TUMI Neurosurgical Center

A virtual platform to catalyze the neurosurgical training and treatment in limited-resources facilities of Peru via cost-effective technologies.

The "TUMI Neurosurgical Center" is a virtual platform that aims to interconnect organizations from high-income countries and Peruvian institutions to provide sustainable technologies capable of improving neurosurgical education and treatment in limited resource hospitals. 

Our algorithms will allow handling patient health information efficiently and provide a communication system for organizations dedicated to helping underserved people during medical missions. Importantly, It will also constitute a hub for the development of virtual and augmented reality technologies able to provide remote assistance for Neurosurgery and education.

There is an unmet need in neurosurgical care, especially in low- and middle-income countries (LMICs). For instance, about 5 billion people lack access to surgery worldwide, and nine out of ten patients in LMICs do not have access to basic neurosurgical procedures. Consequently, this has resulted in lost human lives, the impairment of patient and family’s quality of life, and economic costs to many countries. Moreover, it is estimated the absence of solutions to this problem will result in a total loss of $ 12.3 trillion dollars by 2030.

In Peru, about 40% of the population do not have access to neurosurgical care and there is a ratio of 1 neurosurgeon per 125,000 people, aside from the expensive nature of surgeries. Thus, there is a lack of access and affordability to neurosurgical care. Moreover, the scarcity of multidisciplinary teams and modern technological equipment is dramatically accentuated in rural and poor areas. For example, patients need to travel long distances to seek basic surgical care, and most of the time do not reach on time or the outcomes are poor due to precarious settings.

Many international taskforces consider this neurosurgical gap and disparity as a “moral, health, and financial necessity” and recommend the buildup of human resources and cost-effective technologies able to address the patient delivery demand in the upcoming years. 

Peruvian pediatric and adult patients are underserved due to a lack of accessibility and affordability to basic neurosurgical procedures. Also, the majority of neurosurgery professionals do not receive training in novel procedures largely due to the expensive costs of required equipment. Several efforts to bring world-class treatment to these patients have been done in the last decades such as the temporary training of local neurosurgeons in high-income countries, the sporadic visit of surgical missions partnered with international organizations, and the creation of specialized centers. Although these initiatives are remarkable, they still face challenges related to the follow-up of patients, the monitoring of their progress, and the sustainability of projects.

Hence, the "TUMI Neurosurgical Center" aims to provide cost-effective technical solutions to health care professionals and patients seeking neurosurgical care in limited-resources facilities of Peru. I strongly believe the use of augmented and virtual reality will catalyze the buildup of the local workforce, the learning of novel neurosurgical techniques, and the treatment of low-income patients in a collaborative and remote fashion.

Thus, this virtual platform will be open to existent and new partnerships between international and local organizations to plan surgeries, discuss patient cases, follow-up clinical records, provide a teaching environment and a space for the use of telesurgery. Through charity, this concept will help to multiply the current efforts while maintaining the organizations' autonomy for the benefit of underserved patients.

As a final-year medical student interested in Neurosurgery, I have dissected the problem through reading landmark research papers, talking to local professionals, engaging in discussion with international physicians, and from past personal experiences. Besides, I have established a medical student chapter in partnership with the “Mission Brain” Foundation, a non-profit organization that has contributed to providing treatment to underserved patients worldwide with the help of leading neurosurgeons in the field.

In the last year, I have tried to reach out to pioneer software companies dedicated to the creation of remote visualization and assistance programs, although they are not strictly focused on neurosurgery (e.g, Proximie, VIPAAR). Also, I have been learning about the future perspective of software created for the HoloLens™ device of Microsoft via their company webinars. In special, HoloLens has achieved promising results in the surgical field to provide remote surgical assistance (see video).

Although to this date, I have not received any response or mentoring from these companies, I have been talking to enterprises dedicated to producing physical neuroanatomical models, some of which are powered by augmented reality in cellphones, that might be able to join us in the future software development. Moreover, the prospective alliance with the Biomedical engineering school at my university may create the perfect hub for idea developments from young people.  As a result, with your initial core support, we can profoundly impact many lives starting in Peru and expanding to the world. 

Inspired in a "TUMI", an ancient surgical blade that Peruvian cultures used to perform advanced procedures at that time (e.g trephinations, cranioplasties with gold) and an innovation symbol in the early history of Neurosurgery, this concept reflected in a virtual Neurosurgical Center has the potential to bring back the innovation trend of ancient cultures for the benefit of many needed patients in the present. In other words, it has the meaning of acknowledging our rich culture to partner with brilliant minds in the current century.    

I conceived this project after spending a large amount of time understanding this problem that took away the lives of my grandparents, researching the current literature, and investing my efforts to avoid the perpetuity of daily problems in places with limited, if not inexistent, neurosurgical resources. With the further development and inclusion of cutting-edge technologies, companies, and organizations like yours, our concept can make a significant impact starting in Peru and moving to the most underserved areas worldwide.

The website and mobile app of the TUMI Neurosurgical Center will include algorithms to handle patient clinical information, radiological images, and an optimized messaging system for communication between associated members; consequently, it will make the accomplishment of surgical missions and the follow-up of the treated patients easier and faster while protecting patient health records and maintaining the autonomy between partner organizations.
These platforms are also going to train organizations and local physicians via augmented and virtual reality software; thus, helping to provide remote neurosurgical assistance. The software will be optimized for platforms such as the "HoloLens" headset, mobile phones, tablets, or new cost-effective devices created in partnership with the affiliated institutions, including the biomedical engineering and medical school from my institution.

All these joint efforts will contribute to the sustainability of surgical missions in Peru and the buildup of the workforce in the long run. 

This project is in the initial face of development but according to reported numbers of organizations bringing humanitarian labor and the number of patients treated in a year, I foresee the benefit of training 50-200 local health professionals and the service of 100-500 patients including children and adults during the first year of implementation. Notably, these numbers can exponentially increase depending on the incorporation of new partners and companies, and funding. It is important to point out that my current affiliation with the Mission Brain Foundation might serve to expand this idea to new territories where they have previously served during medical missions (e.g, Mexico, The Philipines, among other countries). 

To provide connection, interaction, and progress tracking between organizations in charge of the neurosurgical treatment of low-income patients.

• Organizations bringing neurosurgical treatment from high-income countries have been mapped out (about 10 of them have previously delivered treatment in Peru). Specially, The Mission Brain Foundation, where I currently serve as a volunteer in my medical school chapter, will be the first to help on this project pilot alongside our university hospital.

To develop cost-effective Virtual/Augmented Reality technologies for remote guidance and education in Neurosurgery

• The Biomedical Engineering school at Universidad Peruana Cayetano Heredia is an important ally to develop such technologies. Moreover, some companies that develop education software based on VR/AR might be able to join upon the initial funding of this project. 
• Furthermore, the financial support of the center will be based on charity donations, the application to grants offered by Universidad Peruana Cayetano Heredia, fundraising campaigns, and the investment of companies willing to collaborate with us. 

TUMI is aligned with four UN sustainable development Goals:

• “To ensure healthy lives and promote well-being for all at all ages”
• “Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all”
• “Reduce inequality within and among countries”
• “Strengthen the means of implementation and revitalize the global partnership for sustainable development”

The main indicators to measure the progress of the TUMI Neurosurgical center are:

• The number of Peruvian areas and hospitals with at least one established partnership program registered at TUMI.
• The number of new partnerships registered and established in a year via TUMI.
• The number of patients treated between international and local surgeons during a medical mission.
• The number of patients treated by previously trained local surgeons in an autonomous way.
• The number of Peruvian neurosurgical trainees that completed VR/AR educational modules
• Specially designed surveys to measure the impact of TUMI on the education of trainees 
• The number of innovations created in a year (e.g, VR/AR-based software and hardware)

During the initial development stages of this center, the financial support might be difficult to obtain due to the limited market for this project nature. However, as we group more organizations and institutions, they will be willing to donate and sustain the benefits from this initiative.

As I approach certain local public institutions, the time to consolidate the paperwork, establish a formal partnership, and write the policies to protect the health patient information might be lengthy. Nevertheless, I will create a specific team dedicated to optimizing the time and solving this concern. 

I grew up in the city of Cutervo during the first fours years of my life, a rural city lacking a robust surgical workforce to address the most basic surgical needs nowadays. Sited in the highlands, Cutervo is deeply affected by its remote location and absent specialized center within 5-8 hours of travel. Unfortunately, that has remained unattended for decades and has taken away the life of many impoverished citizens, including my grandparents. Nevertheless, I have been motivated to take action on this thanks to my athletic background of enduring though challenges (e.g, I have run several ultra-marathons: 100 km on the desert, an 80km race, three 42km marathons in 3 consecutive days, and fourteen marathons in total) and being a national silver medalist in track and field.

Universidad Peruana Cayetano Heredia is ranked number 1 in innovation and the second-best institution in my country. Importantly, my medical school is recognized for its extensive work, amount of publications and grants received from prestigious institutions such as the National Institue of Health (NIH), the Bill & Melinda Gates Foundation, among others. Besides, the School of Biomedical Engineering was established in an alliance with the best Peruvian institution, Pontificia Universidad Católica del Perú. As a result, locally we have the leadership and commitment to supporting this concept.

I currently serve The Mission Brain Foundation as the founding president in my medical school chapter, which is in charge of creating fundraising activities and events to support local neurosurgeries of low-income patients, and the education of local students and neurosurgical trainees. Originally, it was founded by Dr. Alfredo Quiñones-Hinojosa and Dr. Michael Lawton, two world-class neurosurgeons and chairs of the Neurosurgery departments at Mayo Clinic Florida and The Barrow Neurological Institution in Arizona, respectively. Their teamwork has translated into thousands of patients treated in Mexico, Peru, The Philipines, and more countries. Hence, they are leading the improvement of Global Neurosurgery and constitute the first partner to launch TUMI worldwide.