Training therapeutic endoscopy in Africa Olivier Le Moine, MD, PhD Department of Gastroenterology Hôpital Erasme, Brussels, Belgium
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BACKGROUND Portal hypertension and its complications related to Hepatitis B virus infection and Schistosomiasis have a very high prevalence in Senegal and West Africa (> 17%) Benign strictures of the oesophagus (accidental caustic ingestion in children and Plummer Vinson in adults) and malignant diseases are major healthcare problems in those countries. Simple endoscopic treatments as variceal band ligation or oesophageal bougienage were not available before the project 07/03/2013 3
AIMS OF THIS BELGIAN PROJECT To set up a close collaboration with Senegalese doctors and nurses in order to: To create a therapeutic endoscopic platform in Dakar, To teach basic endotherapy in the local conditions To spread eventually the experience to the whole country and the sub-region through the creation of the University Certification in Gastroenterology 07/03/2013 4
PREREQUISITES Evaluation of needs, preparation, confidence Universities partnership and political support Share the budget (between partners and private funding) Train mainly locally Involve doctors and nurses Take the opportunity of new technologies in Tele-Medicine Always think about: Basic logistics (water, electricity ) Costs (reusable devices) Create the breeding ground for autonomy to favour South-South cooperation 07/03/2013 5
METHODS: A LONG PROCESS First visit First Workshop First «atelier» Project preparation Project approval 1999 2000 2001 2002 2003 2004 2005 2006 Evaluation of the needs Creation of trust and friendship START! 07/03/2013 6
HUMAN RESSOURCES IN BELGIUM Doctors and Nurses Université Catholique de Louvain (UCL) Universiteit Gent (U Gent) Université Libre de Bruxelles (ULB) Université de Liège (Ulg) Vrije Universiteit Brussel (VUB) 28 missions over 4 years: this means half a year presence of a doctor and a nurse locally 07/03/2013 7
PLANNING OF MISSIONS IN DAKAR AND BELGIUM ( JULY 2005- JUNE 2009 ) YEAR 1 YEAR 2 YEAR 3 YEAR 4 Missions per year in Dakar Belgian Doctor 1 week 12 6 6 4 Belgian Nurse 1 week 12 6 6 4 Video-conferences per year 3 6 6 6 Fellowship in Belgium Senegalese nurses (2 months) 2 1 Senegalese doctors (6 months) 1 1 07/03/2013 8
BUDGET OF THE PROJECT ( ): JULY 2005 JUNE 2009 Senegal Rotary Belgium (CUD) Grand Total Renovation 38.000 - - 38.000 Equipment 15.000 54.420 18.358 87.778 Travel & hosting - - 116.278 116.278 Per Diem & Grants - - 42.864 42.864 Varia - - 28.268 28.268 TOTAL 53.000 54.420 205.768 313.188 Meaning less than 80.000 per year over 4 years 07/03/2013 9
L ASSISE LOCALE Pr M. Mbengue Pr M.L. Diouf Pr T.M. Diop
Khadija Aminata Malik 07/03/2013 11
SENEGALESE CONTRIBUTION Renovation and extension of the Endoscopy Unit Acquisition of a video processor with gastroscopes Creation of the Dakar University Certification in Gastroenterology 07/03/2013 12
RENOVATION PLAN Medical Office Toilets Waiting room Secretariat Disinfection Room Storage Recovery room Endoscopy rooms 1&2 07/03/2013 13
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RESULTS: THERAPEUTIC ACTIVITY (0 TO 10%) 160 140 120 100 80 60 VB Ligation Dilatations Others 40 20 0 2004 2005 2006 2007 2008 2009 07/03/2013 20
07/03/2013 21 ROTARY MATCHING GRANT
RESULTS: NURSES INPUT Knowledge of procedures/devices Help before and during procedures Scopes and ancillary devices disinfection Patient information before the procedure Contact with the patient during the procedure Information of patient /family after the procedure Situation in 2004 Situation in 2009 - ++ - ++ ± ++ - + ± + - + 07/03/2013 22
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UNIVERSITY CERTIFICATION IN GASTROENTEROLOGY 07/03/2013 24
CURRENT SCOPE OF THE PROJECT & POTENTIAL PERSPECTIVES Plateau technique Formation Expertise Enseignement Web-advice Mobile Endoscopy? Plateaux techniques Traitements Triage Enseignement Web-advice 07/03/2013 25
DEMAND FROM SURROUNDING FRENCH SPEAKING COUNTRIES ASKING FOR THE UNIVERSITY CERTIFICATION IN GASTROENTEROLOGY 07/03/2013 26
CONCLUSIONS This Project was build on a new concept: Learn and Train on site with doctors AND nurses With a limited belgian and private budget as well as confidence and active participation from senegalese and belgian partners, therapeutic endoscopy is settled in Senegal and is expected to grow more and more with the opening of University Certification in Gastroenterology Continuation of Education will now be cheaper and easier through the use of new technologies in Tele- Medicine A huge effort remains to be done for local scope maintenance and small repairs 07/03/2013 27
SLAVERY: millions of Africans were deported to America s From this door they went for a one way journey, 07/03/2013 28 eyes fixed on a never ending pain. Jo NDIAYE
BELGIAN PARTICIPANTS Academisch Ziekenhuis Vrije Universiteit Brussel (UZ Brussel) Mana, Fazia MD Urbain, Daniel MD Vlaes, Martine (nurse) Universitair Ziekenhuis Gent (UZ Gent) Anno, Heidi (nurse) Colle, Isabelle MD Devos, Martine MD Tollenaere, Tonia (nurse) Van Vlierberghe, Hans MD Centre Hospitalier Universitaire de Charleroi (CHU Charleroi) Bayot, Geneviève (nurse) Lamy, Vincent MD Centre Hospitalier Universitaire de Liège (CHU Liège) Belaiche, Jacques MD Fonsny, Véronique (nurse) Mathieu, Bernadette (nurse) Mesureur, Thierry MD Somja, Francine (nurse) Centre Hospitalier Universitaire Saint-Pierre (ULB CHU Saint-Pierre) Buset, Michel MD Dessy, Marie-Thérèse (nurse) Cliniques Universitaires Saint-Luc (UCL Saint-Luc) Aouattah, Tarik MD Deprez, Pierre MD Gaillez, Guy (nurse) Ikabou, Sebali (nurse) Cliniques Universitaires de Bruxelles Hôpital Erasme (ULB Hôpital Erasme) Dahri, Nabila (nurse) Delhaye, Myriam MD Delannoy, Dominique (nurse) Devière, Jacques MD Dib, Karima (nurse) Eisendrath, Pierre MD Evrard, Sylvie MD Lachapelle, Vinciane (nurse) Le Moine, Olivier MD Louis, Hubert MD Luyckx, Sabine (nurse) Mamboleo Tabu, Bernadette (nurse) Pirson, Michel (nurse) Simeti Naume, Brigitte (nurse) Vandermeeren, Alain MD Van Elsen, Béatrice (nurse) Van Horick, Julie (nurse) Wambacq, Valérie (nurse) Zola Mayuvula, Maxime (nurse) 07/03/2013 29