HEAL Africa Research Articles

High burden on tuberculosis treatment for society-a survey study

3.8 million died with tuberculosis infections at an accelerated rate since 2018 and the trend will continue to reach 4.6 million by 2030 (Table 1) (Figure 1). Since 2018 the number of resistances has increased significantly, and the trend will continue until 2030, thus complicating treatment and increasing the costs from US dollars 8.2 billion in 2018 to dollars 32 billion in 2030 (Table 2) (Figure 2). The costs associated with resistant tuberculosis management with direct and indirect costs have been increasing ever since 2023 (Table 2) (Figure 2). The Heal Africa research team has demonstrated on 155 patients that a solution to cure the non-resistant cases and resistant cases exists thus reducing the costs and eradicating tuberculosis worldwide (Table 3) (Figure 3). The Heal Africa research team is seeking to expand the cohort study to 1000 patients to prove beyond doubt that this solution is unbiased. A projection chart to demonstrate the reduction of the death toll (from 4.05 million in 2024 to 0 in 2025) and the gains in terms of costs (from 18.8 US billion in 2024 to 1.8 US billion in 2025) by using our solution is given below (Table 3, Figure 3) & (Table 4, Figure 4).

Neonatal surgical mortality at a low resource setting, HEAL Africa tertiary hospital, Eastern Democratic Republic of the Congo.

This study describes the experience with common neonatal surgical conditions and their outcomes at a single center in the Eastern Democratic Republic of the Congo (DRC) over a period of 7years (2016-2022). A retrospective review of neonatal surgical admissions and their outcomes was performed for patient admitted between January 2016 and December 2022 at HEAL Africa teaching hospital. Data were collected from the neonatal admission and discharge registry for all patients with a potential surgical condition. 107 neonates potentially requiring surgery were identified. 81.3% were referred from facilities within 10km of HEAL Africa. The most common diagnosis was myelomeningocele/meningocele (27.1%). 68.2% of patients had an operation. The overall mortality was 29% for all patients and mean length of stay 9.9days. Operated patients had a lower mortality at 16.4% (p-value < 0.001, OR 0.155, CI 0.062-0.389) while patients with a birth weight of less than 2500g were more likely to die (p-value < 0.001, OR 5.333, CI 2.062-13.79). The neonatal mortality rate for patients presenting with a potential surgical condition is extremely high. This is multifactorial and largely related to patient selection inherent to resource limitations.

HEAL Africa score to predict failure of surgical repair of obstetric urethro-vaginal fistula in the Democratic Republic of the Congo

IntroductionObstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC).MethodsThis is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test.ResultsSurgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51–8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70–23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14–15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36–7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12–15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15–2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%.ConclusionWe report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.

Exploring the Tension between Christianity and African Traditional Religion in the Methodist Church of Southern Africa

In the 19th century, missionaries from England brought Methodism to Southern Africa. Like all other missionaries who brought Christianity to Africa, they brought not only the Gospel, but also their culture and language. This article seeks to acknowledge the strides made by the Methodist Church of Southern Africa (MCSA) regarding implanting Methodism in African soil. Thus, the article further explores the tension that persists in the MCSA between Christianity and African Traditional Religion (ATR). It argues that this tension opens opportunities for the MCSA to explore. The article uses secondary or desk research as a methodology to investigate this topic. The research showed that there is a tension that exists between Christianity and ATR, which affords the MCSA an opportunity to explore what it means to be African and Methodist in the MCSA; to dissect the causes of this tension; and to interrogate these causes for what it means for the MCSA. The article concludes that the tension under study has resulted from the MCSA taking its time to put its resolutions in black and white in the form of liturgy, policy, or guidelines. Thus, a recommendation is made for more dialogue and openness concerning areas where the MCSA could venture towards achieving its vision of “A Christ Healed Africa for the Healing of Nations”. Finally, the article argues that in order to heal Africa, the book of order and the Gospel preached in the MCSA should speak and make sense to Methodists of African descent.

Maternal Psychosocial Stress Is Associated with Reduced Diversity in the Early Infant Gut Microbiome.

The developing infant gut microbiome is highly sensitive to environmental exposures, enabling its evolution into an organ that supports the immune system, confers protection from infection, and facilitates optimal gut and central nervous system function. In this study, we focus on the impact of maternal psychosocial stress on the infant gut microbiome. Forty-seven mother-infant dyads were recruited at the HEAL Africa Hospital in Goma, Democratic Republic of Congo. Extensive medical, demographic, and psychosocial stress data were collected at birth, and infant stool samples were collected at six weeks, three months, and six months. A composite maternal psychosocial stress score was created, based on eight questionnaires to capture a diverse range of stress exposures. Full-length 16S rRNA gene sequences were generated. Infants of mothers with high composite stress scores showed lower levels of gut microbiome beta diversity at six weeks and three months, as well as higher levels of alpha diversity at six months compared to infants of low stress mothers. Longitudinal analyses showed that infants of high stress mothers had lower levels of health-promoting Lactobacillus gasseri and Bifidobacterium pseudocatenulatum at six weeks compared to infants of low stress mothers, but the differences largely disappeared by three to six months. Previous research has shown that L. gasseri can be used as a probiotic to reduce inflammation, stress, and fatigue, as well as to improve mental state, while B. pseudocatenulatum is important in modulating the gut-brain axis in early development and in preventing mood disorders. Our finding of reduced levels of these health-promoting bacteria in infants of high stress mothers suggests that the infant gut microbiome may help mediate the effect of maternal stress on infant health and development.

Clinico-epidemiological profile of children living with HIV/AIDS managed at Heal Africa Hospital, Goma, Democratic Republic of the Congo.

Conflict in the DRC led to a poor health care. HIV/AIDS in children remains one of the leading causes of pediatric morbidity and mortality. This cross-sectional study used a sample size of 238 files and aimed to determine the epidemiological profile of children living with HIV at Heal Hospital in 2015. The age ranged from zero to fifteen, with a mean of 6.1 (±3.9) years. Records of PMTCT were noted in 12%. The mean birth weight was 3(±0.8) kg, most cases (88 percent) had normal vaginal delivery. Many of them (71 percent) were living with at least one parent. The majority of the children (92 percent) were from Goma, and 75 percent were diagnosed at WHO Stage 3. At least one episode of hospital admission was reported in 71 percent. Respiratory tract infections were the most common disease, and they were also the leading cause of death. Based on the CD4, which was the most cost-effective method of monitoring, there was an improvement in immunity at the last visit. This study pointed out the importance of PMTC and early management of children leaving with HIV/AIDS. Outreach would encourage voluntary HIV/AIDS testing for pregnant women in armed conflict zone.

Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019.

BackgroundDespite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC).Material and MethodsThis was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence.ResultsOverall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1–6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33–550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10–9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02–45.21).ConclusionPrior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.

Trends in sexual violence patterns and case management: a sex disaggregated analysis in Goma, Democratic Republic of Congo

BackgroundBoth conflict and non-conflict sexual violence have been well described in the Democratic Republic of Congo (DRC). However, there is little empiric data comparing sexual violence patterns for males and females in the DRC, and little is known about how post-sexual assault care experiences may differ between the two sexes.MethodsThis was a retrospective, registry-based study at HEAL Africa Hospital. Researchers extracted and analyzed available data for all patients seeking post-sexual assault care between July 2013 and December 2017. Comparative analysis was conducted using SAS to document patterns of sexual violence among male and female survivors and to describe the clinical management of males and females seeking post-assault care.ResultsBetween July 2013 and December 2017, the hospital provided post-sexual assault care to 1766 patients (1623 female and 93 male). Female survivors were more likely to be minors under the age 18 (p < 0.0001) with a mean age 16.5 years versus 22.3 years for males. For both sexes, approximately half of all perpetrators were civilians who were known to the survivor (friends, family members, colleagues or neighbors). After sexual assault, males (79.6%) were more likely than females (55.7%) to present to the hospital within 72 h (p-value < 0.0001). Among female patients, 12% had a positive pregnancy test at the time of presentation and another 43% received emergency contraception. Male survivors were more likely to test positive for HIV (p-value = 0.0032) and to receive HIV post-exposure prophylaxis as well as prophylactic antibiotics (p-value < 0.0001).ConclusionsIn this single-centre registry, non-conflict-related sexual violence affected both women and girls as well as men and boys in North Kivu with civilian-perpetrated assaults being most common, and girls under the age of 18 being disproportionately affected. Overall, delays to seeking post-assault care appear to have decreased over time, although females presented later than males. These differences, as well as sex discrepancies in receiving HIV prophylaxis and prophylactic antibiotics, are not well understood. Additional research is needed to understand these phenomena such that equitable and optimal care can be ensured for both female and male sexual violence survivors.

Late abdominal pregnancy in a post-conflict context: case of a mistaken acute abdomen - a case report

BackgroundAbdominal pregnancies have been reported in both high-income countries as well as low- and middle-income countries. They are frequently missed in routine antenatal care in resource-limited settings and delayed diagnosis is usually associated with poor fetal and maternal outcomes including death. This case report is among the first from eastern Democratic Republic of Congo (DRC), a post-conflict region.Case presentationIn this case study, we present a 25 year-old primigravida patient referred to HEAL Africa hospital for management of an acute abdomen at 33-weeks gestation. Her chief complaint was severe abdominal pain associated with each fetal movement for a period of 1 week prior to admission. A diagnosis of peritonitis was made. Emergency laparotomy revealed a normal live 2 kg baby with placental implantation on the greater omentum and small intestine mesentery. The placenta was not removed. Both maternal and fetal outcomes were good.ConclusionAbdominal pregnancy with a normal live fetus at such an advanced gestational age is rare. This case reminds clinicians that abdominal pregnancy remains a differential diagnosis for painful fetal movements.

Field hospital: HEAL Africa and the politics of compassion in Eastern Congo

The essay explores the image of the church as field hospital so as to make explicit the interconnections between evangelism, ecclesiology, and politics. Founded by Dr. Jo Lusi and his wife Lyn, HEAL Africa’s holistic ministry in and around Goma in Eastern Congo provides an illuminating example of mission’s critical and constructive engagement with societies, change, and conflict. Accordingly, by attending to the story of HEAL Africa, the essay shows how the church’s engagement with a wounded world takes the form of compassion in its many dimensions. Thus, what HEAL Africa’s compassionate engagement in Eastern Congo helps to illumine are the historical, practical, and spiritual dimensions of the church as a field hospital.

Fistula after attended delivery and the challenge of obstetric care capacity in the eastern Democratic Republic of Congo

ObjectiveTo analyze the history of women with fistula in the eastern Democratic Republic of Congo (DRC) to understand the determinants of fistula development. MethodsIn a retrospective observational study, data were analyzed from a survey of all women who underwent surgical fistula repair at HEAL Africa Hospital, Goma, between April 1, 2009, and March 1, 2012. Characteristics and obstetric histories were obtained by self-report. ResultsThe mean age of the 202 participants at treatment was 30.7years (range 5–69). The mean duration of fistula was 45.6months (range 0–600). In total, 171 (91.4%) fistulas were caused by obstructed labor, and 147 (86.5%) were vesicovaginal. Most women (129/175 [73.8%]) reported having received care during early labor under the supervision of a nurse or doctor in a healthcare facility. Among 176 women for whom delivery data were available, 102 (57.9%) delivered at a hospital, 42 (23.8%) at a health center, and 32 (18.2%) at home. Only 46 (26.3%) of 175 women were transferred to a higher level of care during labor. ConclusionsIn the eastern DRC, efforts to enable transport to a healthcare facility and to encourage attended births must be accompanied by improvements in the capacity of existing facilities and in the training of staff to enable the timely diagnosis of labor abnormalities and appropriate intervention.

Healthcare providers’ perspectives on the social reintegration of patients after surgical fistula repair in the eastern Democratic Republic of Congo

ObjectiveTo understand perspectives of local health providers on the social reintegration of patients who have undergone fistula repair in the eastern Democratic Republic of Congo. MethodsIn a qualitative study, semi-structured individual interviews were conducted with patient-care professionals working with women with fistula at HEAL Africa Hospital (Goma) and Panzi Hospital (Bukavu) between June and August 2011. The interviews were transcribed and themes elicited through manual coding. ResultsOverall, 41 interviews were conducted. Successful surgical repair was reported to be the most important factor contributing to patients’ ability to lead a normal life by all providers. Family acceptance—especially from the husband—was deemed crucial for reintegration by 39 (95%) providers, and 29 (71%) believed this acceptance was more important than the ability to work. Forty (98%) providers felt that, on the basis of African values, future childbearing was key for family acceptance. Because of poor access and the high cost of cesarean deliveries, 28 (68%) providers were concerned about fistula recurrence. ConclusionProviders view postsurgical childbearing as crucial for social reintegration after fistula repair. However, cesarean deliveries are costly and often inaccessible. More work is needed to improve reproductive health access for women after fistula repair.

Antiretroviral treatment program retention among HIV-infected children in the Democratic Republic of Congo.

BackgroundRetaining patients with HIV infection in care is still a major challenge in sub- Saharan Africa, particularly in the Democratic Republic of Congo (DRC) where the antiretroviral treatment (ART) coverage is low. Monitoring retention is an important tool for evaluating the quality of care.Methods and FindingsA review of medical records of HIV -infected children was performed in three health facilities in the DRC: the Amo-Congo Health center, the Monkole Clinic in Kinshasa, and the HEAL Africa Clinic in Goma. Medical records of 720 children were included. Kaplan Meier curves were constructed with the probability of retention at 6 months, 1 year, 2 years and 3 years. Retention rates were: 88.2% (95% CI: 85.1%–90.8%) at 6 months; 85% (95% CI: 81.5%–87.6%) at one year; 79.4% (95%CI: 75.5%–82.8%) at two years and 74.7% (95% CI: 70.5%–78.5%) at 3 years. The retention varied across study sites: 88.2%, 66.6% and 92.5% at 6 months; 84%, 59% and 90% at 12 months and 75.7%, 56.3% and 85.8% at 24 months respectively for Amo-Congo/Kasavubu, Monkole facility and HEAL Africa. After multivariable Cox regression four variables remained independently associated with attrition: study site, CD4 cell count <350 cells/µL, children younger than 2 years and children whose caregivers were member of an independent church.ConclusionsAttrition remains a challenge for pediatric HIV positive patients in ART programs in DRC. In addition, the low coverage of pediatric treatment exacerbates the situation of pediatric HIV/AIDS.

Analysis of a pilot program to implement physical therapy for women with gynecologic fistula in the Democratic Republic of Congo

ObjectiveTo describe components of a physical therapy pilot program for women with gynecologic fistula, and to report prospective data from the first 2years of program implementation. MethodsA single-cohort observational study with repeated measures was conducted at HEAL Africa Hospital, Goma, Democratic Republic of Congo. Hospital staff received training in pelvic floor physical therapy. Guidelines for exercise, functional training, and reproductive health education were integrated into the existing program. Demographics, clinical findings, and functional outcomes were recorded. Key stakeholders were interviewed to understand the perceived strengths and limitations of the program. ResultsA total of 205 women were followed up; 161 participated in physical therapy, with an average of 9.45 sessions. Of 161 women examined postoperatively, 102 (63.4%) reported no incontinence; they remained continent at discharge. Of 21 who indicated a change in level of incontinence during postoperative physical therapy, 15 (71.4%) improved. The program was feasible and well received by staff and patients. ConclusionPelvic floor physical therapy could have significant results in women with gynecologic fistula, may be an important adjunctive treatment in comprehensive fistula care, and warrants further investigation.

Contribution of safe motherhood solidarity groups in using and accessing maternity services during a period of armed conflict

This report presents the results of a study on Reproductive Health done in North Kivu in September 2009. It was conducted by HEAL Africa, in partnership with the Provisional Division of Health, and financed by the University of Ottawa, Canada/CRDI with technical assistance from Western Cape University of South Africa. The study was conducted in the health zones of Birambizo and Kayna within the framework of the central office. The focus of the report is on one aspect of Reproductive Health—Low Risk Maternity. This study was conducted in rural areas given that Reproductive Health indicators are much weaker when compared with urban areas, according to EDS RDC, 2007 [1]. This study emphasizes the following points: General characteristics of the participants in the study, and the utilization and accessibility of maternity services in rural areas in conflict situations. The formula SPSS 12.0.1 was used to facilitate data analysis in the study. This study comes at a point in time when its relevance to HEAL Africa’s work will assist HEAL and its partners in determining the focus of interventions done in health zones in order to improve maternal and neonatal health. HEAL Africa firstly stepped into a Safe Motherhood pilot project in June 2006 for 9 months in the Masisi zone, then in 2007 in the Birambizo and Kayna health zones. In November 2007, HEAL expanded into Walikale and in October 2008, into Kirotshe, Binza, and Lubero. The intervention kit consists of reinforcing the capacity of existing health facilities, training traditional midwives who serve as a link between the community and the health structures, the provision of sanitary equipment, medical essentials and community mobilization was done through local leaders about health and reproduction, and organizing women of reproductive age in solidarity groups (SG) to generate maternity insurance. The community approach “Solidarity Groups for Maternity Insurance” constitutes the spine of HEAL Africa within the support it provides in Reproductive Health. The principal idea is to educate and train communities on how to use the MMR services that are available in their community, and to remove financial barriers to accessing health services. The 4 pillars that comprise the Safe Motherhood program are: family planning, prenatal care, safe assisted delivery and essential obstetric care. These four strategic measures are integral in assuring primary health care and equality for women. This study evaluates this approach, keeping in mind local strategies and their effects on improving the utilization and accessibility of reproductive health services.

Fertility desires and the feasibility of contraception counseling among genital fistula patients in eastern Democratic Republic of the Congo

Objective To determine the fertility and contraceptive desires of genital fistula patients in eastern Democratic Republic of the Congo (DRC) and to evaluate the impact of contraceptive counseling and its effect on contraceptive knowledge and use. Methods Group contraceptive counseling was offered to fistula patients at HEAL Africa Hospital between February and May 2010. Fertility desires and contraceptive knowledge were assessed via verbally administered questionnaires before and after counseling, and use of modern contraceptive methods was tracked. Results Of the 61 participants, 22/34 (64.7%) of those who desired children wanted to wait at least 1 year after repair before attempting pregnancy. Overall, 31/58 (53.4%) women had heard of birth control, although only 15 (24.6%) knew any specific methods, and none had ever used contraception. After counseling, all participants could recall 1 or more methods. Of the 25 participants discharged over the subsequent 3 months, 5 (20.0%) and 3 additional fistula patients selected a modern method of contraception. Conclusion Desire for contraception and birth spacing among women with fistula is significant. Basic group contraception counseling and access are feasible and lead to increased contraceptive knowledge and use.

Sexual Violence toward Children and Youth in War-Torn Eastern Democratic Republic of Congo

BackgroundThe epidemic of gender-based violence in the Democratic Republic of the Congo (DRC) has garnered popular media attention, but is incompletely described in the medical literature to date. In particular, the relative importance of militarized compared to civilian rape and the impact on vulnerable populations merits further study. We describe a retrospective case series of sexual abuse among children and youth in eastern DRC.MethodsMedical records of patients treated for sexual assault at HEAL Africa Hospital, Goma, DRC between 2006 and 2008 were reviewed. Information extracted from the chart record was summarized using descriptive statistics, with comparative statistics to examine differences between pediatric (≤18 yrs) and adult patients.Findings440 pediatric and 54 adult sexual abuse cases were identified. Children and youth were more often assaulted by someone known to the family (74% vs 30%, OR 6.7 [95%CI 3.6–12], p<0.001), and less frequently by military personnel (13% vs 48%, OR 0.14 [95%CI 0.075–0.26], p<0.001). Delayed presentation for medical care (>72 hours after the assault) was more common in pediatric patients (53% vs 33%, OR 2.2 [95%CI 1.2–4.0], p = 0.007). Physical signs of sexual abuse, including lesions of the posterior fourchette, hymeneal tears, and anal lesions, were more commonly observed in children and youth (84% vs 69%, OR 2.3 [95%CI 1.3–4.4], p = 0.006). Nine (2.9%) pediatrics patients were HIV-positive at presentation, compared to 5.3% of adults (p = 0.34).InterpretationWorld media attention has focused on violent rape as a weapon of war in the DRC. Our data highlight some neglected but important and distinct aspects of the ongoing epidemic of sexual violence: sexual abuse of children and youth.

Healing Africa? Reflections on the peace-building role of a health-based Non Governmental Organization operating in Eastern Democratic Republic of Congo

Whilst there are convincing theoretical arguments about the peace-building potential of the health sector, case studies documenting its interventions remain limited. This article contributes to the existing ‘Peace through Health’ literature by considering the model of HEAL Africa, a health-based non-governmental organization operating in Eastern Congo. Several of HEAL Africa's projects seek to prevent and reduce key risk factors; for conflict, and to contribute to longer term rehabilitation. Many of these interventions are born out of HEAL's emphasis on providing emergency health care – and the neutrality, legitimacy, access and longevity which this generates. However, this focus also tends to act as a limiting factor on the application and resourcing of its conflict prevention and reconstruction efforts. Whilst this case study warns against overstating the potential role of the health sector in promoting peace, HEAL's activities provide evidence of the types of positive contributions that can be made in practice. The role of the health sector, equipped as it is with useful tools for conflict transformation, should therefore be considered more proactively by the peace-building community.

ES03 GOITRE SURGERY IN AFRICA

Purpose: To highlight details and difficulties of management of large goitres in the developing world.Method: This paper presents a retrospective review of patients undergoing surgery for large goitre at the HEAL Africa Hospital (Health, Education, Action, Leadership) in Goma, Democratic Republic of Congo.Results: Dr Neil Wetzig has been involved in training African doctors in goitre surgery since 2003. In northern parts of D R Congo a very high incidence of large goitre exists. Published estimates range from 48–85% and it is suggested that four million people in the north of Congo have large goitres. The types of cases encountered will be discussed, along with the likely causes of endemic goitre, including dietary factors in this community, and the social effect of having a large goitre. Patients undergoing surgery at “HEAL Africa” have a mean age of 44 years, a mean duration of goitre of 7 years and they are predominantly euthyroid range. 88% are female. The difficult circumstances in which this surgery is performed, with poor lighting, poor power supply, poor instruments and limited resources, for example limited suture material, will also be outlined. Details will be presented of the teaching that has been conducted for local Congolese doctors, including surgical aspects of these large African goitres, in particular one case of a huge four kilogram recurrent goitre with skin erosion occurring in a 20‐year‐old woman. This experience of very large goitre in Africa is unique for surgeons from developed countries, and the techniques used are of importance to all thyroid surgeons.