Introducing endourology to a developing country: how to make it sustainable

Abstract

Background: Endourological procedures are not routinely performed in low-income countries in sub-Saharan Africa. The problems that are involved in introducing endoscopic services are low level of medical personnel trained in endoscopic procedures and infrastructure development in these countries. Materials and methods: Recently, endourological facilities were created at the Hawassa Referral Hospital in Ethiopia. This work is the result of close collaboration between the UROLINK and the Hawassa Referral Hospital Link coordinator. Between 2010 and 2012, the UROLINK team visited Hawassa three times to set up endourological services. Results: A local surgeon has been trained in basic endoscopic procedures. Optical urethrotomy and flexible and rigid cystoscopy have been successfully introduced. We discuss the difficulties involved in such a project like initial assessment, providing equipment, maintenance of equipment, and, particularly, training of the surgical team. The follow up from the trips is short and the sustainability of the goal remains to be seen. Conclusions:The introduction of endourological services in Hawassa offers a chance of improving urological care locally. The experience of Hawassa is representative of other low-income countries and may provide valuable lessons. A few key principles (need, equipment, cost, surgical technique, and training) should be kept in mind.

<p>Urolithiasis: Presentation and Surgical Outcome at a Tertiary Care Hospital in Ethiopia</p>

“…2,3,16,20,21 This reflects the lack of trained professionals and endourologic instruments. 16,[22][23][24] As Ethiopia is a fast-growing, sub-Saharan Africa country, located near to the Afro-Asian stone belt, the burden is expected to be rising and becoming a public health issue. 5 However, data are scarce and the treatment options are limited.…”

An Evaluation of the Role of Simulation Training for Teaching Surgical Skills in Sub‐Saharan Africa

“…Teaching FLS via telesimulation can be successful, with a 100% pass rate in a telesimulation group compared to 38% in a self-practice group [ 23 ]. Other box-simulator models, such as the Bristol transurethral resection of the prostate simulator, have been used in the development of endoscopic urological services in Ethiopia, but did not report any specific learner outcomes [ 12 ].…”

“…Most simulation programmes described in SSA have been supported via overseas organisations, often with provision of short-term overseas trainers [ 12 , 14 , 15 , 22 , 26 ]. Organising local faculty support in countries with an already limited number of surgeons, combined with weak transport infrastructure and large distances can make it challenging to deliver teaching interventions.…”

Urolink supporting the development of urological services in Hawassa, Ethiopia

“…A number of challenges were also identified: lack of endourological equipment; theatre and ward staff with no experience in endoscopic surgery; suboptimal facilities to sterilise equipment; and limited access to endourological accessories. A plan was developed between the local team and the BAUS Urolink committee members to deliver training and develop urological services (Table ).…”