By Adjadé Ganiou, Ephraim Lonté KINTOSSOU, El Fadli Mohammed, Rhizlane Belbaraka. Department of Medical Oncology, CHU Mohammed VI, Cadi Ayyad University, Marrakech, Morocco.

Through this story, we present the reality of doctors in sub-Saharan Africa and Benin in particular. They face difficulties in accessing quality training. Benin, like many other African countries, does not have medical specialists in oncology. Those who decide to fill this void by going on training abroad unfortunately do not have the support of their government. The onset of the COVID-19 pandemic has made this adaptation in a foreign land even more difficult.

Preamble

In a lifetime, living abroad can be a life-changing experience. Anyone who has lived outside their country knows that it was a memorable experience [1].

The choice of medical oncology as a medical speciality, for us Benin doctors, is motivated by the fact that there are no oncology specialists in Benin in the face of an upsurge in cancer cases in the country. In this perspective, Morocco, through the Moroccan Agency for International Cooperation (AMCI), is one of the best African countries granting the opportunity of training leading to a diploma, free of charge, to sub-Saharan doctors in particular.

An opportunity which however brings us to live far from our family, to learn another language, and to adapt to another culture. One of the peculiarities here is that as Beninese doctors we, unfortunately, have to live without financial and material support of our government.

Medical oncology training

The training in Medical Oncology in Marrakech in Morocco takes place at the Oncology and Hematology Center of CHU MOHAMMED VI of Cadi Ayyad University over a period of four years. It closely associates scientific research and clinical practice through the diagnosis of cancers and oncological emergencies, their management, and the monitoring of patients.

This is sustained training for which foreign doctors are not yet remunerated. We are therefore subject to hospital stress, culture shock with the language barrier, and for the most part to psychosocial and economic difficulties.

However, being in contact with another culture has allowed us to have a much clearer idea of ​​ourselves, to adapt to different unusual situations, and to increase our faculty of observation and spirit of openness [1]. This difficult experience is all the more interesting as it demands a better professional performance. As a result, insufficient resources at work, poor management of the workplace, and difficulties in reconciling work and life at home appear to be causes of poor health for doctors with a major psychological impact which justifies the difficulties of some doctors working abroad [2].

On the occurrence of COVID-19

The arrival of coronavirus disease (COVID-19) added to this special context. A pandemic caused by SARS-COV2, one of the main pathogens that primarily targets the human respiratory system, coronavirus infections are known to cause illnesses ranging from the common cold to severe acute respiratory syndrome (SARS) [3]. In a short time it became of great concern for global public health by its lethal potential. Transmission is primarily human-to-human through direct contact or through droplets spread by coughing or sneezing from an infected individual with an incubation period of 2 to 14 days [4].

Various drastic measures have been implemented including the ban on public gatherings and social isolation.

The psychological effects of isolation, already described in the literature, have grown considerably with this pandemic [1].

Health workers are the main actors in contact with infected patients; thus, they are at high risk of becoming infected.

As a doctor, we were strongly urged to raise awareness and above all to continue the monitoring and management of cancer patients. The latter receiving immunosuppressive therapy are particularly at risk of contracting the disease and therefore have a poor prognosis.

The confinement thus decreed, the fear of being contaminated especially for us, health workers, the fact of being far from our families who are unfortunately exposed, social tension and the collapse of the world economy are all factors to integrate and quickly be able to manage in order to meet the requirements of our training.

Conclusion

Living abroad, whether, in the Maghreb, the West, or elsewhere, the realities are often the same. To meet the health needs of their country, sub-Saharan doctors often have to be trained in countries with more resources. Depending on the country of origin, they have different statuses depending on whether or not they have the support of the government of their country. Therefore, in addition to the psycho-social and financial impact, cultural adaptation is necessary. All the more so in this period of the COVID 19 pandemic where special arrangements are being made with new treatment recommendations and where we must combine protective measures, prudence in the administration of care, and the continuation of our training.

As a solution, we propose to the various governments that send their nationals to continue their training abroad, the provision of an aid fund. Psychological support through a listening cell should be provided – mutual aid which can also be duplicated by the health facilities in which the doctors evolve. These doctors, who are always available for the sick and their families, sometimes struggle to externalize their feelings for various reasons, a situation which has been accentuated with this pandemic. The figures indicating burnout of 28% of Spanish residents give evidence to this, among other things, with the main reason being the lack of balance between personal life and work. [5]

References:

1.Moriarty R. Travailler à l’étranger a changé ma vie ! courrierinternational.com. Forbes - New York. 2019.

2. Granek L, Buchman S. Improving physician well-being: lessons from palliative care CMAJ. 2019 Apr 8; 191(14): E380–E381.

3. Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Knowledge and Perceptions of COVID-19 Among Health Care Workers: Cross-Sectional Study. JMIR Public Health Surveill. 2020;6(2):e19160. Published 2020 Apr 30.

4. Backer J, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Euro Surveill. 2020;25(5).

5. Jiménez-Labaig P, Pacheco-Barcia V, Cebrià A, Gálvez F, Obispo B, Páez D, Quílez A, Quintanar T, Ramchandani A, Remon J, Rogado J, Sánchez DA, Sánchez-Cánovas M, Sanz-García E, Sesma A, Tarazona N, Cotés A, González E, Bosch-Barrera J, Fernández A, Felip E, Vera R, Rodríguez-Lescure Á, Élez E. Identifier et prévenir l'épuisement professionnel chez les jeunes oncologues, un défi écrasant à l'ère du COVID-19 : une étude de la Société espagnole d'oncologie médicale (SEOM). ESMO ouvert. 2021 août;6(4):100215. doi : 10.1016/j.esmoop.2021.100215. Publication en ligne le 26 juillet 2021.PMID : 34325108 Article PMC gratuit.