Needs and Opportunities in Sub-Saharan Africa
Lewis R. Roberts, MB, ChB, PhD
Professor of Medicine, Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, MN; President, Africa Partners Medical
Mark Topazian, MD
Professor of Medicine, Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, MN
Sub-Saharan Africa is at a turning point. A new generation, raised with cell phones and the Internet, is changing age-old social paradigms and political realities across the continent. Medicine in Africa is changing too. Patients are better informed, available therapies are broadening, and there is an urgent need for large numbers of well-trained health-care providers. More than ever, American gastroenterologists can make a difference in Africa.
Gastroenterology is at the forefront of Africa’s needs and opportunities. By some estimates, GI complaints account for up to 50 percent of patient visits, and GI illnesses are leading causes of mortality. Consider the following scenarios:
- A nine-month old infant presents with diarrhea and lethargy. You perform a venous cut-down and begin an intravenous saline infusion. When you round several hours later, you discover that the IV became dislodged, and she died.
- A 36-year-old man presents with bleeding esophageal varices. An African endoscopist, trained by visiting Americans, successfully ligates the varices. Antiviral therapy for hepatitis B is advised, but the patient is unable to afford the medication. Four years later, he is diagnosed with hepatocellular carcinoma.
- A woman dies of esophageal squamous cell carcinoma, the leading cause of cancer death in her region. Her oldest son undergoes screening upper endoscopy with chromoendoscopy, and is found to have esophageal squamous dysplasia that is treated endoscopically.
Each of these true stories reflects the toll of preventable illness as well as the opportunities for progress that exist across sub-Saharan Africa.
Robert Sedlack, MD, teaching variceal band ligation at a workshop in Accra, Ghana.
There is a critical need for trained health-care professionals in sub-Saharan Africa, including gastroenterologists. Besides seeing referrals and performing endoscopic procedures, African GI and liver specialists play a key role in training and creating health-care policy. However, most countries have few trained gastroenterologists. This shortage limits training opportunities for young physicians. Training in America or Europe is often an inadequate solution, as it is difficult for trainees to return to their home countries after settling in the developed world, and training in high-resource environments addresses a different spectrum of disease.
Initiatives are underway in many African countries to train gastroenterologists. Foremost among these are residency and fellowship programs at both national and mission hospitals. The World Gastroenterology Organization (WGO) has training centers in South Africa, Morocco and Egypt. Gastrointestinal endoscopy and device companies also play an important role by providing donations and loaning equipment and supplies to facilitate training. There are many opportunities for American gastroenterologists and hepatologists to teach in these settings.
The AGA has supported the creation of a postgraduate training program in gastroenterology and hepatology at Korle Bu Teaching Hospital in Accra, Ghana. The first fellows will begin training in September 2013. Short-term visiting professors are needed to teach in this program and in annual GI endoscopy workshops facilitated by AGA, WGO and industry partners. AGA members from seven states have joined colleagues from Africa and Europe to conduct these workshops, training endoscopists from six West African nations in therapeutic techniques such as variceal band ligation.
Our experience as visiting faculty in African settings has taught us these lessons:
- Be flexible and ready to adapt to the needs of learners and the resources at hand.
- Relationships are just as important as curriculum. Get to know your colleagues and students.
- Your effectiveness will increase with each return visit to the same location or program. Plan on returning.
Are you interested in teaching in sub-Saharan Africa? We know of opportunities in countries across the continent. In particular, we hope to include experienced gastroenterologists and hepatologists in a short-term teaching rotation for the AGA-sponsored training program in Accra, Ghana. If you have an interest in partnering with us, please contact Lewis Roberts (firstname.lastname@example.org), Mark Topazian (email@example.com) or the AGA Institute International Committee (firstname.lastname@example.org).
Dr. Roberts received significant research support from Bristol-Myers Squibb. He is also a member of AASLD’s hepatobiliary neoplasia special-interest group steering committee.
Dr. Topazian had no conflicts to disclose.