A Surgical “college without walls”

February 14, 2019
Líbhan Collins, Key Correspondent for the Irish Forum for Global Health


The second day of the Irish Forum for Global Health Exchange Conference boasted speakers from a wide variety of organisations. One particular focus was on on partnerships and interdisciplinary actions in the broad field of work that is global health. One such partnership is the College of Surgeons, East, Central and Southern Africa (COSECSA) and the RCSI.

Opening the presentation, RCSI’s Deirdre Mangoang stressed the importance of surgical training and the impact of an unskilled health workforce. She shared a picture of Salome Karwah, a Liberian nurse and Time magazine’s person of year in 2014 for her efforts treating patients with Ebola. In 2017, this skilled and respected nurse died from post-operative complications following a cesarean section. As highlighted by the speaker, this surgical procedure is a relatively common and should not result in death, yet this is likely not an isolated case. Globally, five billion people have limited access to safe or sterile surgery due to financial barriers or lack of availability. Largely, it is low to middle income countries facing lack of trained surgeons. On top of this, many operations carried out in under-developed areas are done by non-physicians.

With COSECSA and RCSI working together since 2007, sufficient support was possible so that, in this particular case, the surgical team in Lusaka felt confident to undertake the major surgery after eight months of preparation. After successful surgery the general surgeon who worked on the twins, Dr. Zulu, spoke to The Irish Times, proudly stating, “This is our landing on the moon.” Yet still there are only 4 surgeons in Zambia specialising in pediatrics.

COSECSA is a non-profit organisation receiving guidance from the RCSI and supported by funding from Irish Aid. This programme trains surgeons in partnership with RCSI, and academic online learning is paired with onsite clinical training. Currently there are 600 surgeons being trained in African Countries. ‘College without walls’ refers to surgeons being trained in the field rather than stationed in a college or university. The partnership allows graduates to stay in their home country or within Africa contributing to economic growth and to improvements in health outcomes. This results, for example, with conjoined twins being able to stay in Zambia for surgery. In February 2018 this was a major landmark for medicine in Zambia. Omphalopagus twins, with joined liver and intestine, were surgically separated in the University Teaching Hospital of Lusaka. Training surgeons in the country meant the family didn’t have to travel or seek foreign assistance.

Global surgery is an emerging area in health with room for growth. RCSI recently established an institute for global surgery to further training, research, and advocacy with the desire to increase their contribution to improving health outcomes in low and middle income countries. This partnership paves the way for a long term, stable health system where all kinds of surgeries can take place by skilled and trained professionals in a suitable environment. Together, COSECSA and RCSI are not just giving aid to African countries. They are helping to establish a self-sufficient culture of highly-skilled and competent surgeons to reduce mortality rates and increase life expectancy.

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