Canadian explains MIS procedure
CANADIAN paediatric surgeon Dr Georges Azzie drew attention to the importance of contextualisation in the implementation and teaching of minimal invasive surgery (MIS) in sub-Saharan Africa, on Tuesday.
He was speaking during his lecture to medical practitioners at the Health Resource Centre in East London. Azzie was welcomed as guest lecturer at the annual Eyabantwana for the Children Trust lecture.
MIS or laparoscopic surgery, is a modern surgical technique where operations are performed far from their location, through small incisions elsewhere in the body. The removal of the gallbladder and appendix were commonly conducted using MIS today, although many other operations use this method which reduces pain, shortens hospital stays and produces more favourable cosmetic results.
“I have seen too many thoughtful programmes get funded, instituted and die an unceremonious death due to a lack of understanding of context. Africa is commonly on the receiving end of advances [developed elsewhere]. The US are dishing out what Africa does not necessarily want,” Azzie said. He shared that 234 million major operations were taking place worldwide each year. The wealthiest one-third of the world, benefits from 75% of these operations, while the poorest third receives 3%. Billions of people lack access to surgery.
“If people don’t help one another, someone might drive the move to MIS for you.”
He added that in low to middle income countries, it was commonly the military, mercenaries, missionaries, etc. who brought skills to the country.
“Are these the people you want dictating your fate? No! But if you don’t take the bull by its horns, it will happen.”
Azzie used various methods of teaching this surgical procedure in Botswana and after only achieving a two out of 10 pass rate on the “fundamentals of laparoscopic surgery” course, sought a better contextualised solution. In the case of Gabarone, it was telesimulation that ultimately achieved a 100% pass rate and resulted in local surgeons “owning” the programme without imposing procedures from other countries.
Before authorising the use of laparoscopic surgery, Azzie recommends the need to be defined and assessed in conjunction with local stakeholders. The potential for sustainability must also be taken into account.
“There is an incredible scope for MIS in Africa, but people have to decide on finances. Will there be ongoing support, maintenance of equipment and training to continue?”
He said the greatest barrier to implementation was often a lack of open-mindedness.
“I have learned that many of my early convictions have now become controversies. Don’t be convinced by anything, but constantly be re-assessing what is best,” advised Azzie.