Volunteer: Dr. Giorgio Marco Rubin, Neurosurgeon
Host Institution: Muhimbili National Hospital, Dar es Salaam, Tanzania
Volunteer Dates: June 19 – July 3, 2026
As part of FIENS’ commitment to advancing neurosurgical education through sustainable partnerships, Dr. Giorgio Marco Rubin recently completed a two-week volunteer engagement at Muhimbili National Hospital in Dar es Salaam, Tanzania. During his visit, Dr. Rubin worked alongside faculty, residents, and medical students, providing hands-on surgical mentorship, participating in clinical teaching, and sharing his extensive expertise in complex cranial neurosurgery.
Each morning began with multidisciplinary case conferences where emergency and elective neurosurgical patients were reviewed by consultants, residents, and medical students. These discussions provided valuable opportunities for collaborative learning, clinical decision-making, and the exchange of surgical knowledge.
Throughout the volunteer assignment, Dr. Rubin participated in the management of numerous complex neurosurgical cases, including cerebellar tumors, suprasellar tumors, craniopharyngiomas, aneurysm surgery, and meningiomas. Every operative case served as a teaching opportunity, with senior and junior neurosurgical residents actively assisting in the operating room and receiving individualized instruction throughout each procedure.
One particularly meaningful aspect of the visit was Dr. Rubin’s emphasis on thoughtful surgical decision-making. In one case, a planned microvascular decompression procedure was cancelled after confirming that the patient’s trigeminal neuralgia was being successfully managed with medication, demonstrating the importance of patient-centered care and avoiding unnecessary surgery.
The volunteer experience also highlighted the realities faced by many neurosurgical programs in resource-limited settings. Surgical cases were occasionally delayed or postponed because of blood shortages, limited ICU capacity, operating room infrastructure issues, and logistical constraints. Despite these challenges, Dr. Rubin remained actively engaged in both the operating room and postoperative patient management, working closely with the local team to optimize patient care and support clinical decision-making.
Over the course of his visit, Dr. Rubin contributed approximately 120 volunteer hours, including preparation, clinical service, teaching, and follow-up activities. His work directly benefited an estimated 60 learners and patients, including neurosurgical residents, medical students, children, and adult patients requiring complex neurosurgical care.
Reflecting on the experience, Dr. Rubin emphasized several important lessons for future volunteers, including careful preoperative planning, thoughtful use of cerebrospinal fluid drainage during complex tumor surgery when appropriate, and vigilant postoperative monitoring in the intensive care unit. His observations also identified opportunities to strengthen systems of care through improved operating room efficiency, critical care management, and resource coordination.
Originally planning to divide his volunteer service between Tanzania and Uganda, Dr. Rubin extended his stay at Muhimbili National Hospital after learning that scheduling conflicts in Uganda would limit educational opportunities. This flexibility allowed him to continue supporting the Tanzanian neurosurgical team and maximize the impact of his volunteer service.
FIENS extends its sincere appreciation to Dr. Giorgio Marco Rubin for his generosity, expertise, and dedication to advancing neurosurgical education. Volunteers like Dr. Rubin help strengthen local training programs, build surgical capacity, and foster lasting international partnerships that improve neurosurgical care for patients around the world.
Based on my experience, I would suggest the following practical recommendations for neurosurgeons volunteering in Africa:
- Locate all the microsurgical instruments.
Identify in advance where the microsurgical instruments are stored. Sometimes the best instruments may be included in a different set, such as the pituitary surgery set. Knowing where these instruments are located before starting surgery can be important. - Start surgery early in the morning whenever possible.
It is common for surgery to start quite late. Whenever possible, the surgical schedule should begin early in the morning. This allows sufficient time for complex procedures and reduces the risk of surgery extending unnecessarily late into the day. - Make the first case an easy and predictable one.
The first operation should ideally be a relatively straightforward and predictable case. This allows the visiting neurosurgeon and the local team to establish communication, understand how they work together, and identify any logistical or technical problems before undertaking more complex surgery. - Review the anesthetic preparation carefully.
Before major surgery, discuss the anesthetic plan with the local anesthesia team. Confirm the number and type of venous lines required, the adequacy of anesthesia and physiological monitoring—including end-tidal monitoring—and the availability of blood products if required. - Consider CSF drainage in patients with very large tumors.
In selected patients with very large tumors, preoperative CSF drainage may facilitate the surgical procedure. Regarding tumor resection, the primary goal should be to relieve symptoms and achieve a safe surgical result rather than pursuing maximal tumor debulking at all costs. A staged approach can always be considered when appropriate.
If a ventriculostomy is planned as a separate procedure before the craniotomy, the additional procedure and its associated costs should be clearly discussed and accounted for in advance.
