Abstract
ObjectivesSurgery is a cornerstone of the management of cervical cancer. Women diagnosed with cervical cancer in sub-Saharan Africa have very little access to specialised (gynaecologic oncology) surgical services. We describe our experiences and challenges of training local general gynaecologists to surgically treat early stage invasive cervical cancer at a private sector healthcare facility in a fragile, low-income African nation.MethodsImplementation of the training curriculum began with assigned self-directed learning. It continued with on-site training which consisted of preoperative surgical video reviews, pre- and intra-operative assessment of disease status, deconstruction of the designated surgical procedure into its critical subcomponents and trainees orally communicating the steps of the surgical procedure with the master trainers. High-volume repetition of a single surgical procedure over a short time interval, intra-operative bedside mentoring, post-operative case review and mental narration were critical to the process of surgical skills transfer.ResultsNineteen radical abdominal hysterectomies were successfully performed over four training visits; trainees were able to perform the procedure alone after eight cases; surgical complications decreased over time. The trainees have continued to perform the surgical procedures independently.ConclusionLife-saving surgical capacity for the treatment of cervical cancer has been established and sustained at a private sector healthcare facility in a fragile, low-income African setting, through an innovative model of surgical training.
Highlights
Worldwide, cervical cancer is a major public health problem, with over 500,000 new cases and 300,000 deaths occurring worldwide in 2018 [1]
In January 2016, a joint venture was formed between the Dikembe Mutombo Foundation (DMF) and the Friends of Africa Inc. (FOA)
DMF is a non-profit organisation located in Atlanta, GA, and is dedicated to improving the health, education and quality of life for the people of the Democratic Republic of the Congo (DRC) through primary healthcare and disease prevention, the promotion of health policy, health research and increased access to healthcare education
Summary
Cervical cancer is a major public health problem, with over 500,000 new cases and 300,000 deaths occurring worldwide in 2018 [1]. Most of the increase will occur in the world’s most impoverished regions [3] To address this impending tragedy, the Director General of the World Health Organisation (WHO) issued a call for widespread implementation of proven and cost-effective measures to eliminate cervical cancer as a public health problem [4]. FOA is a US 501c3 non-profit organisation whose mission is to increase gynaecologic cancer prevention and treatment capacity in Africa and the African Diaspora besides innovative on-site education and clinical demonstrations. Informed by the conference presentations, the outcomes of the hospital site visit, and consultations with the Ministry of Health, a strategy was developed to train local cadre (professional hospital staff) to organise and perform the following services: cervical cancer screening using visual inspection with acetic acid, treatment of cervical cancer precursors with thermal ablation or large loop excision of the transformation zone, punch biopsy of cervical lesions suspicious for cancer, staging and surgical treatment of early stage invasive cervical cancer and palliation of advanced stage disease. Buffet Foundation, the scope of training was vastly expanded to include breast cancer early detection and treatment services, chemotherapy services, clinic infrastructure development, international educational opportunities for Congolese trainees and breast and cervical cancer early detection outreach activities
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