As identified in the Global Burden of Disease report (2012), spine disorders present an enormous burden on individuals, their families, communities and societies and are the leading cause of disability worldwide. In Botswana, the burden of low back pain has been estimated to be the 5th leading cause of disability adjusted life years (DALYS) in 2013 and neck and back pain combined is ranked as the number 1 cause of years lived with disability (YLDs), increasing from the third position in 1990 to the first position in 2013. In the developing world the burden of spine disorders is expected to be higher than in high income countries; there is a critical lack of access to patient-centred, evidence based spine care in low income countries due to poor prioritization and integration of spine services and lack of available trained health workforce to manage these conditions.
Visionary leadership and reaching out globally to like-minded volunteers led to development of an innovative, patient-centred, model of spine care in collaboration with the government in Botswana; integrating spine services across primary care settings (within the Shoshong community health centre), in secondary care level with the local district hospital in Mahalapye for advanced testing and treatment as needed, and collaboration at the tertiary care level with spine surgical services in Gaborone; active and ongoing engagement of patients, community and all health team members in program design, delivery and evaluation; partnerships with local community, government and academic institutions support long-term sustainability.
