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Basic surgical skills in Rwanda

After working with surgeons in Palestine to establish a foundation training course, the College is backing a similar scheme in Rwanda

BSS Rwanda

“Once a month, everyone in the country, including the president, is encouraged to take part in community rebuilding projects such as painting schools or repairing roads. It’s part of the vision to rebuild the country following the genocide 21 years ago,” says David Sedgwick FRCSEd, about Rwanda’s ‘Umuganda Day’. Similarities could be drawn between this approach to improving the country’s infrastructure and his own work in Rwanda aimed at the next generation of surgeons.

Mr Sedgwick has been a basic surgical skills (BSS) instructor with the College for 20 years, and for the last 14 years has been a course convenor. He has a long-standing interest in teaching surgical skills and trauma care, and has taught on courses in Hong Kong and Mumbai. He was convenor of the team of six UK surgeons running BSS in East Jerusalem’s Augusta Victoria Hospital over the past four years, which was attended by Palestinian surgical trainees from Gaza, the West Bank and East Jerusalem.

It was while visiting Rwanda to teach on a trauma care course that Mr Sedgwick took the BSS proposal to Dr Ntakiyiruta Georges, head of the Department of Surgery at the University of Rwanda. Two previous courses had been run by Mr Robert Lane FRCSEd and colleagues, which provided the foundation for the BSS courses.

In supporting such work, the College’s aim is to build capacity in national healthcare systems in low- and middle-income countries. Therefore, the BSS courses are run with an ‘exit plan’ for RCSEd involvement to be gradually scaled back until courses are run entirely by local surgeons. Rwanda has a severe shortage of surgeons: there are fewer than 60 for a population of almost 12 million surgeons. Thereafter, the college continues to ‘badge’ the course and visit regularly to see how it has developed.

As an example, Mr Sedgwick highlights the BSS in Palestine, which was officially handed over to a local faculty last year, having launched in 2011. “The last course in East Jerusalem was taught 100% by Palestinians. And it was very exciting to witness that. The plan is to go back there in a mentoring capacity and, eventually, maybe once a year we will go over to credential the course in the same way that we do in Hong Kong, Bali and Malaysia.”

Reaching that milestone, when a course is finally handed over to local staff, very much depends on the starting point. Mr Sedgwick explains: “When we began in Palestine, there was no course and no trainers. It’s taken us five years to get to the point where the Palestinians could ‘fly solo’.

“Now the Basic Surgical Skills Course is about to become mandatory for surgical trainees in the Palestinian Medical Council’s curriculum. That’s really important because they’re going to need to run at least three courses a year. Clearly, we can’t run three courses a year from the UK, but what we can do is visit once a year for an update on how things are progressing.”

Mr Sedgwick has made a huge personal commitment to the Rwandan venture, lobbying the Scottish Government for support and even raising funds from his local Burns and Rotary clubs. However, with the backing of the College, the course can be officially badged by a recognised professional education body with a strong reputation in the international surgical community.

The College has also provided funding via the Binks Trust – which was specifically endowed to the RCSEd for surgical training in Africa – with additional support from the College’s International School of Surgery.

Dr Georges explains the reasoning behind working with international partners such as the RCSEd: “Lack of funding and availability of local trainers can make it difficult to deliver courses, but collaboration with international faculty and partners can strengthen local capacity to do so. Of course, the added benefit is that trainees are taught by certified instructors on an already established, high-standard course.”

Rwanda has a severe shortage of surgeons: there are fewer than 60 for a population of almost 12 million. Most work at the teaching hospitals in Kigali and Huye, which can be overwhelmed by surgical emergencies, leaving little time for elective surgery.

The first College-badged BSS in Rwanda took place in October 2014, with the second course due to be held in October 2015 when 20 first-year surgical trainees will attend. However, as Dr Georges explains, the demand for basic skills courses extends beyond core surgery trainees: “Trainees in ENT, and obstetrics and gynaecology would also benefit from the course. Plus, medical officers at district hospitals perform most of the surgery – mainly Caesarean sections – which will have many unnecessary complications due to a lack of basic surgical training. Teaching BSS to GPs would increase the access to essential surgery.”

All partners involved in delivering the course are under no illusions about the scale of the challenge to improve Rwanda’s surgical capacity, but increased access to basic surgical skills represents a step in the right direction.

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