Haemorrhagic stroke in the Democratic Republic of the Congo: a neglected neurosurgical emergency care in a health system with critical gaps: a mini review.

Haemorrhagic stroke, caused by bleeding in the brain, is one of the most dangerous types of stroke. It kills many people and leaves others with lifelong disabilities. In the Democratic Republic of the Congo (DRC), this problem is serious but often ignored. While most strokes in wealthy countries are caused by blocked blood vessels, in Africa, a much larger number are caused by bleeding. In the DRC, the problem is that stroke patients often arrive late at hospitals, and most hospitals do not have brain imaging or enough specialised stroke staff to treat them promptly. The country has fewer than 20 neurosurgeons for more than 100 million people, and most of them work in major cities. People living in rural areas usually cannot access proper care. Even when patients arrive at a hospital, surgery and intensive care are often unavailable. Stroke is usually managed as part of general health programmes, but the surgical aspect of haemorrhagic stroke is rarely included. This results in many deaths that could be prevented. This paper examines haemorrhagic stroke in the DRC from a neurosurgical perspective. We highlight how the lack of specialists, equipment, and clear treatment protocols worsens the situation. Simultaneously, there are opportunities for improvement: training general doctors and nurses in basic neurosurgical care, utilising telemedicine for advice, and developing national policies that include surgery. Collecting better data and establishing global partnerships will also be beneficial. Increasing focus on haemorrhagic stroke can save lives and reduce disabilities in the DRC.