Neurosurgical services in the Northern Zone of Sarawak in Malaysia: The way forward amid COVID-19 pandemic

Low, Peh Hueh; Mangat, Manvinder Singh; San Liew, Donald Ngian; Hieng Wong, Albert Sii

Background The novel coronavirus disease 2019 (COVID-19) pandemic has set a huge challenge to the delivery of neurosurgical services including the transfer of patients. We aimed to share our strategy in handling neurosurgical emergencies at a remote center in Borneo Island. Our objectives included discussing the logistic and geographical challenges faced during the COVID-19 pandemic. Methods Miri General Hospital (MGH) is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services. Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases. Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly. All patients were screened for potential risk of contracting COVID-19 prior to the surgery. Based on this, the level of personal protective equipment required for the healthcare workers involved was determined. Results During the initial six weeks of the Movement Control Order (MCO) in Malaysia, there were 50 urgent neurosurgical consultations. Twenty patients (40%) required emergency surgery or intervention. There were nine vascular (45%), five trauma (25%), four tumor (15%), and two infection cases (10%). Eighteen patients were operated at MGH, among whom 17 (94.4%) survived. Ninety percent of anticipated transfers were avoided. None of the medical staff acquired COVID-19. Conclusions This framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.