The Legacy You Leave

On Nov. 10, 2021, Deanna Saylor, director of the Johns Hopkins global neurology program and neurology program director at the University of Zambia School of Medicine, gave an inspiring and insightful presentation during which she shared her experience developing Zambia’s first neurology residency program and addressed the importance of advancing neurologic care worldwide. She began with the question, “Why global neurology?”

The Global Burden of Neurologic Disease

The answer is simple: Low and middle income countries have a critical need for more neurologists. Although 75% of the global burden of neurologic disease is in these countries, they have the smallest workforce to care for patients. According to the World Health Organization’s 2017 Atlas Country Resources for Neurological Disorders, the United States has more than five adult neurologists per 100,000 people, while Zambia has 0.02 adult neurologists per 100,000 people.1

It’s mind blowing and devastating how striking the burden of neurologic disease is for low and middle income countries. For sub-Saharan Africa, there is an urgent need for more neurologists — the African Region accounts for almost two-thirds of the global total of new human immunodeficiency virus (HIV) infections.2 In sub-Saharan Africa, ​25.7 million people were living with HIV in 2018. This comprises the majority of the total number (approximately 37.9 million) of patients who have HIV globally. HIV and its associated opportunistic infections have many neurologic manifestations that should ideally be managed by a physician formally trained in neurology.

Stroke is also an overwhelming concern in low to middle income countries globally, since access to care and preventive medicine is not readily available for many people. According to the inpatient neurology registry from the University Teaching Hospital (UTH) in Lusaka, Zambia, stroke accounted for 43% of all neurologic admissions from October 2018 to April 2019. The answer to, “Why global neurology?” may be simple, but the solution is complex and multifaceted. The world needs people who are willing to tackle this problem head-on ­— people like Dr. Saylor.

I work closely with Dr. Saylor — she is my fellowship director for the global health neurology fellowship — and I speak honestly when I say she is the most hard-working person I have ever met and that she has a heart of gold. I believe there is a specific personality in medicine among those who pursue global health — they are patient, kind, low maintenance, innovative, driven, selfless. Deanna is the epitome of all these characteristics. She’s lived full time in Zambia since 2018, to develop the country’s first neurology training program and inpatient neurology service. In her Nov. 10 presentation, she discussed her approach to this ambitious feat, and I am lucky enough to have witnessed firsthand what an incredible training program she’s built.

Creating Leaders in the Field

There is a strong emphasis on resident education and protected didactic time in addition to clinical duties. We’ve had lecturers from Johns Hopkins as well as other renowned academic institutions teach us the most up-to-date guidelines in their specific field. During weekly case presentations, residents and attendings can discuss complex cases and review interesting imaging. I look forward to it every week! Our residents and attendings don’t hesitate to share their knowledge or ask for others’ input. It’s a teamwork approach to learning that ultimately leads to better patient care. There are also weekly journal club presentations during which residents learn how to critique and present neurologic research. Conducting research is a training requirement, so graduates can learn how to interpret and develop locally relevant data as it pertains to neurologic care in their community. Needless to say, the program’s graduates and trainees are some of the most astute physicians I have ever worked with.

Besides forming a structured curriculum, Dr. Saylor has worked to create a loving, supportive work environment in which people truly feel more like family members than workmates. Words would never be able to express how thankful I am to Dr. Saylor and all my neurology colleagues at UTH for all the time and effort they’ve invested into my training. Dr. Saylor has taught me that the most lasting and poignant impact you can have in medicine is through teaching others. If you teach them in a meticulous yet compassionate fashion, they will train those who follow in a similar manner. This way, more and more patients will benefit and thrive over time. Your legacy lives on through those you teach. In the words of American historian Henry Adams, “A teacher affects eternity: he can never tell where his influence stops.”

Link to Deanna Saylor’s Presentation:

References:

1 who.int/publications/i/item/atlas-country-resources-for-neurological-disorders

2 afro.who.int/health-topics/hivaids


Related Content

Want to read more from the Johns Hopkins School of Medicine? Subscribe to the Biomedical Odyssey blog and receive new posts directly in your inbox.