Building workforce capacity for the surgical management of cervical cancer in a fragile, low-income African nation—Democratic Republic of the Congo

Abstract

Objectives: Surgery 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.Methods: Implementation 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.Results: Nineteen 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. Research

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

“…After initial problems, positive changes emerged, such as value in cancer care, digital communication, convenience, inclusivity and cooperation, decentralization of cancer care, acceleration of policy change, human interactions, hygiene practices, health awareness and promotion and systems improvement [ 18 ]. A very large number of papers related to COVID-19 (at the moment of manuscript preparation over 180 thousand positions indexed in PubMed) is associated with variable quality of data sourcing and analysis and low practical usefulness in clinical settings.…”

Establishing women’s cancer care services in a fragile, conflict and violence affected ecosystem in Africa

“…This report gives an overview of our approach to programme implementation in which workforce training was integrated with service delivery and clinical infrastructure development [9,13]. Other manuscripts in this series provide a detailed and rigorous evaluation of the clinical outcomes of our activities [15][16][17].…”

To parachute or not

“…The activities resulted in the successful transfer of diagnostic and surgical skills to local Congolese collaborators. In partnership with the healthcare facility where the activities were implemented (Biamba Marie Mutombo Hospital) a new women's cancer care infrastructure was simultaneously developed that offers life-saving radical surgery for early cervical cancer and breast cancer; oncoplastic and palliative breast surgery; and chemotherapy for cervical and breast cancer [9][10][11][12]. Along with compensation for their work, the gain for the HIC collaborators was the satisfaction of expanding women's oncology services in a country in dire need of such.…”

“…Working in Africa over the past two decades with the sole intent of building gynaecologic and breast oncology capacity, we strongly condemn the negative aspects of parachuting. Instead, we embrace the activities exhibited by our constructive approach (positive parachuting) to capacity building, as per our work in the DRC, Malawi and Zambia [9][10][11][12][13][14][15][16]. Our capacity building activities in these countries have always been performed with local experts as peers, lead authors and co-authors [9][10][11][12][13][14][15][16].…”

“…Instead, we embrace the activities exhibited by our constructive approach (positive parachuting) to capacity building, as per our work in the DRC, Malawi and Zambia [9][10][11][12][13][14][15][16]. Our capacity building activities in these countries have always been performed with local experts as peers, lead authors and co-authors [9][10][11][12][13][14][15][16]. Additionally, we have chronicled our work in Africa related to our method of capacity building using the principles of implementation science [17].…”