Traumatic Brain Injury in Latin America

By Juan Carlos Arango Lasprilla, PhD and Melina Longoni Di Giusto, MD

In contrast to the US and Canada, no national records exist on the incidence of traumatic brain injury (TBI) in Latin American countries. Public health TBI studies based in Mexico, Ecuador, Argentina, and Brazil have provided an opportunity to understand the incidence in Latin America^1-4. For every 100,000 individuals, roughly 70-360 new individuals sustain a TBI with most occurring due to road-traffic accidents as well as violence^5-8. Trauma-related deaths in Latin America are estimated to be 75.5 per 100,000 people⁶.

Many Latin-American countries experience a number of risk factors that exacerbate the increasing mortality rate, such as under-staffed and under-resourced health systems, lack of preventative measures, socioeconomic disadvantage, and residing in areas plagued with sociopolitical conflicts. Poor health care systems result in disparate access to hospitals due to the lack of regionalization, which causes an unequal distribution of patients across the available hospitals⁹. An emergency transport system is not well organized, which results in delays in receipt of needed care. In contrast to the US, where air transport is the norm for the most severe trauma cases, most Latin American countries rely on land transport causing significant delays. Under-staffed and under-resourced hospitals may not have sufficient beds available in their intensive care units (ICU), enough qualified medical personnel and specialists (e.g., neurosurgeons) to provide the highest level of care, and financial resources to provide needed treatments or use the latest diagnostic tool or intervention technologies. Similar to the US, urban settings have greater access to staff and resources, while suburban and rural areas experience significant disparities to healthcare and access to care. Without long-term care follow-up or specialty neurotrauma care, the risk for severe disability and increasing costs to all involved – the person with TBI, the family, the healthcare system, and the society as a whole¹⁰.

Universal public healthcare is nearly nonexistent in most Latin-American countries. Countries that are working towards universal healthcare, include but are not limited to Argentina, Colombia, Brazil, and Mexico, but often do not have the needed financial protections to keep medical bills low¹¹. Panama has one of the highest levels of healthcare coverage with 85% coverage. One of the challenges is that each country decides on how they will work towards universal healthcare coverage. The reality is that a high percentage of people are without healthcare coverage in Latin America. Places like Bolivia (35%), Paraguay (46%), Argentina (48%), and Uruguay (53%) have the lowest coverage within a public healthcare system. As one can imagine, economically disadvantaged individuals within these countries are at the lowest likelihood of receiving rehabilitation¹². Not until recently have physical medicine and rehabilitation physicians (physiatrists) been incorporated into select hospitals in a few Latin American countries.

With significant cognitive, behavioral, emotional, and physical changes following TBI, rehabilitation services are scarce and result in a major financial burden for family members. Since there are limited rehabilitation hospitals specialized for brain injury, the vast majority of patients return home to be cared for by their loved ones. Family is an important value of the Latin American culture, and families assume responsibility for the care and well-being of their loved one with TBI. Caregivers assume a significant burden due to the lack of financial resources and social supports¹³. Access to health information and support from their community or healthcare professionals are highly-rated family health needs mentioned by caregivers^14-16. Brain injury professionals must collectively advocate for improved TBI prevention and care in Latin America and across the globe. Below we provide examples of four core areas to implement strategies to improve TBI care and outcomes in Latin American countries that could also serve as a guide to better support individuals of Latin American descent around the world:

• Improve TBI prevention and early intervention through legislation of public health measures (e.g., helmets and seatbelts) and workplace safety, finance the improvement and maintenance of road infrastructures, expand pre-hospital services (e.g., ambulance services), and strengthen neurotrauma care and personnel (e.g., CT scanners and neurosurgeons).
• Improve in-hospital and follow-up TBI care through an increase in the rehabilitation workforce (e.g., physiatrists, psychologists, occupational therapists, physical therapists, and speech and language pathologists), develop more specialized inpatient/outpatient rehabilitation services, and create national trauma registries.
• Build workforce development within the neurotrauma and neurorehabilitation professional community to share best practices, offer quality brain injury training, and develop specialized post-graduate and continuing education programs.
• Guide and advance the field on the development, testing, and research of culturally appropriate and culturally relevant assessments, tools, and interventions for use by Latin American individuals with brain injury.

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