Editorial Message: Things are Getting Better

Dear Readers,   A middle-aged gentleman was brought to the emergency room of the hospital complaining of severe pain in his right leg. He had been in excellent health until approximately 2 weeks prior when he underwent a right inguinal hernia repair at another hospital. Examination of the patient’s leg showed it was gangrenous from the toes to the groin. The patient had crepitance of the subcutaneous tissue of the right lower quadrant of the abdomen. After a brief but intensive period of resuscitation, the patient underwent a high above-knee amputation of the leg and debridement of the abdominal wall of the right lower abdomen. In addition to the gangrene of the leg, the patient had necrotizing fasciitis of the abdominal wall. Exploration of the previous inguinal hernia repair site revealed that the right common femoral artery had been ligated under the inguinal ligament! The 2 surgeons managing the patient are not sure he will survive. As horrible as this sounds, it actually happened about 1 month ago at the Mbingo Baptist Hospital, Bamenda, Cameroon. Incidences such as this are not uncommon in Africa because of the inadequate training of native surgeons.   Realizing the unlikelihood that anything would improve led a group of missionary and volunteer surgeons to take action. In 1996 the Pan-African Academy of Christian Surgeons (PAACS) was formed to provide excellent training for surgical residents, to provide certification for them, and to show the deficiencies in the government surgical training programs. Training surgeons in their home countries was thought to be the best approach since locally trained surgeons are more likely to stay in their countries and help their people. In addition, it is less expensive to train surgeons locally. It cost about $18,000 (US dollars) each year for 5 years to train a surgeon in Africa. Thus, for a total cost of $90,000 USD, you will have a well-trained, certified surgeon who will stay in his country and treat his people. This is far less that the cost of training surgeons in the United States or England. Currently there are 8 PAACS surgical residency programs in 6 countries: Bongolo Hospital, Lebamba, Gabon, Mbingo Baptist Hospital, Bamenda, Cameroon, Soddo Christian Hospital, Soddo, Ethiopia, Myungsung Christian Medical Center, Addis Ababa, Ethiopia, Memorial Christian Hospital, Malumghat, Bangladesh, Tenwek Hospital, Boomet, Kenya, Kijabe Hospital, Kijabe, Kenya, and Galami Hospital, Niger.   To be sure these graduating residents were adequately evaluated and certified, the College of Surgeons of East, Central, and Southern Africa was established in 1998 as the examining and certifying body for the PAACS residency programs. As part of the Kenya Surgical Society, and overseen by Dr. Pankaj Jani of the University of Nairobi, this group develops both the inservice exam given at the end of the second year of training and the completion exam at the end of the fifth year.   Every other year, first and second year surgical residents assemble at the Brackenhurst Conference Center in Limuru, Kenya, for a 2-week basic science course. The course includes detailed lectures on fluid and electrolyte therapy, anatomy, operative techniques, operative skills, and ethics. Part of the training program involves work in a surgical skills lab recently opened at the University of Nairobi to practice knot tying; doing intestinal anastomoses, arterial anastomoses, and ureteral anastomoses; and wiring jaws for the treatment of fractured mandibles.   This year I was honored to be asked to teach a wound course as part of the program. It was to be the first time wound care topics were included in the program! We covered everything from the basics of wound care to unusual wounds and ulcers they might encounter. During the hands-on portion of the course, we taught compression bandaging, making negative pressure wound dressings, and making advanced wound treatment products. My wife, Sheryl, organized and led some of the evening programs for the residents. It was a great experience for us, and we hope for the residents.   We met some amazing, dedicated surgeons and their families who are working in the far reaches of Africa providing greatly needed surgical care and training for African surgeons. The enthusiasm of the surgeons and residents for the work they are doing is very exciting. I have been truly honored to have had a very small role in their training and hope that we can continue to help prepare these young surgeons for their future treating very difficult wounds as well as surgical problems.   Their attitude is reflected in the words of a song they sung at several of the sessions. In Swahili the words are “Mamba Sawa Sawa”— things are getting better. Because of PAACS surgeons and residency programs, things are getting better for patients in Africa.