Journal Article

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Intestinal Volvulus at St Francis Hospital, Kampala
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2001) Kakande, I; Ekwaro, L.; Obote, W. W.; Nassali, G.; Kyamanywa, Patrick
A review of sixty patients with intestinal volvulus was undertaken at St Francis Hospital, Nsambya, Kampala. Forty three (71.7%) of the patients presented with sigmoid volvulus while 12 (20°0) had ileosigmoid knotting. There were 53 males and seven females. The ages of sigmoid volvulus patients ranged between 20- 87 years while for ileosigmoid knotting the range was 22-75 years with a mean of 41 years. The majority (53.5%) of the patients belonged to the Ganda tribe and were of low socialeconomic class. Resection and primary anastomosis was performed in 24 (560/0) of the 43 patients who presented with sigmoid volvulus. Two patients died following resection and primary anastomosis but both cases had presented with gangrenous bowel. Only one of the 12 patients with ileosigmoid knotting died. Resection and primary anastomosis is a generally safe procedure in the management of sigmoid volvulus. However, it should be avoided in cases of gangrenous sigmoid volvulus.
Anaesthesia for Elective Inguinal Hernia Repair in Rural Ghana - Appeal for Local Anaesthesia in Resource-poor Countries
(SAGE PUBLICATIONS INC , 2455 TELLER RD, THOUSAND OAKS, USA, CA, 91320, 2006-07-01) Wilhelm, T.J.; Anemana, S.; Kyamanywa, Patrick; Rennie, J.; Post, S.; Freudenberg, S.
Local anaesthesia has been identified as the most favourable anaesthesia for elective inguinal hernia repair with respect to complication rate, cost-effectiveness, and overall patient satisfaction. Operation theatre notes in all seven hospitals in the Northern Region in Ghana over the period of 1 year were reviewed. Only 22.4% out of 1038 repairs were performed under local anaesthesia while predominantly spinal and general anaesthesia were used (48.0 and 29.6%, respectively). African surgeons chose local anaesthesia far less frequently than visiting overseas surgeons (15.6 versus 27.7%, respectively). All surgeons in resource-poor countries should be encouraged to use local anaesthesia more frequently for elective inguinal hernia repair. Valuable resources in sub-Saharan African hospitals could be saved, especially if used in combination with outpatient surgery. The technique should be taught in teaching institutions. A simple step-by-step technique is described.
Sterilized Mosquito Net Versus Commercial Mesh for Hernia Repair: An Experimental Study in Goats in Mbarara/Uganda
(KARGER , ALLSCHWILERSTRASSE 10, BASEL, SWITZERLAND, CH-4009, 2007-08) Wilhelm, T.J.; Freudenberg, S.; Jonas, E.; Grobholz, R.; Post, S.; Kyamanywa, Patrick
Background: In industrialized countries alloplastic meshes are routinely used for hernia repair. However, in developing countries they are rarely available or affordable. This study compares textile properties and tissue response of commercial polypropylene mesh (PM) vs. sterilized nylon mosquito net (MN). Methods: Textile properties were examined in vitro. In 12 goats one MN and one PM (5.5 ! 8 cm) were implanted onto the posterior layer of the rectus sheath. Wound healing was clinically assessed. Histology was assessed after 4 or 16 weeks. Results: MN was thinner and lighter, but weaker than PM. All wounds healed without complications. After 16 weeks foreign body granulomas in the MN group contained a higher proportion of inflammatory tissue (32.7 vs. 22.1%) and more giant cells (3.1 vs. 1.7/10 granulomas) with a significantly lower partial volume of foreign body (23.2 vs. 36.9%). Partial volume of fibrotic tissue was similar. MN was 1,000-fold cheaper than PM. Conclusions: PM was superior concerning strength and extent of inflammatory response. However, the findings indicate that MN might serve as a cheap substitute if an alloplastic mesh is needed but no commercial one is available or affordable. Further studies are justified which should include mosquito nets of different materials and long-term outcome.
Using CanMEDS to Guide International Health Electives: An Enriching Experience in Uganda Defined for a Canadian Surgery Resident
(CMA-CANADIAN MEDICAL ASSOC, 2008) Goecke, E Michelle; Kanashiro, Jeanie; Kyamanywa, Patrick; Hollaar, L Gwendolyn
Background: Surgery residents who wish to travel during their residency will often seek an elective experience in a low- or middle-income country. Objectives for international health electives (IHEs) are often vague and poorly defined. Further, feedback to, and evaluation of, the resident after the IHE are often not specific because international preceptors are not familiar with the desired educational outcomes of Canadian residency programs. Residents who choose an elective in a low-income country usually anticipate that they will contribute some medical service to an existing impoverished health care system, and in this setting, they hope to gain exposure to a high operative volume with potentially fewer institutional and administrative obstacles. Methods: In this paper, we describe one resident’s elective experience in Mbarara, Uganda. In addition to her clinical experience, the resident performed a retrospective audit of surgical admissions. After her elective, we asked the resident to reflect on her experience and to use the Canadian Medical Education Directives for Specialists (CanMEDS) framework to describe the challenges she encountered and to define the learning outcomes gained with respect to each CanMEDS role. Results: We discovered that the resident had a rich and insightful educational experience when discussed in this context. As a result, we have created a guide for structuring postgraduate IHEs around the CanMEDS roles, using them to ask pre- and postelective questions to develop relevant and practicalIHE objectives. Conclusion: We propose that this guide has the potential to improve both resident preparation before international experience and also subsequent evaluation of resident performance in this ill-defined area. More important, we found that IHEs are a useful vehicle to evaluate resident achievement of the CanMEDS competencies in a way that is reflective, realistic and representative of the multiple challenges involved when working in international health.
A Comparison of Kampala Trauma Score II with the New Injury Severity Score in Mbarara University Teaching Hospital in Uganda
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2010-03) Mutooro, S.M.; Mutakooha, E.; Kyamanywa, Patrick
Background: Road traffic injury is of growing public health importance because of its significant contribution to the global disease burden. The need to predict outcome of injuries has led to the development of injury scores. The Kampala Trauma Score II (KTSII) now recommended for use in resource-poor settings, has not been compared with, the New Injury Severity Score (NISS) preferred by many authors. We compared the performance, predictive power, sensitivity, and specificity in predicting mortality at two weeks of the KTSII and NISS in patients involved in road traffic accidents seen on the surgical ward at Mbarara Regional Referral Hospital (MRRH). Methods: This prospective study conducted between June 2005 and August 2006, examined clinical and radiological data of 173 consecutive patients admitted to the emergency surgical ward at Mbarara Regional Referral Hospital with road traffic injuries. Only patients presenting within 24 hours of injury and with 3 or more injuries were recruited in the study. The KTS II and NISS scores were computed for each patient on admission. The primary outcome measure was survival. Receiver Operating Characteristics (ROC) analysis, and logistic regression analysis were used for comparison. Results: The KTSII predicted mortality and discharge with AUC of 0.87 (NISS, AUC 0.89). The KTSII was less accurate (AUC 0.65) than the NISS (AUC 0.83) in predicting long stay in the hospital. At cut off point of 9 and below, the KTSII had sensitivity of 87% and specificity of 81% while the NISS had 96% and 78.4% respectively in predicting mortality. The KTS II predicted long hospital stay at cut off score of 9 and below, with sensitivity of 87.5% and specificity of 81%. Conclusions: The KTSII is as reliable a predictive score as is the NISS. This study demonstrated that the KTS II provides reliable objective criterion upon which injured patients can be triaged in emergency care conditions. The KTS II may enhance the use of ambulance services and timely transfer of the injured and its use in trauma management should be further encouraged in resource-poor settings. In addition, the KTS II will make the documentation of the epidemiology of trauma more feasible in resource-poor settings.
Epidemiology of Injuries Presenting to the National Hospital in Kampala, Uganda: Implications for Research and Policy
(BMC , Campus, 4 Crinan St, London, England, N1 9XW, 2010-07-20) Hsia, Renee Y.; Ozgediz, Doruk; Mutto, Milton; Jayaraman, Sudha; Kyamanywa, Patrick; Kobusingye, Olive C.
Background Despite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality. Aim To estimate the epidemiology of the injury seen in patients presenting to the government hospital in Kampala, the capital city of Uganda. Methods A secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005. Results From 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance. Conclusions Road traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development.
Editorial Policy on Co-authorship of Articles from Low- and Middle-Income Countries
(Springer, 2011) Kushner, L. Adam; Kyamanywa, Patrick; Adisa, A Charles; Kibatala, Pascience; Mkandawire, Nyengo; Coleman, Peter; Kamara, B Thaim; Mock, N Charles; Hunter, John G
Global health and the support of surgical research, education, and clinical care in low- and middle-income countries (LMICs) are primary missions of the World Journal of Surgery. As surgery is increasingly recognized as a cost-effective and necessary component of public health [1] more researchers are directing their attention to the issue of surgical capacity, innovations, or conditions in LMICs. With academic and professional collaborations often transcending national borders, it is important to clearly address the issues of co-authorship and sharing the benefits of research. We feel it is inappropriate to publish scientific papers regarding conditions, capacity or innovations in LMICs without involving local scientists. In addition to potentially violating the local population’s trust, policy makers and government authorities in LMICs are more likely to accept and act on the results of research done in their countries if they know that local experts have been involved. To address these concerns, the World Journal of Surgery has decided to introduce a new policy regarding original research received using primary data from LMICs. The journal will now require that all such manuscripts include at least one local co-author. A local co-author is defined as a national of that country who is living and working in the home country. The editors understand that there may be extenuating circumstances in which this requirement cannot be met. In such cases, a cover letter should explain why a local co-author is not included.
Epidemiology of Child Injuries in Uganda: Challenges for Health Policy
(Page Press Publ, 2011-03-01) Hsia, Y Renee; Ozgediz, Doruk; Jayaraman, Sudha; Kyamanywa, Patrick; Mutto, Milton; Kobusingye, C Olive
Globally, 90%ofroad crash deaths occurin the developing world. Children in Africa bear the major part of this burden, with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala, Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. Data were collected when patients were seen initially and included patient condition, demographics, clinical variables, cause, severity, as measured by the Kampala trauma score, and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005, 872 injuryvisitsforchildren <18 years old were recorded. The mean age was 11 years (95% CI 10.9-11.6); 68% (95% CI 65-72%) were males; 64% were treated in casualty and discharged; 35% were admitted. The most common causes were traffic crashes (34%), falls (18%) and violence (15%). Most children (87%) were mildly injured; 1% severely injured. By two weeks, 6% of the patients admitted for injuries had died and, of these morbidities, 16% had severe injuries, 63% had moderate injuries and 21% had mild injuries. We concluded that, in Kampala,children bear a large burden of injury from preventable causes. Deaths in low severity patients highlight the need for improvements in facility based care. Further studies are necessary to capture overall child injury mortality and to measure chronic morbidity owing to sequelae of injuries.
Is HINARI Appropriate for Medical Students in the Developing World?
(John Wiley & Sons, Inc., 2011-12-30) Essen, Van Caleb; Cartledge, Peter; Kyamanywa, Patrick; Manirakiza, Achille
The Health InterNetwork Access to Research Initiative (HINARI), which arose in response to medical literature needs in developing countries, gives online access to scientific information to a variety of institutions throughout the world. This is a great resource; however, little research has been performed on the effectiveness and usefulness of HINARI, specifically to medical schools. Our study sought to find out whether the textbooks (e-books) available on HINARI could form a virtual library that would cover the curriculum of a medical school. After categorising and reviewing the medically relevant e-books on HINARI, we found that they were insufficient in providing adequate subject material relevant to medical school curricula from Rwanda, the United Kingdom and the United States. This literature gap could be closed by additional medical textbooks being made available from contributing publishers. An increase of only 14% in HINARI e-book resources would provide material for the entire medical school curriculum.
Augmenting surgical capacity in resource-limited settings
(Elsevier Science Inc, 2012) Deckelbaum, L Dan; Ntakiyiruta, Georges; Liberman, S Alexander; Razek, Tarek; Kyamanywa, Patrick
Deficiencies in access to surgical care in low-income and middle-income countries are well recognised. Despite the awareness and benchmarks generated by the Millennium Development Goals, 1 most sub-Saharan African nations have a negative annual growth rate in the number of physicians compared with their population growth rate. 2 In several sub-Saharan African nations, there are only 0·9 physicians per 1000 population, compared with 21 physicians per 1000 population in the UK and 28 per 1000 population in the USA. 3 These trends raise concerns about the morbidity, mortality, and disability-adjusted life-years lost due to injury and diseases requiring surgical treatment (including obstetrics) in sub-Saharan Africa. 4 Policy makers and health-care leaders in Rwanda, a nation with only 0·1 general surgeons per 100 000 population (compared with 6·4 per 100 000 in the USA), have recognised the substantial negative socioeconomic effect caused by such deficiencies and have committed themselves to tackling these challenges. 5 , 6 , 7
Knowledge, Attitudes, and Practices in Safe Motherhood Care Among Obstetric Providers in Bugesera, Rwanda
(Wiley, 2012) Puri, Ruchi; Rulisa, Stephen; Joharifard, Shahrzad; Wilkinson, Jeffrey; Kyamanywa, Patrick; Thielman, Nathan
Objective To determine the knowledge, attitudes, and practices of obstetric care providers (OCPs) in Bugesera District, Rwanda, crucial to the delivery of safe motherhood services. Methods A quantitative descriptive survey in Kinyarwanda targeting all OCPs in the district was implemented in November 2010 to determine demographic characteristics, safe motherhood knowledge, obstetric practices, and attitudes toward additional training. Results The study captured 87% of OCPs, of whom 137 of 168 (82%) were A2 level nurses. Most expressed a need to improve their knowledge (60.6%) and skills confidence (72.2%) in safe motherhood. The mean percentage of correct answers of 50 questions assessing overall knowledge was 46.4%; sections on normal labor (39.3% correct) and obstetric complications (37.1% correct) were the weakest. Fundal pressure during vaginal delivery was practiced by 60.8%, and only 15.9% of providers practiced active management of the third stage of labor for all deliveries. Providers supported additional training, and 89.3% expressed willingness to participate in a 2-day workshop even if it were their day off. Conclusion The study has identified a need to improve safe motherhood knowledge and practices of OCPs in the Bugesera District of Rwanda. OCPs support additional training as an intervention to reduce maternal mortality.
Can Focused Trauma Education Initiatives Reduce Mortality OR Improve Resource Utilization in A Low-Resource Setting?
(Academic Press Inc Elsevier Science , 525 B St, Ste 1900, San Diego, Usa, Ca, 92101-4495, 2013) Petroze, RT; Byiringiro, JC; Ntakiyiruta, G; Riviello, R; Briggs, SM; Razek, T; Deckelbaum, D; Sawyer, RG; Kyamanywa, Patrick; Calland, JF
Advanced Trauma Life Support (ATLS) teaches a systematic approach to the initial management of injured patients in over 60 countries. Limited data exists on the impact of ATLS or similar team-based courses on patient outcomes, particularly in low and middle-income countries (LMIC). We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization.
Emergency Obstetrics Knowledge and Practical Skills Retention Among Medical Students in Rwanda Following a Short Training Course
(WILEY , 111 RIVER ST, HOBOKEN, USA, NJ, 07030-5774, 2013) Homaifar, Nazaneen; Mwesigye, David; Tchwenko, Samuel; Worjoloh, Ayaba; Joharifard, Shahrzad; Kyamanywa, Patrick; Wilkinson, Jeff; Rulisa, Stephen; Thielman, Nathan M
Objective:To describe rates of improved knowledge following a structured 2-day emergency obstetrics trainingcourse.Methods:Quantitative assessments to evaluate emergency obstetrics knowledge and practical skillswere administered before, immediately after, and 3–9 months following the training course for 65final-yearmedical students at the National University of Rwanda. A survey was administered during thefinal assessment.Results:In total, 52 (80.0%) students demonstrated knowledge improvement after training. Fifty-seven (87.7%)students improved or maintained their scores from the post-training written test to thefinal assessment,and 32 (49.2%) retained practical skills. Twenty-one (32.3%) of the class demonstrated competency in bothwritten and practical skills. According to multivariable logistic regression analysis, female gender was associatedwith overall competency (P=0.01), and use of the internet for academic purposes more than 3–5 timesper week tended toward competency (P=0.11).Conclusion:A 2-day emergency obstetrics training courseincreased knowledge among medical students. Because educational policies are tailored to address highrates of maternal mortality in resource-poor settings, workshops dedicated to emergency obstetrics shouldbe promoted.
Estimating Operative Disease Prevalence in a Low-income Country: Results of a Nationwide Population Survey in Rwanda
(MOSBY-ELSEVIER , 360 PARK AVENUE SOUTH, NEW YORK, USA, NY, 10010-1710, 2013) Petroze, Robin T; Groen, Reinou S; Niyonkuru, Francine; Mallory, Melissa; Ntaganda, Edmond; Joharifard, Shahrzad; Guterbock, Thomas M; Kushner, Adam L; Kyamanywa, Patrick; Calland, J Forrest
Background. Operative disease is estimated to contribute to 11% of the global burden of disease, but no studies have correlated this figure to operative burden at the community level. We describe a survey tool that evaluates population-based prevalence of operative conditions and its first full-country implementation in Rwanda. Methods. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool is a cross-sectional, cluster-based population survey designed to measure conditions that may necessitate an operative consultation or intervention. Household surveys in Rwanda were conducted in October 2011 in 52 clusters nationwide. Data were population-weighted and analyzed with the use of descriptive statistics. Results. A total of 1626 households (3175 individuals) were sampled with a 99% response rate. 41.2% (95% confidence interval [95 CI%] 38.8–43.6%) of the population has had at least one operative condition during their lifetime, 14.8% (95% CI 13.3–16.5%) had an operative condition during the previous 12 months, and 6.4% (95% CI 5.6–7.3%) of the population were determined to have a current operative condition. A total of 55.3% of the current operative need was found in female respondents and 40.3% in children younger than 15 years of age. A total of 32.9% of household deaths in the previous year may have been related to operative conditions, and 55.0% of responding households lacked funds for transport to the nearest hospital providing general practitioner operative services. Conclusion. The SOSAS survey tool provides important insight into the burden of operative disease in the community. Our results show a high need for operative care, which has important implications for the global operative community as well as for local health system strengthening in Rwanda. (Surgery 2012)
Collaboration in Surgical Capacity Development: A Report of the Inaugural Meeting of the Strengthening Rwanda Surgery Initiative
(SPRINGER , ONE NEW YORK PLAZA, SUITE 4600 , NEW YORK, United States, NY, 10004, 2013) Petroze, T Robin; Mody, Gita N; Ntaganda, Edmond; Calland, J Forrest; Riviello, Robert; Rwamasirabo, Emile; Ntakiyiruta, Georges; Kyamanywa, Patrick; Kayibanda, Emmanuel
Background Increasing access to surgical care is among the prioritized healthcare initiatives in Rwanda and other low income countries, where only 3.5 % of surgical procedures worldwide are being performed. Partnerships among surgeons at academic medical centers, non-governmental organizations, and representatives of industry for building sustainable local surgical capacity in developing settings should be explored. Methods With the goal of improving collaboration and coordination among the many stakeholders in Rwandan surgery, the Rwanda Surgical Society (RSS) convened a participatory workshop of these groups in Kigali in March 2011. The meeting consisted of presentations from Rwandan surgical leaders and focused brainstorming sessions on collaborative methods for surgical capacity building. Results The outcome of the meeting was a set of recommendations to the Rwandan Ministry of Health (MOH) and the formation of an ad hoc team, the Strengthening Rwanda Surgery (SRS) Advising Group. The inaugural meeting of the advising group served to establish common goals, a framework for ongoing communication and collaboration, and commitment to a fully Rwandan agenda for surgical and anesthesia capacity development. The SRS Advising Group continues to meet and collaborate on training initiatives and has been integrated into the MOH plan to scale up human resources across disciplines. Conclusions The SRS Initiative serves as an example of the concept of early communication and international collaboration in global surgical and anesthesia capacity building partnerships.
Prevalence, Indications, Levels and Outcome Limb Amputations at University Teaching Hospital-Butare in Rwanda
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2013) Murwanashyaka, E.; Ssebuufu, R; Kyamanywa, Patrick
Background: Amputation is one of the oldest surgical procedures with artificial limbs identified from over 2000 years ago. Amputation is still often viewed as a failure of treatment but can be the treatment of choice and life saving procedure for severe trauma, vascular disease and tumors. The aim of this study was to determine the prevalence, indications and levels of limb amputation at the University Teaching Hospital Butare (UTH-B) from 1st January 2009 to 31st March, 2012. Methods: The records of 107 limb amputations performed in patients admitted at UTH-B over a period of 2 years and 3 months were reviewed. Results: Out of 3466 operated cases in Surgery Department, there were 107 limb amputations accounting for 3.08% of all operations performed during the study period. Females accounted for 29.9% cases. The mean age was 44.7±21.5 years. The commonest indication was gangrene in 43.95% especially dry gangrene with 22.43%.The most common level was below knew amputation (BKA) with 37.38% of cases. The outcome of the 107 patients amputated: 87.9% had uneventful recovery, 7.5% were re-operated and 4.7% died. Conclusion: The prevalence of limb amputation was 3.08% with the commonest indication as gangrenes most often secondary to peripheral vascular disease. Below knee amputation was the most performed procedure. The majority (87.9%) of the patients had uneventful recovery. The postoperative mortality rate was 4.7%.
The human resources for health program in Rwanda—a new partnership
(Massachusetts Medical Society, 2013) Binagwaho, Agnes; Kyamanywa, Patrick; Farmer, E. Paul; Nuthulaganti, Tej; Umubyeyi, Benoite; Nyemazi, Jean Pierre; Mugeni, Soline Dusabeyesu; Asiimwe, Anita; Ndagijimana, Uzziel; McPherson, Helen Lamphere; Ngirabega, Jean de Dieu; Sliney, Anne; Uwayezu, Agnes; Rusanganwa, Vincent; Wagner, Claire M; Nutt, Cameron T; Eldon-Edington, Mark; Cancedda, Corrado; Magaziner, Ira C; Goosby, Eric
The authors discuss the Human Resources for Health Program, which is working to improve the quality and quantity of health professionals in Rwanda by means of sustained collaborations with U.S. schools of medicine, nursing, dentistry, and public health. A global shortage of 4.3 million health professionals poses a major bottleneck to poor people worldwide with regard to benefiting from the fruits of modern medicine.(1) Among existing health professionals, there are also staggering inequities in skill levels and geographic distribution.(2)-(4) Unsurprisingly, the deepest national gaps in human resources for health run parallel to poor population-level health outcomes.(1) Sub-Saharan Africa bears 24% of the global burden of disease(5) but is served by only 4% of the global health workforce.(1) The health graduate schools in the region face overwhelming financial, infrastructural, and personnel constraints, limiting their ability to address the ...
Strategies to improve clinical research in surgery through international collaboration
(Elsevier Science Inc , Ste 800, 230 Park Ave, New York, Usa, Ny, 10169, 2013) Søreide, Kjetil; Alderson, Derek; Bergenfelz, Anders; Beynon, John; Connor, Saxon; Deckelbaum, L Dan; Dejong, H Cornelis; Earnshaw, Jonathan J; Kyamanywa, Patrick; Perez, O Rodrigo; Sakai, Yoshiharu; Winter, Desmond C
More than 235 million patients undergo surgery every year worldwide, but less than 1% are enrolled in surgical clinical trials—few of which are international collaborations. Several levels of action are needed to improve this situation. International research collaborations in surgery between developed and developing countries could encourage capacity building and quality improvement, and mutually enhance care for patients with surgical disorders. Low-income and middle-income countries increasingly report much the same range of surgical diseases as do high-income countries (eg, cancer, cardiovascular disease, and the surgical sequelae of metabolic syndrome); collaboration is therefore of mutual interest. Large multinational trials that cross cultures and levels of socioeconomic development might have faster results and wider applicability than do single-country trials. Surgeons educated in research methods, and aided by research networks and trial centres, are needed to foster these international collaborations. Barriers to collaboration could be overcome by adoption of global strategies for regulation, health insurance, ethical approval, and indemnity coverage for doctors.
Epidemiology, Management and Outcome of Malignancies Surgically Treated at a Rural Referral Hospital in Butare, Rwanda
(Rwanda Health Communication Center-Rwanda Biomedical Center (RHCC-RBC), 2013) Ingabire, JC Allen; Ssebufu, R; Kyamanywa, Patrick; Bayisenga, J; Bikoroti, J; Kiswezi, A; Mazimpaka, D
Background: In 2008 the International Agency for Research on Cancer (IARC) reported 715,000 new cancer cases and 542,000 cancer deaths occurred in Africa. With increasing development and life expancy, in Africa, that number will double by 2030. In countries where radiotherapy is not available and access to chemotherapy and cancer care is limited, understanding the available care and costs of surgical treatment for different cancers is essential for planning. Methods: A Retrospective cross-sectional study of surgically treated malignancies at University Teaching Hospital-Butare (UTH-B) in Rwanda, for a period of 32 months (January 2011-August 2013). We analyzed operating records, corresponding pathology and financial department records. Results: Of 3009 operations performed during the period reviewed, 208(7%) were for malignancies. Patients were predominantly male (59.6%), with a mean age of 51 years (2-91years). 54.8percent had symptoms for more than 1 year before surgery, 52.4% first sought treatment from traditional healers. Gastrointestinal malignancies comprised 37% of all cancer diagnosis, half of them were emergent presentations, for obstruction or peritonitis. Other cancers included intrabdominal tumors (9.6%), soft tissue sarcomas (8.6%), osteosarcoma (8.2%), melanoma (7.7%), penile cancers (7.7%), breast cancers (6.2%) and others (15%). Metastatic disease was present in 44.2% of patients. Surgical care was palliative for 52.9%. Only 7.7% received chemotherapy. The in-hospital mortality rate was 26.4%. Mean hospital stay was 25 days (1-342 days). Total medical costs were estimated at $140,000 ($673/patient), most (63%) from hospital stay. Conclusions: The low number of cancer procedures, high rate of metastatic disease, and high percentage of emergency surgeries suggest that earlier diagnosis, treatment and access to chemotherapy in Rwanda is needed to avoid complications and high medical costs.
Enhancing Medical Students’ Education and Careers in Global Surgery
(Cma-Canadian Medical Assoc, 1867 Alta Vista Dr, Ottawa, Canada, Ontario, K1g 5w8, 2014) Gosselin-Tardif, Alexandre; Butler-Laporte, Guillaume; Vassiliou, Melina; Khwaja, Kosar; Ntakiyiruta, Georges; Kyamanywa, Patrick; Razek, Tarek; Deckelbaum, Dan L
With surgical conditions being significant contributors to the global burden of disease, efforts aimed at increasing future practitioners’ understanding, interest and participation in global surgery must be expanded. Unfortunately, despite the increasing popularity of global health among medical students, possibilities for exposure and involvement during medical school remain limited. By evaluating student participation in the 2011 Bethune Round Table, we explored the role that global surgery conferences can play in enhancing this neglected component of undergraduate medical education. Study results indicate high rates of student dissatisfaction with current global health teaching and opportunities, along with high indices of conference satisfaction and knowledge gain, suggesting that global health conferences can serve as important adjuncts to undergraduate medical education.

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