SNIDigital Innovations in Learning

International. An international within Nancy Epstein as its editor-in-chief.

An SNI digital, a new, editorially curated, neurosurgery

and medical information multimedia platform

with for the next generation of clinicians in 13 languages. With information operative videos, expert interviews, podcasts, global interactive discussion of James Hausmann as the editor-in-chief,

are pleased to present an interview with neuroscience leaders, another in a continuing SNI digital series And this is with Professor Nimrod Magwambi, who is a master of medicine doctor and a PhD

from London. He's a neurosurgeon, a professor in neurosurgery. in the School of Medicine at Kenyatta University in Nairobi, Kenya.

Dr. McWombee is an internationally known African and African world leader in medicine, neurosurgery, culture, and society.

Is email address is listed below.

The interviewer is James Hausmann, creator and founder of NCEO of SNI and SNI Digital, former professor at the Universities of Michigan, Minnesota, Illinois at UCLA, and former head of

neurosurgery at Henry Ford Health Systems and the University of Illinois at Chicago.

He's a futurist and entrepreneur and a healthcare consultant.

As you look at neurosurgery around the world, as you look at

What do you see are the problems that we're facing and it may not be neurosurgical, probably isn't. I think some of the major problems doctors are facing, they're not paying attention to, which is

what's happening to healthcare.

What's your thinking as you look into the future? What are the problems we're not looking at? What do we need to do?

Okay, what do we need to do, what I'm teaching

currently also undergraduate medical students. And in my teaching of my undergraduate medical students, I'm emphasizing to them the importance of learning the whole environment about medicine. I'm

emphasizing to them the importance of them entering into the field of medical administration.

And I'm also emphasizing to them the importance of them going into politics, all three.

And because they're brilliant people and there's very, very bright kids and I can see their minds, I can see which one can make a very good politician from the way they discuss and talk. So I'll

discuss with them and I'll just tell them, you'll make a very good politician

If you decide you want to go to politics after you finish your first degree, go do some bit of administration and then get into politics. Because then you'll be the decision maker. Politicians are

the ones who are the decision makers and that's extremely important. They make the decisions and those decisions influence what goes on and it's important that we have knowledgeable medical people in

that area And then I explain to them that - It's important to go to administration and therefore learn about administration. And I can tell always when I'm talking to my medical students, I can

usually tell those will not make good clinicians, you know, and they'll tell them, okay, think about going into administration, et cetera. And in that area, you will be the one who is designing

the policies for the politicians

to implement, and then, of course, I'm training doctors who are very, very good and extremely bright, and I tell them, you may need to look how you can go into research, because the ones who

are extremely good and very, very bright, I want to encourage them to go into an area where they can apply their brains into research. Research is very different from clinical practice, because

clinical practice, you can be very good as a clinical practitioner, but not really good as a researcher.

And I think we need to guide our young people, the lines which they follow, so that in future, and I don't think this is only here in Africa, I think it's the whole world. I think it's really

this applies to the whole world, because many of the decisions you'll find being made, are being made by people who don't really understand what medicine is all about But if we had people who

understand what medicine is all about as decision makers, then some of the decisions would not be made, and then there would be balanced views about what is being decided upon. So that's really the

comment I'd like to make about that. I think that's extremely, extremely appropriate comment There's a lot of, in our country, politics don't have a very, it doesn't have a very attractive uh uh

appearance to for people but what you said is if we want to change the health care in the country we have to go into we have to go into politics so that we can influence the people to change it in the

right way that's what you're talking about let me totally agree with that this is not a world where people just go and to me go do your operation come home that night go do one the next day it says

there are far greater influences on medicine that you're ignoring and you have to an obligation to sustain medicine into the future and to keep people aware of the idea that the patient comes first my

mother used to say that all the time because my father they had an apartment next to his office and and she said the patient patient comes first it's sacrifice it's a word you said the first few

minutes of our conversation You'll never hear that word today. Sacrifice. I have to do that in order to look forward and help your country and help neurosurgery and help medicine and help your

people. That's what. Well, today we have the real privilege of being able to talk to

Dr. Nimrod, Junius Agwami, who is in Kenya and is recognized in Africa and around the world is one of the major leaders in neurosurgery in the African

continent. I've had the pleasure of being with him for over two or three years and he's an absolute delight and pleasure and a wonderful person and

I thought it would be very worthwhile for everybody to have a chance to enjoy talking to him as and meeting him as I have. So then we'll start and

maybe you'd like to tell us a little bit about your background growing up and so forth.

Thanks, Jim. Thanks really for this opportunity to share with the rest of the neurosurgical community of experiences in Africa and how far we've come and where we have reached and my background is

as follows.

I grew up in a town called Mombasa, which is in Kenya in my early years, went to primary school and all this was during colonial times because then Kenya was a British colony. And I remember very

well, something which I find very amusing that we had to walk from where We used to stay to my school barefoot because we're not allowed to wear shoes and Still I have never found out the reason why

we're not allowed to wear shoes because our parents would afford to buy a Specials of shoes, but we weren't allowed to wear shoes And I think one of the reasons is because they felt that it would

Discriminate against other students who can't afford to pay to buy shoes. So they say that all students shouldn't have shoes So now you can imagine if you have been to Mombasa, it's a really hot

Climate area and the climate the tarmac, you know, when you're working in the tarmac It's really really hot and we're working barefoot and that's one of the reasons why you look if you look at my

plantar feet Well, they're they're really very very hard because of that experience which I had and then from backstand school I went to a school which was called backstand school. It was named

after one of the colonial people who set up that environment. So it was named after Braxton School. And from Braxton School, then I went to another school, a high school. Now that was what we're

going to do in those days would go to a primary school. So that is Braxton School. And then from there, you go to high school. So now when I went to high school, we had just attained independence

That was in 1963. So then I went to high school, Alindina Vistram High School, but just attained independence. So now I went to Alindina Vistram High School, which was predominantly an Asian

school. Now you need to remember that during colonial times, education in Kenya was segregated. And many people don't know that, that we had education for the Africans, for the Asians, for the

Arabs, and for the whites. So the school then which I went was predominantly Asian school and we had just attained independence. So now it was being opened up for other races to join and therefore

I joined that school. And I think we were only, I think about five or six Africans who joined that school at that time with a population of over 500, 600 Asian students. And it was a great school.

There's no doubt about it It had a wonderful, wonderful curriculum and very, very good results. And then from that school, when I finished my all levels, then I went for my L levels to at Nairobi

school. Now again, you need to remember that this is all happening during colonial, post-colonial times now, almost post-imidial colonial times. And when I went to Nairobi school, Nairobi school

was what was called previously then, just immediately after independence, the Prince of Wales school And, um, it was the Prince of Wales school, it was an elite school, which was really for the

elite ruling class of that time. And when I went to that school, it was an eye-opener for me, because I just found a totally different environment. You know, what I saw at Nairobi school is

something which, you know, I had never seen anywhere else before. It was such, such a well-developed school, and all the facilities were available, games and

everything, education and all that was available. And at that time when I went to Nairobi school, you remember this is just post-colonial, and we were just like maybe 100 to 150 African students,

maybe 150 African students, after a population of about 500, 600 students, so most of the students were basically whites at that stage, and most of the stuff were whites and We only had maybe two

African teachers at that in Nairobi School. So when I finished Nairobi School, then now from there, I went to the University of Nairobi. And then University of Nairobi, I went now to do medicine

in 1971. And I did medicine in 1971, Nairobi School, a University of Nairobi did medicine from 1971 to 2076, graduated with master bachelor of medicine, bachelor of surgery in MBSHB. And then

from there, I went to do an internship at the cost general hospital in Mombasa. And from internship, one year, I then came back to Canadian National Hospital in Nairobi. I took the postgraduate

program in general surgery. And I did a postgraduate program in general surgery at Guillera National Hospital from 1977 to

1980. Finished my postgraduate training in general surgery, I trained in Mitchell as a general surgeon. And then I went to work as a general surgeon in a remote. hospital called Casey Hospital,

not really very much because it was a very, very busy hospital. And I worked there for two years as a general surgeon between 1980 and 1982. And then from 1982, then I came back to Canadian

National Hospital to undertake my training as a neurosurgeon. And then between 1982 and 1984, I was at Canadian National Hospital as a neurosurgeon, as a senior instructor in neurosurgery

Let me ask you a few questions.

Your parents, here in Africa, and your parents wanted you to go to school. Was that difficult? Was it unusual? And what were your parents' backgrounds that enabled them to think about you in

education as a primary goal? No, my parents' backgrounds, my father and my mother, were the first African in their area to get education, the Western education, first Africans to get the Western

education, which in those years, that was in 1900s, 1930s, 40s was quite an achievement. My mother went to those missionary schools and she was able to learn how to read and write a bit of basic

English. And my father went to missionary schools and from there went to father training and went to theology training. And my father really went into theology and was trained as an Anglican priest.

So my father was an Anglican priest in those post-colonial, colonial African times. And maybe those days being an Anglican priest gave my father an advantage because Kenya was really a British

colony So there were some. Advantages, which one would get if you are associated with the English, with the church. So from there, my father really rose and

became a leader in his field in the Anglican church, because he rose to become a bishop of the Anglican church in Kenya.

But there were resistance, and my father used to tell me that his father, his father did not want him to go to school, because my father's father was a medicine man, and he didn't want his son to

go to school at all. And my father's father was a very, very successful medicine man who was widely recognized in the region, he had traveled to Tanzania, Zanzibar, and therefore he didn't want

at all his son to go to adopt this Western type of education. And therefore, for that reason, the diffeder lot with his father. And he was probably, I would say, more close to his mother than he

was with his father because his father didn't want him to go to pursue this Western type of education. Was your grandmother also educated?

My grandmother from my father's side was not educated. My grandmother from my mother's side was educated My grandmother from my mother's side and my grandfather from my mother's side were the first

missionaries who set up schools in the region. So they were

quite educated. But from my father's side, they were not as educated. Well, the reason I asked that is your parents had to be way ahead of their time and having how many brothers and sisters did

you have? We walk quite a number. work at a number, I had five, all of us were five brothers, including me. And all of us were five sisters, including me, five sisters. So now,

the five brothers, some passed on in the Alias because of the problems of health care and all that. So I would say that one of my sisters passed died in early childhood because of malaria. And I

remember very well, really, it was because of malaria. And then the other ones passed on just later on in life because of natural issues in life. Well, here you have 10 siblings, your parents

raised 10 children, and they all went to school ISO. Is that right? They all went to school, and at the moment, The ones who are still alive are all my sisters of pastime. but my brothers, one

has passed on by four of my brothers still alive, and they are all independent. But you see, we lead a life of African socialism where I'm supposed to help them, the ones who are not so

independent. I still have to chip in and see how I can assist them. I can understand that, that's totally reasonable. Well, what I'm trying to get to is your parents were way ahead of their time

educating all 10

siblings, right? 10 children, all of them went to school. And it wasn't like it's a school next door. It says, all of your education was, as I mentioned, somewhat distant. And

it was for them, it was a great sacrifice. And I'm sure, and the other was a great pleasure And they had a great vision to see that education was the way to go.

And then you go to schools and I can't imagine these are schools which have been established under the colonial system and I

can't imagine there's large numbers of people going, so

you're way ahead of your time

and the other peers, am I right about that or wrong? No, you're very, very much right about that and I may add that it was very interesting because during my time my parents sacrificed a lot to

give us good education and it was like this, every end of the year or every end of the semester you'd get a report which you must present before my parents and they review it before they commit

themselves to paying your school fees. So if you don't and if you are so cunning and you don't present your report you didn't do so well because sometimes you know you don't do so well and you just

sit on your report and you're waiting until the next session comes and you're going back to school but you haven't presented your report and therefore schools please have not been paid. So you go to

your parents and you tell them you know I'm supposed to go back to school tomorrow and people have been paid school fees and then my parents would ask but we haven't seen your report then you now

present your report and then they look at it and they say but you didn't do well here what happened and do that. So they would monitor what's going on you know they would monitor what's going on and

I would say that my parents made a lot of sacrifice to give us good education but what I would like to add at this point is that and I have to be honest about this is that we received a lot of support

from people who are working within the missionally setup the white missionaries I really must mention that because they really supported us because they realized that my parents had a heavy heavy

burden. and they would chip in and assist my parents in our education. So that's when I must acknowledge,

and when I write my biography, I will acknowledge some of the people who really played a major role in the education of some of us. Well, I think that's amazing. You mentioned that when you went

to one of the schools that there was an Asian population, a black population, in other words,

there were, I think, four different groups of people there. And you mentioned that at that time, there was segregation,

which is a natural human phenomenon.

Oh, Jim, you know, you need to really understand colonial Africa. You know, colonial Africa was very, very different from the Africa you see now. And I grew up to a colonial times. And I grew

up in the city of Mombasa. Mombasa, the

town of Mombasa, is like any other town in the Western world. So if you imagine any town in the Western world, and then you imagine that town in the Western world that there is zoning, and this

zone is for this race, this zone is for this race, and this zone is for this race. That's how it was in Mombasa during my time as I was growing up And if you imagine that during my time also,

these schools, each zone had a school. Look at it. So this is how it was during my time as I was growing up. So this is the environment I grew up in, and this is the environment which, you know,

all the people who grew up in colonial Kenya grew up in. That's amazing. So now you go to the different preparatory schools, you go to the university,

And then you come back and you want to go and you want to go to medical school, you become a surgeon and you get interested in neurosurgery. Well, is all this training in neurosurgery in Africa or

I thought you'd spend some time in England? Now,

when I was interested in neurosurgery, the neurosurgical units in our hospital had just opened up. The hospital was called Keneta National Hospital Keneta National Hospital was the previous King

George Hospital during colonial times. And then the King George Hospital was renamed to Keneta National Hospital when we got to independence. And then after that, there was a big, big structure

which was built the new Keneta National Hospital from the old King George Hospital. So now the Keneta National Hospital, the new one, is very, very far removed from the previous hospital So this

is where, now, when we started training in neurosurgery, This is the new hospital where the neurosurgical unit was based. Now initially, actually it was based in the old hospital at a unit which

was called Ram Thulawing. Now Ram Thulawing was just a setup which was set up there of about 15 or 20 beds of an neurosurgical unit which was set up when we set up the medical school. And then now

when we set up the new building of the Seattle National Hospital, then we got a totally different unit of our own which was called, which is a award of its own with all its facilities. And this is

where I joined now to train in neurosagerie.

Now you need to remember that during those days, training in neurosagerie, we did not have training programs. So we were basically through training by assistants. you know, accreditation. You

follow the consultant, do the duties and whatever is assigned to you. And during that time, we had one neurosurgeon who had come from India, who was called Javel Al-Dah, who was sent by the

Indian government as

to assist in setting up the neurosurgical unit He was really basically

someone who was sent for staff training. So he was part of staff training. And he assisted us setting up that unit. And we had to work with him. And then after that, we had other

colleagues, one of my senior colleagues who joined in the unit And therefore, it was by actually a decision you work there. And this is a doctor who was called Dr. Dar.

worked really hard to

set up that unit and we would learn from him and such what happened. Of course, he attended in India where the MS master of surgery, master of neurosurgery program had already been established.

She had a master of neurosurgery program from India. And therefore he had a template of how to run the neurosurgical unit. But after that, of course, then now we needed to get further experience.

And then now from there now we needed to go abroad to get accreditation elsewhere And it was arranged that I went to London, I went to Queen Square, and I was sponsored by the Canada government,

which supported my training at Queen Square. And I spent four years at Queen Square, at the National Hospital for Neurology General, Sajla and Queen Square, where I was given the title position of

research registrar, which allowed me to do lab work, do conduct research, as well as to participate in. ward duties. So it was a very, very brief privilege. And I really appreciate what they

did for me because I was able to participate in the clinical duties as well as the research work. And I worked with the medical research council laboratory. And

Dr. Ambush Patel was running a medical research council laboratory lab neuro oncology lab. And

I worked with him and did some good work with him. And I also worked with Dr. Professor David Thomas in his laboratory and did some work there with him and did my PhD there and did my also my

rotations in neurosurgery at Queen Square attended to clinical duties as much as possible as I could. And remember those days, the National Hospital for Neurosurgery also

had another hospital which was called Mideville Hospital. So I used to spend time also at the medical hospital. And that gave me also a good, good clinical experience. Remember that I was going to

Queensville already with four years, two years of ground clinical neurosurgery of my own from Kenya. So I was basically already quite well-vasting neurosurgery. And I went all I needed now was to

just tie upwards to the advanced aspects of neurosurgery at Queensville and do my PhD program. So what year were you born? I was born in 1951. 1951. And more time when you went to medical school,

when did you finish before you went to

Queensville? What time was that? I went to Queensville in 1984

I went to Queensborough in 1984 and I was at Queensborough between '94. 1988. I was on full scholarship, so I had a that was a great, great advantage because I was on full scholarship, which then

could allow me to give me a new way to participate in research, to participate in clinical work. And at the same time, because I was a general counsel, I could do lock-ons and therefore, and a

bit of money here and there, which was very helpful. And so you went to Queen Square, you had this Indian mentor who, and that was also a British colony. And let's see, by that time, I don't

know if India was independent, might have been, was India independent by about that time? At that time, India was independent. In fact, the mentor who I had, Ambrush Patel, Dr. Ambrush Patel,

he's retired now. He's

a British citizen, so he's somebody who was a British And India's cities, but they are very located to India and to to Britain and he was a, he was a, he was then a British citizen. So he

influenced you and asked you and I assume directed you and I think you mentioned another person to to get further training and neurosurgery. Is that right? Yes. And of course, I worked with

the professor David Thomas, Professor David Thomas was

the head of the of neuro-oncology at Queen's Square. He was a senior lecturer at that time when I was working with him. Let alone become professor and Professor Lin Se Simon. You need to remember

that I went to Queen's Square and the Department of Neurosurgery So, all my program there was based under the Department of Neurosurgery at Queen's Square. And this is where really my foundation was.

you know, without their support, I would do it not be there.

I think I met David, I'm dating myself. I was born in 1937. I think I met David Thomas, and I knew Lindsey Simon quite well because he was

president of the World Federation of Neurologic Surgery. He was just a really a very commanding figure, a very outstanding person, and I enjoyed his company a lot And so you really had some

outstanding mentors.

I did, and I must appreciate that the time I spent at Queen Square was an eye opener. I mean, the neurosurgical unit at Queen Square was really marvelous. You know, what I saw there, it was

unbelievable. The work ethic was also unbelievable. I mean, it's from 6 am, everything starts, up goes on up to 8pm, 11pm before you check off. And it's the time when I learned that you can

actually have to work in four hours. And when I spoke through, we used to get some American residents and American doctors who used to visit Queen Square and to share the experiences with us. And

when we share the experiences with us and they would tell us that what we're experiencing is nothing because in the US, it's routine to work

almost for three days or four days. So what I saw at

Queen Square was an eye opener and the integration between neuroadiology, neuropathology and neurosurgery and neurology, that I land at Queen Square. It was a very, very good foundation which I

got at Queen's Square to integrate. all those branches in your training. Because I saw that at Queen's Square. How in your radiology, neuropathology and neurology

would be integrated together in the teaching and in the discussion of patients, in the case discussions. Every week we would have a clinical pathological case which would be discussed and the

neuro-adiologies would review the case, the neuropathologies, review the case. Every specific days would review the images with the neuro-adiologies And you can imagine that in those days, it was

the police city scan days and three MRI days. And

what I remember is the images which

you were reviewing were basically ventricular grams, angiograms. And sometimes the citizens, I think the citizens I just started. And in the neuro-adiology room, they had this huge, huge setup

the images are all mounted and, you know, they are shifted all together as per patient. And it was the duty of the person who is on call to come and mount all those images before the meeting which

starts at about exactly 6am. And when the meeting starts at 6am, you'd come then and pass all those images through that, through those manual screens, you know, where you'll see all of them. I

think it's something which is very difficult to

explain if you haven't seen it. But if you've seen it, then you'll know what I exactly mean. And it's definitely very laborious. But you can imagine and we're sitting there all of us reviewing

these cases, discussing these cases before the surgeries or with these great surgeons. And then after that, they would allow you to go to theater, observe their cases, and remember this is

happening before the imaging images are advanced so really it's a question of now contact because you basically have to people on the shoulder of the surgeons to see what's going on and it's really a

big big favor which many of these surgeons did for us during those days. Well for the people listening to this and watching us going to Queen Square was a I remember from colleagues I had in the

United States was really a great opportunity and what you're telling me at that time is they were they were practicing integrated medicine where it's interdisciplinary medicine if you want to say that

and that's a little different because at our time in the in our country or surgery was a silo neurology was a silo everybody was kind of doing their own thing in separate but you brought in a in an

environment where these different disciplines we're talking to each other and communicating with each other and then making a decision based on

and the combined knowledge of many different people. And at that time, that's unique, that was unique. I remember about that time I went to Henry Ford Hospital and as a chairman and I saw every

surgeon would do everything

and everybody didn't do everything at a high level. And so I had to figure that at that time, it was the time we have to subspecialize. And so I said, well, you're gonna do vascular, you're

gonna do this, you're gonna do pain medicine and so forth and so on. So

neurosurgery was at the time, similar to yours, is you would go, you would learn everything. But people. wanted to maintain that. And at that time, in order to do a good job, you ought to

become specialized. So - and we were, I think, way ahead of people doing that. But it made more sense, because if one person got more experience doing something, he would become very skilled,

very knowledgeable, would have better results. So complications these now we're in the 1980s. I think CTs were introduced in the beginning of in the

'80s

And then MR scans came out in the 1990s. I'm sure you did no more on cephalograms and ventricular grams and so

forth. And so most of the people listening to this don't understand that,

but it was a - and you had to do many things yourself. I remember I drew blood, and I took a patient here and there and so forth And so we're living in comparatively luxurious times. or you don't

don't have to do that. So now you're, how long did you stay in Queen Square? And when did you come back to Kenya? I stayed at Queen Square for four years. So between 1984 up to 1988. So I came

back to Kenya in 1988. That's when I came back to Kenya. Why did you do that? And I'm sure the answer is obvious, but

you're in an environment This was at a time where people were complaining about a brain drain. People would come to, I'm sure to England, they would come to the United States from the developing

world, which I thought was really a terrible disadvantage because we were essentially taking the best and brightest and they would come and they would stay there. You went against the grain. You

went back to your own country. And why did you do that? yes I went back to my own country I think Many times I asked that question, why did you come back? And even when I was in UK, many of my

colleagues who I was working with, they were surprised that I wanted to go back because many of them told me, you know, with the connections you have, you can now go anywhere in the world. So I

told them, I don't know, but I don't think this really is what I want to do Let me go back because I know why I came here. And I think what I have achieved and what I've learned, I may be more

useful where I am going back than to go to another new area. So

I made that decision. Now, of course, when I came back, there were doubts. Let me be very honest with you, there were doubts There are times when I had doubts as to whether I was it worth it.

Um, uh, especially when I face many, many challenges, but ultimately, you know, within those doubts, I must admit that I have no regrets, you know, because, uh, what I've, what I've

achieved and what I did, uh, I don't think I would have done that if I had not come back and I don't think, um, I think I made a difference coming back. And that's the important bit, making a

difference because if I went abroad, I would have made a difference to me personally as an individual, you know, my life would have been very, very different. But coming back to Kenya, I made a

difference to many other people. So this is the way I look at it. That's outstanding. And going back is not easy because you're trained in an environment where you have CT scans and our scans and

all of these things. And you have to come back. We had people who went back to their own countries. And it was sometimes, it was very difficult. The neurosurgeons, the doctors would not accept

you. They would make life more difficult. And we had some people who then came back to our training program. But obviously, you made it work and it was successful And eventually, I assume, and

Kenya, you became head of your department and so forth. Tell us a little bit about what happened there.

I think ultimately,

I joined

the University of Nairobi, where I became the head of the neurosageal department at the University of Nairobi, and then eventually at the University of Nairobi, we set up a neurosageal residency

program at the University of Nairobi So, therefore, we achieved a lot, because coming back also helped us set up a neurosageal residency program, which we set up in

2006, because it was then very difficult getting people to train abroad on this accreditation program, so we said let's set up our own program, which we can be able to train our people, and we

learned a lot from interacting with colleagues, international colleagues, you know, we discussed with our international

and who are running programs that gave us tips on how to set up a local residency program. And then we also established links with colleagues who had residency programs and they would come and they

would help us conduct teaching sessions at our program. And therefore, let's say from 2006, we were able to set up a very, very good residency program It was a must-ense program in

neurosurgery. It's still running very well. It's a six-year residency program in neurosurgery. And it's basically based on any other residency program like in Europe or in the US, where students

do clinical and they do clinicals. They do neurology, neurosurgery, all the specialities. And they do exams every year we monitor them and they do also log books where they do catalogs and we have

to monitor the cases they're doing. And the advantage of having a residency program in a hospital, like the one who worked at the Canadian hospital, this is a referral hospital. It's what you call

in my country, a level six hospital. A level six hospital is a referral hospital. It's a national referral hospital. It's like where I was at Queens Square Queens Square is a national referral

hospital. So I would say that if you train neuroscience at Queens Square, you have that great advantage that you have all the neuroscience with all the specialties all together. And therefore,

this is the same as a level six hospital in Canada. You have all the neuroscience with all specialties all together. Therefore, the resident gets a very, very good exposure in during those six

years. And when he comes out, therefore, he's well grounded to be able to handle the cases which he's going to encounter. So this is what I've done. I did when now I went back to Kenya. And I

did that for all the years in which I worked at the Keshe International Hospital and at the University of Nairobi. Until

2021, when now I retired from the University of Nairobi.

Understanding. So now you became head of neurosurgery there. Did you become involved in national healthcare and the direction of the development of healthcare for Kenya? Did you become in getting

government? Yes, we got involved because we had to be involved in the training of neurosigence, the

number of neurosigence we need in our country, setting up of neurosurgical programs. And what we did at when we started, because remember that when we now started, there was the only neurosurgical

unit in my country. So we went ahead and we trained in neuroscience for the next medical school which was the Moi Teaching and Referral Hospital. So we trained in neuroscience for the Moi Teaching

and Referral Hospital and

all the neuroscience now currently working at Moi Teaching and Referral. So there was about 6 or 7 neuroscience. We literally helped set up that unit because all of them are locally trained in Kenya

and they're very very competent in neuroscience handling very very complex type of cases and then of course we assisted in setting up neurosurgical programs now in the county hospitals which now we is

our next agenda.

Because you've developed this outstanding center and just as an example the case is that you present from Kenya in our Grand Rounds meetings you have people in multiple areas or specializing in

different. some specialties in neurosurgery. So you've continued that even out into the hospitals are further out from Nairobi.

Would you also attract others from Africa to train in your program? How many other second question is how many other training programs like yours was there at that time?

In Kenya, ours was the only program. So currently it's the only master's program we have in Kenya. We plan to set up one at the moment. I'm based at the moment at Kenyatta University Hospital and

University where we plan to set up a neurosurgical residence program and master's program will be the second neurosurgical residency program. Now we trained at the Kenyatta University once we trained

neurosurgical for other countries in Africa. We trained neurosogens for Rwanda, we trained a neurosogen for Botswana, and we turned the neuroscience for more Mauritius, and we've turned the

neuroscience for, for, for, for it's not Zimbabwe. Then I think the,

the, the, the neighboring country of Zimbabwe. Now the, these neuroscience which we have turned up going back to work in their country. And they're doing great, great work in their, in, in

their country

There isn't why they come to train in our program at Canada in National Hospital, I call it our program. I can't call it my program because I'm no longer there. So I'll say our program at Canada

National Hospital is because it's diverse. It has a lot of cases and it has all the specialities together which then makes them get a very, very good experience And that's why it is, you know,

what travels. So what has traveled around so much that, you know, it's such a competitive program now that especially the limitations of numbers, we get so many applications from students who want

to join the program. But unfortunately, we can't take many because this is really a program where you can only maybe take maybe four at most five if you really strain because you're talking of a 2,

000,

3, 000, 300, 000 bed hospital, you know, we're talking of neurosurgical units, which I would say is probably about 50, 60 bed neurosurgical unit. Very large.

And so you trained probably a large quarter of neurosurgeons who are not only in Kenya, but probably around Africa and other places. must be a great satisfaction. That's a great satisfaction. In

fact, one of the neurosagens we trained went to to Canada and she did a fellowship there and she did a fellowship there. She did a fellowship in pediatric neurosagery. She came back but she was

disappointed because she could not get an appointment which she wanted and she went back to Canada. And now I'm made to understand she's unlikely to come back. She's probably going to, she's now

doing some research and settling up, settling

there. My other neurosagery I trained is, was from Botswana and he was so successful that when he went back, he became so successful that he went to full-time practice He really amused me when I

asked him, he told me. Well, this is now my new calling, a new private practice. So he's a very, very busy in Bosnian in private practice. And of course, we give them the foundation and from

that foundation, they build up on it. Because you remember, when you train people, you give them the foundation. And if they are good students, they build up on that foundation. They follow up

on other aspects of fellowship and they build up on that and they move on very well And one of Mauritius also did very, very well, is now a Rosagian in Mauritius and is doing extremely well there.

We, the unit use at the moment also has no sages from other areas of the country. We have a neurosagians, we are training from Tanzania. We trained some, doing my 10 from Tanzania. We have zen

between from Delhi. You have a neurosagian training for four, four, four, four, four, four, four, four, four, four, four, four,

four,

four. one of the West African countries that country remember their name, but we have a new schedule we're trying from our own one of the West African countries.

As you look at neurosurgery now in Africa, as you look at neurosurgery around the world,

what is it that you think that African neurosurgery needs, do they just need more time and more people to develop it? I mean, we've seen people on our meetings who are extremely bright, very

creative, who are maybe the only neurosurgeon book for with millions of people, so it's very difficult, very challenging, but yet these are very, very, very skilled people, very, very

knowledgeable people. What is the greatest need you have now?

I think the They, what I would say is our guess is need is that each country must have its residency program. That's really a priority. And this is what, when we started our residency program,

those are over positioned from our country, our leaders, because they felt that it wasn't important. They said, we don't think this is a priority. And really we had convinced them that this is a

priority We bring children as a major killer in our country, in children. So we need to train our own neurosurgeons. And I think we need to emphasize that each country must have an residency

program. And we need to emphasize that a good residency program should be an institutionalized program. Really, this must be emphasized.

you can't have a residency program, which is a one-man residency program. You know, and there's a risk in that. There's a tendency at the moment to try to advocate one-man residency program where

I am the consultant or sergeant and I have one resident and I'm training that resident. No, I don't think that's really appropriate. I think good residency programs can only succeed in teaching

hospitals And I think good residency programs have to succeed in level six hospitals. And I think we can't share away from that. We need to appreciate that. And if we were neurosaging such a

refined specialty

that it can only be achieved if you train residents in a level six or a referral hospital And therefore, most of our African countries have a referral hospital. And therefore, this referral

hospital must be encouraged to set up a residence program, whichever format you want it to be. If you want it to be where they'll have a master's, if you want it to be where they'll have a

fellowship, whichever, but it must be institutionalized. Within one institution where the resident spends all the years there and a different, different consultant. So that's important And I

think that is one area myself, I'd like to emphasize, because if we don't do that, then we end up training people who will save the endurosurgeons, but they can only do only one aspect of

neurosurgeons. And in Africa at the moment, you cannot do one aspect of neurosurgeons. The neurosurgeons we train in Africa must be competent to handle all sorts of problems. They must handle

brain tumors. They must handle neurotrauma They must have the pediatrics. And this is what I tell my colleagues, the pediatric neurosurgents, when I meet their meetings, you know, because they

sometimes they tell me, Oh, how many pediatric neurosurgents do you have? I tell them, But in my country, 60, 70 of our profession is pediatric neurosurgents.

I mean, you know, it's such called cassettes, pediatric. And therefore, my neurosurgents are all pediatric neurosurgents, right? And therefore, you can't tell me that, How many pediatric

neurosurgents are you having? They're all pediatric neurosurgents, and they're handling these cases, but at the same time, they must be competent to handle adult cases just just so come. So the

training of neurosagerie in Africa is very different from the training of neurosagerie in the Western world. And we need to appreciate that. You know, we're training people to meet our needs, and

this is what we are doing at the moment in my country What are the greatest needs you have? Just for more, excuse me, more neurosurgeons, or what is the greatest needs you have? More than that.

Sajuns are very important and then the other need is to train sub-specialities in some areas. Like let's say as you notice when we presented one of our kisses of endovascular endovascular surgery,

you know where we have trained one will of Sajuns who basically just handles endovascular glycases, we have Nusajuns we have trained who just handles our skull-based kisses because there's not about

it that as much as I can train you as a Nusajun to handle some skull-based kisses, but the complex skull-based kisses require some more intricate training. So we have Nusajuns in my country, we

have trained to handle those types of kisses. So we need to partner with colleagues, you know, international colleagues who can assist us in setting up programs.

for subspeciality training in Africa. You know, some socialities training in Africa, you know, tailored for Africa would be very, very different because number one, if we did that, then our

colleagues from the Western world can come here and also land from the type of cases we have, which are cases which in the Western world you hardly see them. I mean, when I was at Queens Square,

most of the really, really complex cases were coming from India and Africa You know, we would hardly see them from UK and therefore those types of cases which we have in Africa, you know, when we

set the steps of programs, even our Western colleagues would benefit from coming here to train. So we need to have that mindset of setting up subspecialty training programs with the international

organizations here in Africa, which will also serve the Western world. you know, training their submission because they don't see those cases anymore. And when they come here to Africa, there'll

be that opportunity to see that some of the cases which they're not seeing in their country. And now you're talking about the future and that is what would be attractive would be to have people from,

let's say, the Western world, it's the United States and in Europe come and spend time, learn what to do in part the knowledge that they have because they're going to see cases they've never seen

before. And so we see, I talk to young people in England who said that there just aren't enough cases and they're thinking about going to India, Africa, other countries to get training and

experience because there's just not enough cases there I see that happening in our country.

there's a figure that says 85 of the population of the world lives in a low to middle income countries. And that's where 80 of the diseases are 85. So after a period of time you come from a very

well developed country, you're working with

less and less population to be able to cure, because all the diseases are someplace else. So so it becomes a very attractive opportunity for training. Is that so? Yes, it is a very attractive

opportunity for training. And I wish it is pursued well, because as I've said, we have the cases, the cases I see in my country Occasionally I see them in the western world, but as an unusual

kiss, which then attracts attention. Well, in my country, it's really the routine case. Look at it. And we

have very good neurosurgeons who have developed

the skills from handling those cases. But you need to remember that neurosurgeon has advanced so much that, you know, like now if you go to the area of skull base, then you need to have special

equipment. You need to have some physical exposure and because that special exposure in microsagerie, in the sections will help you get good results. And therefore, if we set up those types of

training centers, it will definitely help one doctors from

the Western world will come and see those types of cases and get some experience so that when they have those cases, they know what to do And even when they rotate, like let's say, in my country.

they get that type of experience. And when I have, I have doctors in my program who I

have sent abroad and always what they come back and they tell me when they come back is that

when they go abroad, the residents don't do much. That's always what they tell me. The residents don't seem to do much there. They mainly assist or are doing a lot of administrative work like

unlike what they do in my country because in my country they do a model hands on, hands on work. So therefore, if we created that type of symbiotic environment where we all benefit, you know, you

come, you invest and you set up that type of facilities and experience is gained, we have the cases and I, you know, the unfortunate bit is that because of our level of poverty,

It will take us many years before we really upgrade ourselves to the level of the Western world. So what we are having at the moment, I don't see it disappearing in the next 30, 40 years. Look at

it. So therefore, we need to see how best we

can handle these types of problems and sort them out. Well, we've got limited amount of time here

We developed a program at

the time I told you about the brain drain. We didn't like that and we developed a program. I had a colleague who was very helpful to do that. We developed a program where people would come to us

after they finished their neurosurgical training in their country and they would spend anywhere up to two years. And

we had over 95 return to their country and then went on to establish all the kinds of things you are talking about.

And at that time, we would let them operate. And they would assist and do that kind of thing, which all the kind of regulations now prevent that. But to me, that was very effective and was very

successful. That's what you're talking about. Let me ask you about this, 'cause we've only got about 10 minutes low, 20 minutes left, 10 minutes. As you look at neurosurgery around the world,

as you look at the world, what do you see are the problems that we're facing and it may not be neurosurgical, probably isn't. I think some of the major problems doctors are facing, they're not

paying attention to, which is what's happening to healthcare.

What's your thinking as you look into the future? What are the problems we're not looking at? What do we need to do?

Okay, what do we need to do?

I am teaching currently also undergraduate medical students. And in my teaching of my undergraduate medical students, I'm emphasizing to them the importance of learning the whole environment about

medicine. I'm emphasizing to them the importance of them entering into the field of medical administration

And I'm also emphasizing to them the importance of them going into politics, all three.

And because they're brilliant people, and these are very, very bright kids, and I can see their minds, I can see which one can make a very good politician from the way they discuss and talk. So

I'll discuss with them and I'll just tell them, you'll make a very good politician

if you decide you want to go to politics. after you finish your first degree, go do some bit of administration and then get into politics. Because then you'll be the decision maker. Politicians

are the ones who are the decision makers and that's extremely important. They make the decisions and those decisions influence what goes on. And it's important that we have knowledgeable medical

people in that area And then I explain to them that it's important to go to administration and therefore, learn about administration. And I can tell always, when I'm talking to my medical students,

I can usually tell those will not make good clinicians. You know, and I'll tell them, okay, think about going into administration, et cetera. And in that area, you will be the one who is

designing the policies for the politicians to implement

And then, of course, the eyeball. training doctors who are very, very good and extremely bright and I tell them you may need to look how you can go into research because the ones who are extremely

good and very, very bright, I want to encourage them to go into an area where they can apply their brains into research. Research is very different from clinical practice because clinical practice

can be very good as a clinical practitioner but not really good as a researcher. So I think we need to guide our young people the lines which they follow so that in future, and I don't think this is

only here in Africa, I think it's the whole world. I think it's really this applies to the whole world because many of the decisions you'll find being made, a big made by people who don't really

understand what medicine is all about. But if we had who understand what medicine is all about as decision makers, then some of the decisions would not be made, and then there would be balanced

views about what is being decided upon. So that's really the comment I would like to make about that. I think that's extremely, extremely appropriate comment. There's a lot of, in our country,

politics doesn't have a very attractive

appearance for people, but what you said is if we want to change the healthcare in the country, we have to go into politics so that we can influence the people to change it in the right way. That's

what you're talking about. I totally agree with that This is not a world where people just go and, to me, go do your operation, come home that night, go do one the next day. It's just. there

are far greater influences on medicine that you're ignoring and you have to an obligation to sustain medicine into the future and to keep people aware of the idea that the patient comes first. My

mother used to say that all the time 'cause my father, they had an apartment next to his office and she said the patient comes first, it's sacrifice It's a word you said the first few minutes of our

conversation. You never heard that word today, sacrifice. I have to do that in order to look forward and help your country and help neurosurgery and help medicine and help your people. That's what

you're saying, isn't that right? That's what I'm saying. I think that's excellent. Well, we spent some considerable time. Is there anything you wanted to say we didn't cover?

That's really, I think we've covered everything. And I think, all I can say is Jim, I want to thank you for really giving us this opportunity to share experiences with the rest of the

neurosurgical fraternity and also with the rest of the medical world. I don't want this to become last because you have a family, you have a wife and how many children do you have and tell us a

little bit about your wife and family. Now my wife and family, my wife is an academician She's a professor and she trained in agriculture. She's an agricultural pathologist. And she's now

currently an emeritus professor at the investment of aerobic. Doing a lot of research and international work. I have one child, I have one daughter. She's an obstetrician and gynecologist. She's

in private practice in aerobic and she's very happy in what she's doing she just assists me now and then. in discussing medical issues, but she's extremely happy with being in private practice.

Well, you made major contributions to medicine, neurosurgery in Africa. I know you're recognized all over for that. And you're extremely knowledgeable. And

I really have great admiration for what you've accomplished, what you've done. And what the influence you're gonna have on the development of medicine in the African continent. I think it's going

to be, it has been, is, and will be absolutely very impressive. Thank you, thank you so much, Jim. I

forgot to mention that in 2022, I was acknowledged by continental association of African versus societies for my contribution to neurosurgical training in Africa

and I was given an award for that. Also, I forgot to mention that in 2016, I was also acknowledged by the new African magazine as one of the 100 most influential Africans in 2016. For the role we

played in

separating Chinese twins, Spanish and Chinese twins in Nairobi, Kenya. Oh, I'm standing. Well, I think what we'll do is close is we have to go to our Grand Rounds meeting. I want to thank you

again for spending time with us and letting people around the world know where you've done and you're a role model. Thank you very much. Okay. See you in a few minutes. Thank you. We hope you

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Interview with Nimrod Mwang'ombe, MD; Kenya, Africa; World Neuroscience Leader

James I. Ausman, MD, MA, PhD

Nimrod Mgwang'ombe, MBChB, MMed, PhD (Lond)

SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century

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Interview with Nimrod Mwang'ombe, MD; Kenya, Africa; World Neuroscience Leader

James I. Ausman, MD, MA, PhD

Nimrod Mgwang'ombe, MBChB, MMed, PhD (Lond)

SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century VIDEO EDITORIAL

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SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century

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