ecancermedicalscience

Special Issue

Building workforce capacity for the surgical management of cervical cancer in a fragile, low-income African nation—Democratic Republic of the Congo

13 May 2021
Michael L Hicks, Alex Mutombo, Tankoy Gombo YouYou, Mukanya Mpalata Anaclet, Mulumba Kapuku Sylvain, Kabongo Mukuta Mathieu, Ronda Henry-Tillman, Dorothy Lombe, Maya M Hicks, Leeya Pinder, Louis Kanda, Mirielle Kanda, Groesbeck P Parham

Objectives: Surgery is a cornerstone of the management of cervical cancer. Women diagnosed with cervical cancer in sub-Saharan Africa have very little access to specialised (gynaecologic oncology) surgical services. We describe our experiences and challenges of training local general gynaecologists to surgically treat early stage invasive cervical cancer at a private sector healthcare facility in a fragile, low-income African nation.

Methods: Implementation of the training curriculum began with assigned self-directed learning. It continued with on-site training which consisted of preoperative surgical video reviews, pre- and intra-operative assessment of disease status, deconstruction of the designated surgical procedure into its critical subcomponents and trainees orally communicating the steps of the surgical procedure with the master trainers. High-volume repetition of a single surgical procedure over a short time interval, intra-operative bedside mentoring, post-operative case review and mental narration were critical to the process of surgical skills transfer.

Results: Nineteen radical abdominal hysterectomies were successfully performed over four training visits; trainees were able to perform the procedure alone after eight cases; surgical complications decreased over time. The trainees have continued to perform the surgical procedures independently.

Conclusion: Life-saving surgical capacity for the treatment of cervical cancer has been established and sustained at a private sector healthcare facility in a fragile, low-income African setting, through an innovative model of surgical training.

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