Training for surgery in sub-Saharan Africa

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Published: 17 Nov 2017
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Dr Mohamed Jalloh - Hôpital Général de Grand Yoff /IFRU-SF, Dakar, Senegal

Dr Jalloh at AORTIC 2017 about surgery training for doctors in sub-Saharan Africa.

He describes how training is essential to delivering effective surgical outcomes, and that training on-site builds an effective team accustomed to their area of practice, compared to training in another facility where the team and resources available to a surgeon may not match their daily practice.

We’re going to talk about the training in surgery for cancer in sub-Saharan Africa. As you know, there are many modalities for treatment of cancer and one of the easiest or most effective treatment options when the indication is fine is surgery. Also that’s the modality that requires the least infrastructure. We have difficulty in accessing drugs when it comes to chemotherapy; radiation therapy is very expensive then surgery should be a very effective way of managing the patient and we need to be trained appropriately to do that surgery for the patient.

How does that training get out across the continent?

We have basically three ways of training people. The first one is during the residency programme, if the resident when they’re trained has to be a urologist they should also be trying to do surgery for urological cancer. But you will understand that the limitation of this modality is it depends on the training and did they have a fellowship, did they have the proper training in surgical oncology? So the resident may end up having the role in terms of equipment, in terms of skills that are learned, depending on the training, so this is number one. The second option is sending people away to do a fellowship, going to the US, going to Europe, going to any, or even within Africa in centres that have the facilities and the skills. But then we end up having a surgeon that is trained, that has the skill but when he comes back to his country he may face some difficulties with adjusting – the difficulty of having a team mate who wasn’t trained the same way he used to be trained or just not having the required equipment. As a consequence many fellows return to where they were trained and we have a brain drain and that is not effective. We thought that the best option, which is the third one, is to be trained on site. Even if initially the skill wasn’t available we can have experts, a team of experts, I’m talking about our experience, where you have the surgeon, nurses, anaesthetists etc., they come and, where possible, they come with equipment. The good thing is they’re going to train the surgeon in their natural environment, they’re going to train the nurses and all the required staff and they will have the support of the local authorities. That way they will leave the same team with the same patients with the same environment and they can organise follow-up. That way we can have a strong team.

Any other important points to mention?

Definitely we need to do, and that gives me the opportunity to talk about a collaboration that we have from our centre and other centres in the world, one of the most effective of them being with an NGO called IVUMED based in the US where we have the experience of these experts coming for a few years in different specialties, including surgical oncology, where we have the partnership that allows us to be trained in our centre but allows us also to have continuing medical education through renewed sessions but also through distant learning where we have a kind of telemedicine, not always formal, but where we share the medical records, we share the images and we discuss the indication. We have found that is very effective. That is effective not only for the surgeon training the specific centres but that can end up having hopes where other surgeons can come from other centres within the same country or from neighbouring countries to be trained and that fall into being trained in a very similar environment. So that’s something we need to do and that should be part of the national plans because that is, as I said earlier, a very effective way of controlling cancer if the patients are selected early enough and it would reduce the necessity of using drugs or any other treatment when they are not already available.