Jul 21, 2014

Building Botswana’s Surgical Care and Education Systems

Research, Students
Surgeons at the Princess Marina Hospital in Gaborone, Botswana performing a laparoscopic procedure.

Vitaly Kazakov

Surgeons at the Princess Marina Hospital in Gaborone, Botswana performing a laparoscopic procedure.When Georges Azzie first arrived in Gaborone, Botswana, he was the only paediatric surgeon in that country. Not anymore. Over the last decade, he has been spending three months a year in Gaborone performing surgeries and working with colleagues to address Botswana’s surgical care and education needs.

Azzie, who is an associate professor in U of T’s Department of Surgery and a surgeon at the Hospital for Sick Children, explains that a lack of surgeons, nurses and technical staff is a major health care challenge in Botswana. There are just a few general surgeons serving the country’s two million people, which means training Botswana’s next generation of health care providers is critical.

In 2005, two of the country’s hospitals had equipment for minimal access surgery, but lacked qualified surgeons who could use it. At the request of local officials, Azzie and his U of T partners helped develop a training program to increase the number of specialists in this area. Professor Allan Okrainec, also of the Department of Surgery, came up with the idea for cost-effective mentorship and upskilling. Using telesimulation, they taught 20 Botswana doctors the fundamentals of a minimally invasive surgical technique called laparoscopy.

Dr. Alemayehu Ginbo Bedada is one of the physicians who received that training. He works at the Princess Marina Hospital in Gaborone and teaches at the University of Botswana’s School of Medicine. He was recently in Toronto to present a study that describes a model for establishing a contextually appropriate laparoscopic program in resource-restricted environments.

Bedada’s paper will be published in the Annals of Surgery this year. The study, co-authored with Azzie and a group of local researchers, highlights the success of the Botswana’s program: improved patient outcomes, increased confidence among local surgeons and the fact that it is fully financed by their Ministry of Health.

“The beauty of our program is that we do not rely on external funding,” says Bedada. “Our ability to use only the government’s budget ensures its sustainability. We learned to improvise with the resources we have to achieve the best outcome for our patients. Our results are now equal to, and in some areas, even better than those of our North American partners.”

Bedada and Azzie also focus on the future: they hope to help train a new generation of Batswana surgeons. Two postgraduate students are already training in Cape Town, South Africa, while Dr. Balisi Bakanisi will be completing his general surgical training at U of T in 2015. Four other local medical care specialists are preparing for international training in surgery soon.

“One of the unique things Dr. Azzie did here is pushing for opportunities for local doctors to get advanced surgical training. Young doctors like Balisi are going to come back here and take over from us,” says Bedada.

Azzie’s international experience is extensive. His recipe for building productive, long-term international partnerships is the same wherever he goes: understanding, respecting and empowering your colleagues.

Another key to the success of Botswana surgical care and education initiatives is the team’s ability to work towards the same goal despite different backgrounds. Bedada, an Ethiopian, and his colleagues, who come from Egypt, Uganda, India, Canada, Botswana and other countries, all learn from each other and share the same dedication to their patients in Botswana.

“Longevity of the partnership, and the respect and thoughtfulness of everyone involved in it are the reasons the laparoscopic surgery program succeeded,” says Azzie. “We at the University of Toronto can now speak with significant authority on what it takes to establish a long-term relationship, how to sustain it and grow it further.”

The partnership also helped a number of U of T medical students learn about global surgery and international health in Botswana. In spring 2014, Dr. Stephanie Dreckmann spent six weeks in Gaborone doing a general surgery selective under the supervision of Azzie and Bedada. This experience helped Dreckmann hone her skills, expanded her medical expertise and gave her the chance to serve in management and health advocacy roles within a resource limited setting.

“I’ve been lucky to come along at a time where there is a ground swell of interest in global surgery and international health,” says Azzie. “I have benefitted from the guidance and the expertise of people who are ‘giants’ in this field, and I would like to pass my experience to others. There is a huge potential to expand our collaboration in Botswana to other kinds of surgical care and education.”

Photo: Surgeons at the Princess Marina Hospital in Gaborone, Botswana performing a laparoscopic procedure.