The subject of this paper is very relevant to the practice of neurosurgery in Canada.Reference Bougardis, Rome, Perera and Ebinu ¹ The Canadian landscape is both vast and variable, with differing geographical and populational needs. Like the Canadian landscape, the practice of neurosurgery is both variable and challenging, with patients having different needs depending on the acuity of their condition. Neurosurgical treatment ranges from the very acute to the very elective. Treating these conditions in a country with a large land mass, treacherous weather conditions and both densely and sparsely populated regions is challenging.

In my opinion, this paper highlights two major challenges: cultural sensitivity and the difficulty in treating patients who live in remote locations. Cultural safety training, especially for the care of Indigenous people, is a must. This goes without saying. Patients living in remote areas who live very far away from the nearest hospital are invariably going to have delays in accessing treatment. The advent of telehealth and virtual consultations has helped to bridge this gap; however, these patients will still have to travel if an examination is needed and certainly, if surgery is required to treat life-threatening conditions. There is no getting around delays in urgent treatment for patients in remote communities. We simply cannot place a neurosurgeon at every local hospital to facilitate treatment for these patients. This is both a resource and volume issue. A hospital that will be able to uphold a neurosurgery service needs a fair number of resources, and this is not possible at every local hospital. This paper does a good job of describing the challenges of providing neurosurgery care in Canada without outright saying that the geographical challenges are unavoidable. The inference is there, and I believe this to be true.

In most bigger cities, neurosurgery services are concentrated at one or two hospitals. This distribution of services still requires transfer, causing delays and increasing the costs of healthcare. In remote and rural communities, there is an awareness and acceptance of the delays in treatment that come with the need for transfer of patients. It doesn’t make it any easier. When I accept a patient with a life-threatening condition that needs transfer from a remote community, I stand by waiting and hoping that they are still alive by the time they arrive. This is the reality of neurosurgery practice in Canada and will not change anytime soon.