OPINION: More capacity building needed in the surgery ecosystem in Africa


OPINION: More capacity building needed in the surgery ecosystem in Africa
(FROM LEFT) Tifsehet Lema from CURE Hospital Ethiopia, Lillian Wanjugu from AIC Cure- Kijabe, Kenya and Mary Nampawu from CoRSU Hospital, Uganda hold a practical session following training from The American Hearts Association (AHA) in Nigeria. Smile Train is certified by American Heart Association as an international training Centre for BLS (Basic Life Support) and PALS (Pediatric Advanced Life Support) for partner hospitals in Africa. PHOTO| COURTESY

By Dr. Esther Njoroge

… Today, as the world commemorates World Anesthesia Day, we hope deliberations from the 7th All Africa Anesthesia Congress in Morocco will yield progressive results on the ground in order to live up to our commitment of leaving no-one behind.

Passy, a 7-year-old girl from Goma in the Democratic Republic of Congo, lies unconscious on the operating table at CBCA Bethesda Hospital in Goma, ready to have her cleft palate treated for free, courtesy of Smile Train.

Haggai Musinene, the anesthetist in the room monitors Passy’s breathing, intensely switching his eyes between the screen and Passy’s chest before Dr. Obady Vitswamba, the lead surgeon could touch her.

It’s Haggai’s green light to Dr. Obady that gets things going. 45 minutes later, Dr. Obady lays his instruments down and Haggai patiently monitors Passy as the anesthesia wears off.

Passy, groggy from the medication is whining, but Haggai calms her down as he ensures she’s out of danger before the nurses could care for her a little longer.

Last mile patients like Passy and many others in Africa are not able to access quality surgeries due to the astronomical cost of surgery, lack of infrastructure for safe postoperative care, and emergency resuscitation expertise and supplies.

Deficiencies in these essential areas can increase the risk of complications for patients and this builds on the cost of care, pushing families needing surgical care further into financial hardship.

In addition to empowering local providers like Haggai with education and training opportunities, Smile Train mandates adherence to safety and quality measures including WHO-WFSA International Standards for Safe Surgery and Anesthesia.

Smile Train administers an annual self-certification audit to its international network of more than 1,100 partner hospitals requiring compliance with these standards. In 2019, Smile Train carried out a mandatory self-certification audit to 348 active partner hospitals across 34 African countries.

The audit included questions on partner adherence to Smile Train’s safety and quality standards for medical personnel, OR equipment, surgical and postoperative environment, and high dependency care provisions.

Out of these, 284 hospitals completed self-certification audit, a response rate of 82%. 29 hospitals (10%) lacked access to ECG machines and 70 of them (25%) lacked access to defibrillators. 13 of these hospitals (5%) did not have a PACU, and 34 (12%) did not have crash carts accessible outside of the operating room.

The results from this self-certification audit yielded important insights into programmatic needs of Smile Train partner hospitals in Africa. The self-certification audit is a valuable monitoring tool by which partner hospitals can review their clinical practice and through partnership with organizations like Smile Train, can address areas in need of improvement ensuring safe, high-quality care for their communities.

To this end, Smile Train has provided Pediatric Advanced Life Support training to 78 anesthesia providers from Smile Train partner hospitals in Kenya, Uganda and Nigeria.

In 2019, we plan to train providers from Ethiopia, Zambia, Tanzania, Somalia, Senegal, Nigeria, Madagascar, Mozambique, DR Congo, Kenya and Cameroun.

I recently attended the 7th All Africa Anesthesia Congress in Marrakesh, Morocco, which is the biggest gathering of anesthetists and related fields in the continent, focused on safe anesthesia for Africa.

One of the key findings was that there is great need to support local doctors both in expertise and financially to carry out safe surgeries.

The capacity for hospitals across Africa needs investment support from the government through the Health Ministries. We continue to lobby for training of local professionals in the cleft care ecosystem as part of achieving Universal Health Coverage.

This is not just a Smile Train responsibility, but a round-table discussion between the government, donor agencies and hospital management. Today, as the world commemorates World Anesthesia Day, we hope deliberations from the 7th All Africa Anesthesia Congress will yield progressive results on the ground in order to live up to our commitment of leaving no-one behind.

Dr. Esther Njoroge is the Vice-President at Smile Train Africa.

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