Following completion of my Neurosurgery residency in Dakar Senegal in 2015, I returned home to the Gambia and worked as the only Neurosurgeon for a population of 2 million people in Edward Francis Small Teaching hospital, the main referral hospital of the country . I had to start the Unit of Neurosurgery with barely little equipment. As at then, I had to manage my cases without any bipolar, no drill but had a gigli saw, no microscope etc. As for consumables, I only got some from donated items. Shunts were not available in the country so families had to go to neighboring country Senegal to buy until when I involved a vendor to get a reasonable quantity for my patients. June 2016- August 2018, I did my Fellowship in Pediatric Neurosurgery with Pr Shlomi Constantini in Israel after which I returned back to the Gambia to work in the same Hospital. In September 2018, I applied for the post of Lecturer in the school of Medicine, University of the Gambia which is currently being processed where I will be involved in Teaching Medical students (Neuro anatomy, Neuro lectures, Neurologic examination-since there is no neurologist in the country-,) and residents among other accademic engagements. Within the same month, I worked in the Hospital as a Consultant Neurosurgeon, I had seen seen 5 brain tumors ( 2 were operated under very challanging circumstances and for one I had to borrow the gigli saw from a Private clinic I also work for. One was referred to neighboring country because they can afford it and another discharged home and another died. A case of an unstable burst fracture needing surgery could not be done due to lack of rods and peddicle screws. Within this very same period I attended to 6 patients with severe head injury of whom 4 died, currently there are no ventilators in the Hospital and the biochemistry lab is non functional and there is only one ICU for the entire Hospital. Thus it was a month of deep frustration and depression. However I had engaged the new Chief Medical Director who is a General surgeon and I was informed that Ventilators will arrive soon. I have also proposed to him to have a Pediatric ICU in the department of Pediatrics which never existed and to work on improving patient care in the ICU. I have had series of consultations with the Pediatricians and Internist and the roadmap to establishing the Peds ICU and improving the current one is on going, how far and how soon still remain unknown. The Hospital has a CT Scan that is operational but the MRI has never been and technicians were sent to China to to learn how to operate it who just returned and I will ensure its operational as soon as possible. Neurosurgical equipments ( Microscope, drills, consumables etc are still not available) However the Neurosurgical conditions seen are a major burden considering my training vis a vis the plateau technique at my disposal to deliver standard Neurosurgical care.

Finally, I have also started a part time private practice in Medicare Clinic Support Gambia where the proprietor has been able to purchase some basic equipments for craniotomies etc and it was from the clinic that I was given a gigli saw to operate on one of the patients mentioned above with parasagittal meningioma in the public hospital at no cost. The Clinic also bought Chabbra shunts so that patients with hydrocephalus need not to go abroad just to buy one shunt. Consequently I found this clinic as a complimentry to my efforts in the general hospital.
I look forward to any Neurosurgeon or groups who would like to visit the Gambia or assist us in building a standard department of Neurosurgery