Disseminating surgical experience for sustainable benefits: the Urolink experience.

Abstract

The dissemination of urological knowledge, and consequent surgical expertise, is entirely dependent on the availability of individuals to provide education and the mechanism by which that knowledge is spread. In low, or low-middle, income countries the numbers of specialist surgeons, especially urologists, is extremely limited and the time they have to train aspiring urologists is, therefore, restricted as a consequence of the demand for clinical help. Urologists from high-income countries, being more prevalent, can assist with the education, but are limited by the needs of their own careers and the time they have available to educate in a resource poor setting. Bringing surgeons from a low to a high income environment for training is one option to overcome this trainer/trainee imbalance, but is relatively expensive, bureaucratic, and has inherent risks of the individual being lost from their domestic workforce. Short-term medical trips to educate larger numbers of individuals in their home setting is one of a number of different options that has been used to bridge this gap. It has, however, been suggested that such a model is not the most efficient way of perpetuating knowledge and skills in a low-income environment. Urolink has found, however, that when short term trips are used to support a longitudinal commitment to a centre they can be remarkable effective. By helping the expansion of personnel to a critical mass in designated regional hubs, linked to credible local or regional academic institutions, it has been possible to develop sustainable centres that can disseminate training across a wide geographical area. Such a co-operative approach has been used between Urolink and the Kilimanjaro Christian Medical Centre in Moshi, Tanzania, a model that has initiated the evolution of other regional training hubs across east Africa over the last three decades.