“Trust in God and you will be alright,” read a sign that greeted Professor Barbara Wilson on a recent trip to a Nigerian hospital.
This was an instant reminder to the neuropsychologist of how attitudes towards healthcare are so varied around the world.
She was there to share her experience gained from more than 40 years in the brain injury rehabilitation field. Joining her were fellow eminent professors Wayne Feng and David Good from the US and Caterina Pistarini of Italy.
The trip, last December, was the latest stop of the globe-trotting initiative, the Flying Faculty. The scheme is run by the World Federation for Neuro-rehabilitation (WFNR) and delivers expert training programmes in neuro-rehab across the world.
Welcoming the global contingent to Nigeria was Dr Mayowa Owolabi, who runs the Blossom Neurorehabilitation Centre in Nigeria and serves as the WFNR’s regional vice-president for sub-Saharan Africa.
Barbara (pictured below, third from right) says: “Rehab is very discrepant in different countries. Going there gives others an insight into better ways of doing it. In Botswana, for example, many people still believe in witch doctors, and if you get a brain injury, it’s because you’ve upset your ancestors.”
Over three days, Barbara and her colleagues joined neurologists, physiotherapists, clinical psychologists, speech therapists, medical students and other physicians from across Nigeria.
They squeezed into a classroom in University College Hospital at Ibadan University with no air conditioning and only an electric fan
to cool them.
In the bathroom there was no running water or sanitary system. The hospital itself was in a poor condition, and overcrowded with patients.
But while Nigeria had limited infrastructure, there was no lack of keenness to learn among local healthcare professionals.
“There were so many questions, and such vivid interaction, it was unbelievable,” says Professor Wayne Feng, on Skype from Duke University, North Carolina, where he is chief of the stroke division.
“The infrastructure was very primitive, but the people were well trained with limited resources, and they had enormous enthusiasm.”
The event was aimed at uncovering innovative technologies in neuro-rehab, in order to improve the lives of patients in Nigeria.
It was also designed to foster better relationships between professionals in the country.
“The Nigerians we met definitely needed some help with the infrastructure, and they needed to be better connected to other initiatives,” he says.
“They want to treat stroke patients, and help them get better, but they need to be a part of the world, to learn what other countries are doing, so that they can adopt and form local policy and procedure.”
This was Wayne’s first trip with the Flying Faculty, and his first visit to Africa.
But despite it not getting off to a flying start, after an encounter with a thief in the airport that was “quite a drama”, this didn’t taint his experience, and he would do it all over again.
“It was an adventure. I could sense some scepticism at first, but the WFNR did a wonderful job, to not only provide support, but to kick off the enthusiasm and give the [Nigerian professionals] hope that they are not doing it alone.
“We helped groups across Africa, and West Africa unite, to realise the power of doing things together.”
The Flying Faculty began in 1996 as a small team of medics visiting Bosnia.
Over the last 20+ years it has spread its reach globally; taking in trips to places such as India, China and Iran.
Other stop offs include Russia, the Philippines, the UAE, Mongolia and Chile.
It brings together doctors, neurologists, neuropsychologists and therapists in all relevant disciplines.
The idea is simple; any country can apply, and the faculty ‘flies in’ to deliver an expert training programme in a short, intensive time period.
Trainees learn the skills required to develop and implement neuro-rehab services, while the trainers learn about the issues and challenges faced in those countries.
The WFNR, which has around 5,000 members and brings together 40 national societies around the world, funds the costs of the travel.
The host country provides food, accommodation and local travel for the visitors.
“We can go anywhere in the world,” says Tracey Mole, executive director of the WFNR at its HQ near Newcastle upon Tyne in North East England.
“It was set up to respond to requests from countries who needed training or expertise in neuro-rehabilitation.
“That could be something very specific such as stroke training, or it could be sending people to where they already have a training programme in place to help out, or sending a speaker to a conference or a meeting.
“Neurorehabilitation is still in its relative infancy, but in some parts of the world it’s practically non-existent.
“The aim is to provide basic training in countries where there is very little knowledge of neuro-rehab, and very few professionals in that country working in the field.”
The faculty also works with government officials from the country, to help them recognise and understand the need for neuro-rehab in that part of the world.
“It’s not just to put on a training programme, but to develop an interest in the field in that area and to get people involved in creating a national society.
“That’s a great way to get people in the area to work together… and for people working in those areas to be able to network with the rest of WFNR, so that they have access to all the knowledge that’s available.
“That’s a pretty big thing, especially when you’ve got a country with perhaps only three neurologists.”
Professor Barbara Wilson went on her first trip with the Flying Faculty to Chennai in India in 2014, where she and others collaborated with Indian psychologists to deliver a neuropsychological rehabilitation workshop, which was deemed a great success.
She returned to the country with the WFNR in 2017 for a six-day programme on acquired brain injury in Kolkata, and believes the visits have improved her practice.
“In India, there are so few neuropsychologists for such a huge country and they have to work a lot more closely with families, so that has influenced me,” she says.
“It is a two-way thing, a question of learning from each other and not just us taking things to them. It’s very much two-way traffic.”
Not only developing countries can be lacking in terms of their understanding and implementation of neuro-rehab, however.
“The same is happening in the States,” says Barbara. “They do almost no rehab now, all neuropsychologists do is assessments, and that’s not what rehab is about.”
Barbara puts this down to, “managed care, insurance companies and medicine for profit, not for the good of the people”.
Meanwhile, the Flying Faculty faces its own challenges. International travel is reportedly becoming increasingly difficult in the current climate, with the US tightening its immigration policy.
Tracey is seeing more and more members coming up against barriers with visa applications, particularly when travel involves Middle Eastern countries.
“We went to Iran but it was very difficult,” she says.
“We had people who were reluctant to go because we knew there was a probability that they wouldn’t be able to get back into the US after they’d been there.”
Barbara experienced this at first hand. Despite being the only Brit ever to be granted an award from the National Academy of Neuropsychology in America, the 2015 Iran trip caused problems on her return to the US.
“I was in Iran for a week and it was the most wonderful hospitality and terrific treatment. But because of that I was no longer welcome in the States.”
Barbara (pictured in Iran) was not deemed eligible for the US Visa Waiver and instead was forced to undergo an intense interview at the American Embassy in London.
She was eventually granted her visa, but is now reluctant to return.
“I was grilled for two hours it was horrible.
“All I was trying to do was make their brain injury services better.”
This is a goal commonly shared by members of the Flying Faculty which, despite the challenges presented by the task of flying a group of health professionals to often unstable countries across the world, continues to reach new heights.
The WFNR now has specific funding available for education and training to support the initiative.
It is actively encouraging more countries to apply, to allow it to spread neuro-rehab skills and knowledge even further afield.
“We’re here, we’re willing and able to assist,” says Tracey.
“We’ve got funding available now and we’ve got the expertise.”
And with experts such as Barbara and Wayne on board, the group is bound for success in its mission to provide the very best neuro-rehab training to health professionals across the globe.
“I want the best for survivors of brain injury, and I want the best throughout the world,” Barbara says.
“That’s why I do it. My raison d’être is to make life better for survivors of brain injury.”