TRAINEES AND STUDENTS

TOMORROWS
DOCTORS

The Association of Surgeons in Training

travelled to Rwanda, East Africa, to deliver
its Foundation Skills in Surgery course

lmost one million people, mostly ethnic

Tutsis, were killed during the Rwandan
genocide of 1994. In this period, and for
many years after, Rwanda had the lowest life
expectancy of any country in the world1. Since
then the economy and healthcare system
have made remarkable progress, with adult mortality
rates decreasing and life expectancy almost doubling.
Nonetheless, Rwanda remains extraordinarily poor, with
a per capita income of $1,500 a year, and many citizens
unable to access even the most basic healthcare1. With only
50 surgeons serving a population of 11.8 million, the need
for surgical training is particularly great2.
With a growing interest in surgery worldwide, the
Association of Surgeons in Training (ASiT) set about
organising a pilot surgical skills course at the Central
University Teaching Hospital (CHUK) in Kigali, the
Rwandan capital. The Foundation Skills in Surgery course,
developed by ASiT, has been run within the UK and

REFERENCES
1. World Health
Organization
Global Health
Observatory Data:
Rwanda.
www.who.int/
countries/rwa/
en/ (accessed
25/09/2014).
2. Petroze RT,
Nzayisenga A,
Rusanganwa
V, Ntakiyiruta
G, Calland JF.
Comprehensive
national analysis
of emergency and
essential surgical
capacity in
Rwanda. Br J Surg
2012; 99: 436443.

Rwanda has made

great strides in
increasing life
expectancy

Republic of Ireland for several years. This one-day course

aims to teach medical students and foundation doctors
the fundamental skills for safe surgical practice during the
early years of surgical training. Topics covered include:
sterile gloving and gowning; safe handling of instruments;
knot-tying and suturing techniques. This course content
was adapted for delivery in a resource-poor setting, and
combined with work undertaken previously in Rwanda by
Ed Fitzgerald for the Lifebox Foundation (www.lifebox.
org), a non-governmental organisation working to make
surgery safer in low and middle-income countries.

With only 50 surgeons

serving a population of
11.8 million, the need for
surgical training is particularly
great so the skills teaching
we were able to provide these
final-year medical students
seemed incredibly valued
50 | Surgeons News | December 2014

A clinical
skills session
includes suturing
techniques

Trainees learn
about good
practice

The target audience for this course was final-year

medical students at the University of Rwanda. Rwandan
medical education is delivered predominantly through
traditional observational experiences, and there is a real
shortage of dedicated practical surgical skills training.
Next year, this cohort of students will become interns and
will be performing tasks such as Caesarian sections in the
district hospitals of Rwanda, so the surgical skills teaching
we were able to provide seemed incredibly valued.
Over two days, 55 final-year medical students attended
the course, many of whom had travelled for many hours
to attend and arrived more than an hour early. The
morning talks covered the importance of good medical
record-keeping and the basics of suturing, drains and
instruments, with much interaction from the students.
This was followed by the clinical skills session, in
which students practised sterile gloving and gowning
(surprisingly difficult in an uncomfortable 29C heat),
hand and instrument knot-tying, safe handling of sharps,
and suturing techniques such as interrupted, mattress
and subcuticular alongside skin-lesion excision.
Afternoon talks covered the importance of auditing
and research to maintain good clinical practice, and the
concepts of collaborative research and the GlobalSurg
programme. The final session covered surgical safety and

FURTHER
READING
ASiT Rwanda
Foundation
Skills in Surgery
blog: www.asit.
org/news/FSS_
Rwanda_2014
Lifebox
Foundation:
www.lifebox.org
GlobalSurg: http://
globalsurg.org
If you are
interested in
supporting future
ASiT international
surgical training
ventures please
donate at
www.givey.com/
asitrwanda or
email info@asit.org

Lifeboxs work on the implementation of the surgical

safety checklist, and pulse oximetry.
The course was concluded with a prize-giving session
of donated books and equipment. The remainder of these
donations was divided between the surgical section of
CHUKs library and the University of Rwanda Student
Surgical Society for distribution throughout the countrys
district hospitals.
Feedback demonstrated that the course was highly
appreciated by the students, with a median rating of
9.25/10. Qualitative feedback was universally positive, with
themes including a desire for longer and repeated training.
The venture was a truly eye-opening experience
providing insight into the healthcare and social
challenges doctors face within low-income countries,
and giving an opportunity to develop cross-cultural
communication skills and working relationships. There
are plans to return to Rwanda next year, with the focus
on engaging local senior doctors and securing further
funding, both essential in order to create a genuinely
sustainable training programme.
ASiT is thankful for the support of Dr Georges
Ntakiyiruta, Chief of Surgery at CHUK, as well as
Zeta Mutabazi and Philippe Nyembo, two enthusiastic
medical student coordinators who took charge of local
arrangements including ensuring that porcine tissue had
accompanying veterinary authorisation one of many
lessons we learned.
ASiT is extremely grateful for support from the Royal
College of Surgeons of England, the Royal College of
Physicians and Surgeons of Glasgow, Lifebox Foundation,
Swann-Morton and MedAID, together with all the
individual trainees who donated money and equipment.
RLH, AB and WM were awarded the Rex & Jean Lawrie
Fellowship and JEFF, AJB and VG were awarded the
Stefan & Anna Galeski Fellowship, all in association with
the Royal College of Surgeons of England.
Rhiannon L Harries, J Edward F Fitzgerald,
Andrew J Beamish, William Muirhead,
Aneel Bhangu, Vimal Gokani
Association of Surgeons in Training, @ASiTOfficial
www.rcsed.ac.uk | 51