By Alfred Kongnyu Njamnshi, MD, MA, DMS, FMH

In 2008, when then-president of the World Federation of Neurology (WFN) Prof. Johan A. Aarli set foot in Yaoundé for the 18th Congress of the Pan African Association of Neurological Sciences, (PAANS¹), Cameroon—fondly referred to by its citizens as “Africa in miniature”²—was a peaceful, prosperous, powerful, and promising nation of the central African sub-region. At that time, there were only a handful of neurologists in Cameroon, and there was no training program for neurologists in the medical schools of the country.

Dr. Mbome Njie Victor, representing the prime minister, delivers the speech at the closing ceremony on WBD.

In organizing this congress, a great need was felt to reach out for the preparation of future neurologists in the country. This was done through a pre-congress activity that consisted of selecting the best students from some primary, secondary, and university institutions in Yaoundé, introducing them to the neurosciences, and evaluating their performances after a short educational intervention on the epilepsies³.

Concerning this innovative program, Prof. Aarli had this to say: “The type of outreach program presented in Cameroon is important because it makes neurosciences not a foreign and exotic subject, but a part of their daily life and of public health.”¹ On the congress proper, he reported, “I had the pleasure to attend the PAANS congress in Yaoundé, Cameroon, in November 2008 … The PAANS Congress served as an important information and discussion forum for African neurology. The meeting also was attended by local politicians and representatives from the government, which is essential in increasing the visibility of neurology.”⁴

Dr. Edwige L. Mendo, neurologist trained in Cameroon and serving in the South region of the country, presenting the key message of the painful truth of migraine at the ST Muna Foundation on WBD.

The congress organizers had worked hard to convince the government of the Republic of Cameroon on the importance of neuroscience to national development. Indeed, this was the first time in the 36-year history of PAANS that the government of the host country was the unique sponsor of the entire congress. At the opening and closing ceremonies, several cabinet members accompanied the Vice Prime Minister H.E. Amadou Ali, the chair of the congress, which was held under the highly distinguished patronage of the president of the republic, head of state.

The primary theme of that congress was “The Epilepsies,” and the secondary theme was “Headaches.” It was attended by the then-president of the International League Against Epilepsy, Prof. Peter Wolf. The president of the International Headache Society could not attend due to a last-minute emergency. It was during this congress that Prof. Aarli challenged the government of Cameroon to start residency programs in the neurological sciences that could serve the country as well as the sub-region. This challenge was well received, and two years later, residency programs in neurology, neurosurgery, and psychiatry were established in the Yaoundé School of Medicine in the University of Yaoundé I. More details on the fruits of this development over the years shall be reported subsequently.

Currently, 11 neurologists (two from the Democratic Republic of Congo [DRC] and nine from Cameroon), five neurosurgeons, and six psychiatrists (one from DRC) have been trained in these programs. Also, our neurology department recently hosted a trainee neurologist from Belgium (now a practicing neurologist) for a period of six months⁵. It is worth noting that one of our youngest trainees just received his award as fellow of the European Board of Neurology on June 28, 2019, as the sole candidate from sub-Saharan Africa, following a tight examination in Oslo with his European counterparts and neurologists of other nationalities, in the international examination organized by the European Academy of Neurology.⁶

The Painful Truth

In recent years, however, the indescribable beauty of this young and healthy nation, like that of a young headache-stricken patient, has been significantly threatened and bruised by a series of crises that can be described by no other word than migraine, and that is the painful truth.

Closing ceremony group photograph with representative of the prime minister (4th), BRAIN Board Members (Pr Etya’ale Daniel, 1st , Pr Leke Rose 2nd) and president of ST Muna Foundation (Battonier Benard Muna, fifth from right, in front row)

Indeed, the pain has been throbbing, sparing no part of the country. First is the eastern tropical forest region of the country with the influx of refugees fleeing from their own internal crises in the Central African Republic and the multiple consequences thereof.

Second, more severe attacks have ravaged the western mountainous region of the Far North, spreading terror, panic, and chronic phobia in the populations.

Third, as if this were not enough, for the past three years, the North-West and the South-West regions of the country are the theater of a hemorrhagic conflict, and the populations of these two regions have been victims of uncountable, painful, persistent, and pervasive attacks, sometimes caught as it were between the hammer and the anvil.

The full extent of the reality of this extremely painful truth has not been and may never be adequately measured, but one thing is certain: the nausea and emesis accompanying the atrocities, the photophobia and sonophobia associated with the increasingly sophisticated firearms, will have long-lasting and far-reaching consequences on brain health and on health and development in general. It is disheartening to note that two-year-old internally displaced children are familiar with and easily recognize the sound of firearms.

You may be tempted to observe that what appeared to be a simple migraine aura, rapidly and unexpectedly developed into a hemiplegic migraine with one whole side of the nation completely paralyzed intermittently through the “ghost-towns,” then to chronic migraine or better still “chronic hemiplegic migraine.” The prevailing situation could best be described as a “chronic familial hemiplegic migraine” as many family members of the people of this one-time peaceful nation are now directly or indirectly affected.

The painful truth is that every part of the whole is seriously hurting. The migraine crisis in Cameroon, which is the most common crisis in the country, has severely impacted every aspect of national life and has been underrecognized, underdiagnosed, thus underresearched, and undertreated (crisis-treatment) despite many laudable efforts.

The country has become peaceless and sleepless, running short of its prosperous and promising nature. Land of promise, where is your promise? Land of glory, where is your glory? Nevertheless, together as a TEAM (Together Each Achieves More), we all can use our brains to make sure that the suffering brains and bodies of the people in Cameroon affected by this migraine receive the help they need as the key messages of the World Brain Day7 2019 suggest to become once again a peaceful and prosperous land of promise and glory.

May I remark in passing, but seriously so, that the migraine in Cameroon is not unique to Cameroon. Although some of the aggravating factors of these migraines generally tend to be environmental, not easily lending themselves to intrinsic control mechanisms in the context of a total absence of biofeedback mechanisms, it would appear that only a concerted, concentrated, and constant effort for lasting prophylactic solutions, coming from the ingenuity and strong will of endogenous healthy brains, will be effective.

This would involve a deliberate, directed, and delicate mix of multiple neuronal networks, that work together in synchrony and symphony, in promoting brain health and through brain health, promoting health at large as there is no health without brain health. To ensure success in this endeavor, in terms of effective and efficient neurophysiological mechanisms especially neurotransmission, neuromediation, and neuromodulation, this approach may also involve neuroepigenetics as we are dealing here with a migraine. This process, in itself is not pain free.

The Powerful Tribute: The novel concept of the “Brain Week in Cameroon”

In the midst of this deeply rooted pain and mounting pressure, Brain Research Africa Initiative (BRAIN) has chosen to hope for peace and to work for peace in this fatherland of Cameroon. Since inception by the WFN, we in Cameroon have always celebrated the World Brain Day (WBD) but this was generally limited to an academic or professional audience. This year, BRAIN created the concept of the “Brain Week in Cameroon” involving five main BRAIN activities beginning from a week before the WBD and climaxing with the celebration of the WBD. The goal was to have a nationwide campaign of:

Alfred K. Njamnshi, founder and executive director of BRAIN, delivering the inaugural Monekosso-Muna BRAIN Lecture: The Foundations of Neuroscience Research in Cameroon and Africa.

• Bringing BRAIN health closer to the populations (diagnosing and treating disease in sick brains)
• Raising BRAIN awareness among the populations (sensitizing healthy brains to remain healthy)
• Activating BRAIN networks with the institutions (building partnerships for brain health)
• Increasing BRAIN capacity in the professionals (training through professional education)
• Nurturing future generations of BRAIN professionals (celebrating excellence to generate interest in neuroscience careers among the youth).

The inaugural “Brain Week in Cameroon” ran from July 15 to 22, 2019, under the distinguished patronage of the Prime Minister, Head of Government, Chief Dr. Joseph Dion Ngute and in partnership with the government of Cameroon.

First, free neurology, neurosurgery or psychiatry consultations in regional or tertiary health facilities took place in seven of the 10 administrative regions of the country (including some of the migrainous regions), thus bringing brain health care closer to the populations.

Second, multimedia sensitization talks, workshops, and symposia were carried out to raise brain awareness and the national communication media had at least a nationwide audience.

Third, the first two activities provided a forum for networking and building partnerships for the promotion of brain health. Specific public-private partnership agreements were also established between state and private institutions.

Fourth, with the participation of state universities, academic symposia were conducted in two faculties of medicine to increase the capacity of medical students, physicians, and other health personnel in the management of brain disease, particularly migraine.

Finally, a general symposium was conducted in the nation’s capital city of Yaoundé on primary headaches, with special emphasis on migraine, and the icing on the cake was the establishment of the novel concept of “The Monekosso-Muna BRAIN Lecture,” in honor of and as a tribute to the founding fathers of Cameroonian and African neuroscience research.

The late Prof. Gotlieb Lobe Monekosso employed field epidemiological and clinical approaches in the 1960s in Nigeria to study what was variably called at that time, endemic neuropathies, degenerative tropical neuropathies, tropical nutritional neuropathy, or tropical ataxic neuropathy while late Prof. Walinjom FT Muna since the 1990s set the pace for clinical research on HTLV-associated myelopathy, stroke, neuroAIDS, and the epilepsies in Cameroon.

The Monekosso-Muna BRAIN Lecture celebrates excellence in neuroscience and aims to stimulate and attract the young generations to consider taking up careers in neuroscience.

The theme of Brain Week in Cameroon 2019 was, “Promoting Brain Health and Conflict Resolution,” and the core messages highlighted the fact that we all need healthy brains, free from drugs and disease, in healthy bodies, for rational use in dialogue, constructive communication, and negotiations, and to resolve interpersonal, intergroup, or even international conflicts. Thus, BRAIN has attempted to extend and contextualize the WFN concept of “World Brain Day” to the concept of “Brain Week in Cameroon.”

Most of the activities of Brain Week in Cameroon were carried out by or under the leadership of brain health specialists or experts trained in Cameroon and serving in the different regions of the country, some of them under extremely difficult conditions. BRAIN received the partnering support of public and private media agencies as well as some private health institutions in this endeavor. Brain Week in Cameroon has come to stay and to grow, and the Prime Minister of Cameroon, writing on brain health, has encouraged BRAIN to “continue to sensitize the government and other partners on this important aspect of human health.”

The Way Forward

BRAIN, in partnership with the Cameroon Government, has chosen to light a candle, rather than curse the darkness of the migraine in Cameroon through the celebration of Brain Week in Cameroon and World Brain Day. BRAIN plans to cover all of the 10 administrative regions of Cameroon in the next edition of Brain Week in Cameroon and World Brain Day and to consolidate and spread this concept and strategy for the promotion of brain health in the region.

Past prime minister and board chair of BRAIN, H.E. Philemon Yang (center), took time off to attend a reception on WBD. He congratulated and encouraged the young BRAIN leaders from the seven regions of Cameroon to continue to work for brain health with courage, determination, and patience.

Since it has been said that every cloud has a silver lining, BRAIN hopes that the WFN and other partners such as the World Brain Alliance will find an interest in supporting BRAIN in its vision and mission so that as a team, we can work together toward the preventive treatment of the migraine in Cameroon, Africa, and the world, thus promoting brain health. •

Readers should note that articles in World Neurology represent the opinions of the author and not necessarily the view of the World Federation of Neurology.

Alfred Kongnyu Njamnshi, MD, MA, DMS, FMH is professor of neurology and neuroscience, faculty of medicine and biomedical sciences at the University of Yaoundé I, (FMBS-UYI), Yaoundé, Cameroon. He is also the founder and executive director of the Brain Research Africa Initiative (BRAIN), Geneva, Switzerland, and Yaoundé, Cameroon. He is head of the neurology department at the Yaoundé Central Hospital, chair of neurology-neuroscience training programs and head of the neuroscience lab, FMBS-UYI, and past president of PAANS, WFN delegate for Cameroon and emeritus regional director for Africa of the World Federation of Neurology.

References

1. Schneider ME. PAANS: Reaching out to future neurologists, Success seen in African outreach. World Neurology, vol. 24, No. 1 February 2009, pp1 &4. www.wfneurology.org
2. Johnson-Hanks J. Education, Ethnicity, and Reproductive Practice in Cameroon Population 2003/2 (Vol. 58) DOI : 10.3917/popu.302.0171 Pages 153 – 179.
3. Akinyemi R, Yepnjio F, Njamnshi AK. Neuroscience in Africa: raising the next generation and changing attitudes towards epilepsy: IBRO (2008) brain campaign funds Pre-PAANS congress 2008, Yaoundé, Cameroon. http://www.braincampaign.org/Pub/Pub_Main_Display.asp?LC_Docs_ID=3740 (accessed December 5, 2008).
4. Aarli JA, The President’s annual report: Outreach and Exchange. World Neurology, vol. 24, No. 1 February 2009, pp6. www.wfneurology.org
5. Naeije G, Yepnjio FN, Bissek AC, Tabah EN, Tatah G, Fonsah JY, Fogang Y, Kuate C, Dachy B, Njamnshi AK. Yield of training exchanges between Europe and Sub-Saharan Africa. Acta Neurol Belg. 2013 Mar; 113(1):31-4.
6. Brain Research Africa Initiative, BRAIN has a new Fellow of the European Board of Neurology, https://brainafrica.org/brain-has-a-new-fellow-of-european-board-of-neurology 2019.
7. World Federation of Neurology, World Brain Day 2019, Migraine: The painful truth. https://www.wfneurology.org/world-brain-day-2019.

It is a pleasure and an honor to present Mexico’s candidacy to host the WFN World Congress in 2023.

Mexico represents the 15th largest economy in the world and the 15th largest exporting power.

One of the principal economic bases of the country is tourism. According to the World Tourism Organization, Mexico ranks sixth in terms of the number of visits by foreign tourists. Also, it promotes the diffusion of the natural, cultural, gastronomic, and historical attractions of the country.

Mexico has a well-earned reputation for being a hospitable country with people friendly to tourists. We currently have agreements with more than 97 countries whose citizens do not require a visa to visit us.

Due to its geographical location (in the center of the American continent), Mexico is the gateway to Central and South America. Its air connectivity is one of its advantages; today, there are daily direct international flights to 51 destinations so it is highly likely that attendees only have to take one or two flights to attend the congress. This significantly reduces travel costs for attendees.

Although a WFN world congress has never been held in Central America, we have experience in organizing international congresses, such as the congress of the Pan American Section of the WFN (PANFS) which took place in in 2016 in Cancun, Mexico. Other examples of international events held in Mexico City are International Conference on Emergency Medicine 2018 and World Congress of Cardiology and Cardiovascular Health 2016, among many others.

It is important to mention that Mexican government provides the possibility to calculate zero percent VAT for International Congresses when these are carried out by foreign organizations.

In addition to its economic, geographic, and logistical advantages, Mexico City has much more to offer its visitors.

Once known as the “City of Palaces,” Mexico City has four areas declared World Heritage Sites by the UNESCO. The first is the “Centro Histórico” or downtown area where many beautiful religious and historical buildings can be appreciated, including the Metropolitan Cathedral, the National Palace, and the Fine Arts Palace, a beautiful art nouveau style building. The second World Heritage Site is the Xochimilco Ecological Park, considered by many as the “Venice of Mexico,” thanks to its beautiful canals that can be visited on board a trajinera (a curious wooden gondola-type vessel decorated with flowers).

The third World Heritage Site is the Autonomous National University of Mexico, and the fourth one is the Luis Barragan´ studio. Mexico City offers a large variety of museums, including The National Museum of Anthropology, the National Museum of Art, and the National Museum of History (located in Chapultepec Castle). To the north of the city, you can visit the Guadalupe Basilica, the second-most visited religious sanctuary in the world after Saint Peter’s Basilica in the Vatican.

We hope to count on your support to continue promoting the development of neurology in this region of the world.

Montréal tops the rankings of host cities in the Americas for most international conferences¹. Its attractions and qualities have made it a go-to location for business and leisure travellers. As one of the largest hubs for neuroscience in Canada—240 neuroscience professionals and over 40 companies related to neuroscience, Montréal is a first-rate destination for all with a passion for innovation, understanding the brain and treating patients with neurological disorders.

Together with the Canadian Neurological Society (CNS), generous funding for travel grants by the city’s convention community will enable a record number of scholars and fellows from emerging economies, such as Latin America and Africa, to attend this major event.

In order to foster innovative care and research on a global scale, The Neuro—McGill University’s Montreal Neurological Institute and Hospital—will make its open data platforms available to the members of the WFN and help identify potential Canadian collaborators. Founded by Dr. Wilder Penfield, The Neuro is a world leader in the field and has a rich history of welcoming the international neuroscientific community—trainees, researchers and clinicians alike. A pioneer, The Neuro is the first Open Science institute in the world, helping accelerate new therapy research and solutions.

The WCN 2023 will also be an opportunity to expand the annual grants and awards program the CNS jointly administers with the World Federation of Neurology. A new program being developed will focus on colleagues from Sub-Saharan Africa.

Montréal is a smart choice for WCN 2023. Recognized as Canada’s research and higher education capital, the city has 1,500 institutions active in R&D, 200 research centres, 11 higher learning institutions including four major universities, and two academic health centres—neurology from pediatric to adult, from general to highly specialized—making it a high-tech, artificial intelligence, health and life sciences hub. Among the Top 20 safest big cities in Canada and the United States², Montréal also enjoys one of the most vibrant urban scenes, thanks to its numerous world-class festivals, international cuisine, legendary hospitality and European flair. It is home to a richly multicultural community where 100 languages are spoken. Easily accessible and practical, it is only 20 minutes from the airport, which services 150 direct flights from North Africa, the Middle East, Asia, Latin America, Europe, and North America. The wide range of downtown accommodations includes 16,000 hotel rooms within a 10-minute walk from the city’s convention centre, 4,000 of which are directly linked to the centre. Its proximity to 90 million Northeastern Americans less than a two-hour flight away, or within driving distance, means even more students, young researchers, and clinicians can attend the congress. Participants will be able to partake in technical tours of The Neuro and several other university and hospital sites during their stay in Montréal. Success, innovation, and expertise await you in Montréal. October is when the city really shows its true autumn colours.

References

1. Union of International Associations 2017/2018
2. FBI & Statistics Canada 2018

By Dr. Abdul Malik, MD, DCN, PGDN, MBA

The Neurology Awareness and Research Foundation (NARF) in Pakistan organized countrywide activities to mark the fifth Annual World Brain Day, with the theme Migraine: The Painful Truth. Migraine affects one in seven people and, together with other headache disorders, is one of the leading causes of disability worldwide.

Besides countrywide awareness activities in all four provinces across Pakistan, NARF organized the majority of its activities in the largest city of Karachi. Flyers about migraine were distributed for the general public in the family medicine clinics. NARF also prepared migraine signs/ symptoms/ treatment/ diet and lifestyle modifications awareness mounts, which were placed in 1,000 clinics across the country. A month-long Facebook campaign as well as Twitter activities were executed by placing video messages and awareness posts in local languages as well as the matter provided from the WFN. World Brain Day posters were placed in almost all the major institutes and departments of neurology in Pakistan.

On July 22, under the aegis of the World Federation of Neurology (WFN) in association with the International Headache Society (IHS), NARF celebrated the Fifth Annual World Brain Day with a free migraine clinic and press conference by the renowned neurologists of the country, including Prof. Mohammad Wasay, NARF president; Prof. Aziz Sonawala; former PHS president; and Profs. Arif D. Herakar and Dr. Abdul Malik from the Liaquat College of Medicine & Dentistry in Karachi. In the free migraine clinic, which was held at the Karachi Press Club, a large number of patients attended. They were provided free consultation as well as provided medications for the prophylactic treatment of migraine.

A unique activity was conducted for the awareness of migraine in collaboration with the students of the Masters for the Headache Disorders (MHD) from the University of Copenhagen and Danish Headache Center in Denmark. This activity was done under the patronage of the Prof. Rigmor Jenssen, course director. We had prepared and disseminated messages on migraine awareness provided by the WFN. This included almost 20 videos messages in 16 languages from 14 countries (Colombia, Denmark, Greece, Ireland, Italy, Latvia, Nigeria, Pakistan, Philippines, Slovenia, Spain, Sweden, the U.K., and the U.S.).

On July 31, 2019, a Continuing Medical Education (CME) activity on #migraine #thepainfultruth: Diagnosis & Management was held at Liaquat College of Medicine & Dentistry (LCMD) in context with #worldbrainday. Prof. M. Wasay, Prof. Aziz B. Sonawala, and Associate Prof. Dr. Abdul Malik were the speakers. Prof. Rizwan Azami, director of medical services DSH, and Dr. Rashid Naseem Khan, principal LCMD, were the guests of honor. A large number of undergraduate students, postgraduate trainees, and faculty members attended the interactive session.

The awareness activities were covered in national and local newspapers as well as in the electronic media. There were TV shows on migraine for public interest as well a question-and-answer session about migraine signs and symptoms and treatment. In the Urdu language, an article was published in a local magazine about the awareness of migraine.

In short, a comprehensive advocacy campaign for migraine awareness was executed on the occasion of this year’s World Brain Day 2019 in Pakistan, keeping in view that migraine is the most common neurologic disorder that is treatable.

Dr. Abdul Malik, MD, DCN, PGDN, MBA, is associate professor of neurology in Karachi, Pakistan.

It has been a great privilege to be treasurer of WFN since 2015. During this time, I have been delighted to see the finances of the federation become even stronger.

Richard Stark

WFN’s mission statement is: “… to foster quality neurology and brain health worldwide, a goal we seek to achieve by promoting global neurological education and training, with the emphasis placed firmly on underresourced parts of the world.”

I strongly support these aims, and my experience on the board of trustees for the past four years confirms that it is applied in practice.

The role of the treasurer is to advise the other trustees about the state of the finances, and thus which programs can be supported. For example, one of our current major programs involves supporting training in Africa and Latin America. The impact on the budget extends for some years into the future. We must be confident that our position is sound (and will remain so) in order to make the commitment to support training for up to four years in the future.

The income stream for WFN derives in part from member society fees and royalties from the Journal of Neurological Sciences (which are both relatively stable), and more substantially from the Congress (WCN), which is much more volatile. The 2015 meeting in Santiago significantly exceeded expectations, and the Kyoto meeting in 2017 was an outstanding financial success. As treasurer, I must thank all those involved in those meetings for working so hard to ensure success. Early projections for Dubai 2019 are positive also.

The financial success of WCN depends largely on the support from pharmaceutical companies, which depends, in turn, on the stage of commercial development of their products. These factors are outside our control. The management of the WFN’s finances, therefore, requires an astute and flexible approach, efficient administration, and conservative estimation of projected income streams.

My experience over the past four years has helped me to have a more indepth understanding of these issues and should be helpful to the WFN over the next four years. I believe, therefore, that I have something of substance to offer if elected.

I should set out some aspects of my background that have relevance to the position of treasurer of WFN. These include:

• treasurer of the Sydney 2005 WCN, which was a huge financial success
• treasurer of the Australian Association of Neurologists (1997-2003)

WCN 2005 took place at a time of substantial exchange rate volatility, and the strategies designed to minimize adverse impacts of this contributed to the financial success of the conference. Subsequent experience as treasurer of WFN over the past four years (with the impact of Brexit) has reinforced the necessity to have funds diversified in such a way as to minimize volatility while not excluding the possibility of organic growth.

The WFN has a strong tradition of efficient use of funds. This relies on the generous donation of time from the executive as well as the hard work of administrative staff. This efficiency must continue. If elected to a further term, I undertake to continue to work diligently with the executive to ensure that the financial management of the WFN allows it to pursue its aims and objectives.

By Prof. Serefnur Ozturk

The Turkish Neurological Society has been celebrating World Brain Day since 2014. Every year, we follow WFN guidelines and create public awareness by organizing meetings, public service announcements, and newsletters. This year, we partnered with İstanbul, Besiktas municipality, and organized a meeting about this year’s theme “Migraine: The Painful Truth.”

The meeting took place on July 22, World Brain Day, and was open to public attendance. Migraine is a common disorder in our population (reported as one of five women and one of 10 men). Banners were distributed throughout İstanbul promoting the meeting along with powerful support by social media and the national press.

We appreciate the WFN for supporting societies with toolboxes and webinars every year. We also encouraged our members to organize World Brain Day events, and this year, many meetings were held across Turkey. Furthermore, we collaborated with the International Headache Society to increase awareness for migraine.

Prof. Serefnur Ozturk is president of the Turkish Neurological Society.

By Osigwe P. Agabi, MBBS (BENIN), MWACP, FMCP

Undertaking my residency training in neurology in Nigeria had its advantages. I got to learn and practice in a culture where my expertise would be deployed, and the diversity and sheer number of neurological cases and conditions enabled me to hone my clinical skills. The training also afforded me the privilege of providing answers (and some succor, I hope) to patients whose conditions had been undiagnosed or misdiagnosed, cursorily attributed to “spiritual” forces in the absence of a logical alternative explanation. This was enabled by the increase in availability of some technologies, including brain imaging and support laboratory diagnostics for those who could afford them.

Despite these, however, one gaping void was the absence of expertise and technology for electromyography and nerve conduction study (EMG/NCS) testing. Four decades prior was the last time my training center had functioning EMG/NCS, and the combination of competing financial commitments and lack of expertise ensured this was not revived.

That was until early 2018, when a good natured alumnus donated EMG equipment and conducted a preliminary workshop that whet my appetite. About the same time, serendipity brought my mentors together at the EAN regional teaching course in Ouagadougou, and discussions ensued that culminated in the opportunity to begin my formal training in EMG/NCS in Austria.

As I sat down on the Lufthansa flight bound to Vienna from Lagos, Nigeria, my thoughts wandered. What would Austria be like? What will this experience be? Will I achieve my objectives? Will the weather be kind? Will I have problems communicating, as I speak no German?

I reached for my phone and looked down at the pictures of Profs. Walter Struhal and Wolfgang Grisold I had downloaded before the journey. It was this duo of renowned neurologists who had graciously agreed to offer themselves to train me in nerve conduction studies and electromyography at no cost that informed this journey. I thought about my family and the neurology unit back at the Lagos University Teaching Hospital in Nigeria. I thought most especially about my teacher, mentor, and boss, Prof. Njideka Okubadejo who had given her all to the actualization of this dream and how lucky I was to have her. I was still in this train of thought when I was jolted into consciousness by the air hostess who was waiting to take my order of refreshment.

I arrived in Vienna and headed straight for the University Hospital in Tullin where Prof. Struhal is head of neurology. Prof. Struhal is a kind gentleman with a calm disposition. I was taken to my apartment that contained most of what I was going to require for the period of my stay.

The next day, I was formally introduced to the neurology department and completed some administrative formalities. Every morning, there was a presentation of all patients, new and old, by the consultants with their relevant investigations and neuroimaging. I looked forward to this exercise every morning not only for its robust intellectual nature but also for the demonstration of genuine patient empathy. I was received warmly by all. I observed the team spirit, astute dedication to duties of all, both young and old.

The synergy between doctors, nurses, and other support staff was exemplary. I worked closely with Drs. Andreas Seiser and Brigit Riemer who were the neurologists in charge of neurophysiology. They walked me through the rudiments of NCS and EMG. They loved to teach and made the process seamless. I cannot forget the patients who offered themselves freely to this exercise so I could learn. I was glad to observe sessions of transcranial magnetic stimulation, fiber-optic endoscopic evaluation of swallowing, and some autonomic nerve testing, among others.

Twice every week, I commuted by train to Vienna to catch up with Prof. Grisold in his private practice. In his office, he laid bare nerve conduction and electromyography. He taught with uncommon dedication and passion, making sure I had an untainted understanding of the concepts. He taught me many secrets that only years of practice could bring. He had sessions with me as the patient. It is a great privilege to have been tutored by him. I will forever remain grateful.

Prof. Grisold wanted me to broaden my horizons on my many spheres of neurology. He reached out to many of his colleagues, including Dr. Stefan Meng, a radiologist with expertise in nerve and muscle ultrasonograpy. Dr. Meng was warm and highly knowledgeable, yet humble. He had some teaching sessions with me at the KFJ hospital in Vienna. Before this experience, nerve and muscle ultrasonography was a distant reality for me.

I also had the rare privilege of visiting Prof. Michaela Auer-Grumbach, a renowned neurogeneticist who added the icing on the cake for me. Before long, my 32-day visit had come to an end.

I am overwhelmed by the unconditional kindness, efforts, and support of Profs. Struhal and Grisold for bringing this dream to reality. This experience has awakened in me a restlessness to develop that which I have acquired and to impart to others after me. Yes, St. Augustine was right when he opined that “the world is a book, and those who do not travel read only one page.”

Osigwe P. Agabi, MBBS (BENIN), MWACP, FMCP, is a consultant physician and neurologist in the neurology unit of Lagos University Teaching Hospital in Nigeria.