The American College of Surgeons (ACS) has partnered with the College of Surgeons of East, Central and South Africa (COSECSA) to create a novel and intriguing model for international surgical training. In brief, this will involve American attendings and residents committing to monthly blocks in Hawassa so that an entire year is covered. Details are below.
In addition to what I learned during my visit to Hawassa, much of the information below was gained by speaking to Dr. Girma Teferra, a vascular surgeon and professor at University of Wisconsin who spearheaded the development of the ACS-COSECSA training hub at Hawassa. He also serves as Chairman of the Board for Ethio-American Doctors Group
The ACS has an office called “Operation Giving Back” created 12 years ago to to provide materials and advice for volunteer humanitarian fellows of the college. Most of the work is identifying and supporting volunteers. They have partner organizations across the US that need surgeons, and the office matches surgeons with them. Since 2015 Dr Girma has been the medical director for this office.
The idea for the ACS-COSECSA training hub at Hawassa came from a realization that programs such as Health Volunteers Oversees (HVO), though committed to teaching, have a hard time maintaining continuity at a single site that would allow for more impactful training. The ACGME already has a template for an accredited international rotation, and US training programs were staring to express an interest in such rotations.
Thus the template of a program, focussed at a single site, was born. The idea is for at least twelve US based programs to commit to one month each, and thus covering a whole year. Residents from those programs would rotate monthly through the site, as one of their accredited rotations. Teaching staff from their institutions would accompany them, and can choose to also spend four weeks or split it into two weeks with another staff member.
Hawassa was decided after a selection process. The initial geography was decided to be Eastern Africa. Surveys were sent to 31 sites, after which three were short listed. Following site visits, Hawassa emerged as the first choice. In part, this was because it was the only referral hospital for a population of 20 million. The leadership (president, dean, president of medical college) as well as the fourteen interested US institutions came to Chicago to formulate a plan.
For the initial six months, from January to June 2018, these fourteen programs are sending members to Hawassa in two week blocks as “reconnaissance”. In July they will meet to assess their findings, and the interested programs will continue in monthly blocks thereafter.
While at Hawassa University hospital, I met with Robyn Richards, the current American surgeon at Hawassa and a surgical trauma-critical care specialist. She works at Texas Tech, in Lubbock. She trained at GW in Washington DC and had rotated through Inova Fairfax Hospital, so we knew people in common. She had also spent 5 years working in South Africa, so has experience working in lower resource settings. Overall, she felt that surgery experience has been very positive.
I also met with the chief of surgery Dr Samuel. He also quickly agreed the program has been very beneficial, particularly in exposing Hawassa surgical residents and staff to subspeciality techniques. I asked him what has been his greatest challenges with the program thus far. He mentioned two things. One has been that in the current arrangement US staff are not available at night, when the majority of general surgeries procedures are performed. Second has been transportation from hotel to hospital. This has been problematic of late as the available hospital cars are not functioning. If an American surgeon is alone, he will not let them travel in town by themselves due to an abundance of safety concern – so they have to get a ride with a doctor. This may be resolved as the hospital cars return from repairs.
This program has great promise and, if successful, would be a fantastic template for other surgical specialties including orthopedic surgery.
posted by Felasfa Wodajo
Ethiopian Diaspora Surgery Network 