History and Current State of Neurosurgery in The Gambia

Background Despite global efforts to improve surgical care access, many low and middle-income countries, especially in neurosurgery, face significant shortages. The Gambia exemplifies this, with only one fully qualified neurosurgeon serving its population of 2.5 million people. This scarcity results in higher morbidity and mortality. Objective We aim to document the history and current state of neurosurgery in The Gambia to raise awareness and promote neurosurgery development. Methods The study reviews The Gambia's healthcare system, infrastructure, neurosurgical history, workforce, disease burden, and progress, with information derived from reference sources as well as author experience and interviews with key partners in Gambian healthcare. Results Neurosurgery in The Gambia began in the 1970s, facing constraints due to competing healthcare demands. Significant progress occurred much later in the early 2010s, marked by the initiation of Banjul Neuro-Missions and the establishment of a dedicated neurosurgery unit.We report significant progress with neurosurgical interventions in the past few years showcasing the unit's dedication to advancing neurosurgical care in the Gambia. However, challenges persist, including a lack of trained neurosurgeons, equipment shortages such as ventilators and diagnostic imaging. Financial barriers for patients, particularly related to the costs of CT scans, pose significant hurdles, impacting the timely diagnosis and intervention for neurological conditions. Conclusion Neurosurgery in Gambia is progressing, but challenges like equipment scarcity hinder further progress. We emphasize the need for addressing cost barriers, improving infrastructure, and fostering research. Engaging the government and international collaborations are vital for sustained development in Gambian neurosurgery.