Kenya has a population of over 30 million people, most of whom live in rural areas. We have six adult and three paediatric neurologists and 10 neurosurgeons, so most neurological care has to be provided by non-neurologists. Unfortunately all the neurologists are based in the capital city Nairobi. We do not have a trained neuropathologist and there is only one clinical neurophysiologist. Most of the neurologists have been trained in the United Kingdom as a consequence of the colonial legacy—there is no neurology training in Kenya. In terms of infrastructure the country has about a dozen CT scanners, three MRI scanners, and two EEG machines.

The three major providers of health care are public (government service), private, and missionary hospitals. The vast majority of the population do not have medical insurance and so have to use the government hospitals which as a result are overstretched. The private hospitals are able to invest in major equipment—for example, there are only two CT scanners in the public hospitals while the majority are in the private sector, as are all the MR scanners.

One of our major dilemmas in the practice of neurology is …