurosurgery. Her other areas of interest include global neurosurgery and clinical research. She is the current Chairperson of the Kenya Association of Women Surgeons (KAWS).

Dr Beverley is a Fellow Royal College of Surgeons, England (FRCS, Eng), a member of the Society of British Neurosurgeons (SBNS), and a member of, the Congress of Neurological Surgeons (CNS).