The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course.

BACKGROUND: Inadequate trauma care training opportunities exist in Low- and Middle-Income Countries. Jos University Teaching Hospital and the West African College of Surgeons (WACS) have synergized, over the past 15 years, to introduce a yearly, certified, multidisciplinary Trauma Management Course. We explore the history and evolution of this course. METHODS: A desk review of course secretariat documents, registration records, schedules, pre- and post-course test records, post-course surveys, and account books complemented by organizer interviews was carried out to elaborate the evolution of the Trauma Management Course. RESULTS: The course was started as a local Continuing Medical Education program in 2005 in response to recurring cycles of violence and numerous mass casualty situations. Collaborations with WACS followed, with inclusion of the course in the College's yearly calendar from 2010. Multidisciplinary faculty teach participants the concepts of trauma care through didactic lectures, group sessions, and hands-on simulation within a one-week period. From inception, there has been a 100% growth in lecture content (from 15 to 30 lectures) and in multidisciplinary attendance (from 23 to 133 attendees). Trainees showed statistically significant knowledge gain yearly, with a mean difference ranging from 10.1 to 16.1% over the past 5 years. Future collaborations seek to expand the course and position it as a catalyst for regional emergency medical services and trauma registries. CONCLUSIONS: Multidisciplinary trauma management training is important for expanding holistic trauma capacity within the West African sub-region. The course serves as an example for Low- and Middle-Income contexts. Similar contextualized programs should be considered to strengthen trauma workforce development.

Construction of a low-cost, improvised, negative-pressure, closed tube surgical drain for low resource settings: A preliminary report.

We describe construction of an improvised, low-cost, negative-pressure, closed tube surgical drain constructed from an empty intravenous fluid container and an infusion giving set used in the low-resource rural context.

A Survey of Perceptions of Surgical Trainees on Feedback During Training in West Africa.

BACKGROUND: Feedback has become an integral part of learning within the medical profession, particularly as training becomes more trainees'-centered. Feedback from the trainees about their training and trainers is essential for effective and high-quality training. The purpose of this survey was to evaluate trainees' perceptions on feedback on their postgraduate training and trainers in West Africa. METHODS: Cross-sectional self-administered written survey of junior and senior registrar attending the annual revision and update course of the West African College of Surgeons. Information sought included sociodemographic variables, perception on feedback, opportunity to give feedback, trainee-trainers relationship and their opinion on different aspects of the postgraduate program where they would like to give feedback. RESULTS: The response rate was 81.5% (66/81). Median age was 33 years. Sixty trainees (90.9%) were junior registrars. Sixty-four (97%) trainees would like to give feedback about their training and trainers. Only 18 (27.3%) trainees have had opportunity of giving feedback about their training. Most trainees (90.9%) would like to give feedback on patient care and learning environment; 89.4% would like to give feedback on their training curriculum and 87.9% would like to give feedback on their operating room experiences. Most trainees (81.8%) believed trainee feedback is of critical importance to training. With regard to trainees-trainer relationship, 39 (59.1%) trainees were either unsatisfied or reported just a fair relationship. CONCLUSIONS: This study has shown that many of the trainees lack opportunity of giving feedback on their training but considered feedback critical to their training. Trainees would like to give feedback on patient care, curriculum, learning environment and operative room experience. Trainee feedback should be encouraged in surgical training in West Africa.

Breast Cancer Screening in a Resource Poor Setting: A Preliminary Report

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre; Lafia; Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered; it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years; mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2) had some knowledge about breast cancer; 1;269 (60.5) had no formal education; 881(42.1) were petty traders while 501(23.9) were full time housewives. Four hundred and seventy (22.4) had a positive family history of breast disease; 437 (20.9) had history of use of oral contraceptives; and 9 (0.4) had a previous breast biopsy. Four hundred and sixty one (22.0) complained of breast discomfort; 184 (8.8) complained of breast lumps; but only 95 (4.6) of them had lump on clinical breast examination; while a further 8 (0.4) lumps were found on breast imaging. One thousand nine hundred (90.7) had normal breast screening results; 166 (7.9) had benign breast diseases and 29 (1.4) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit

Breast Cancer Screening in a Resource Poor Setting: A Preliminary Report

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre; Lafia; Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered; it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years; mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2) had some knowledge about breast cancer; 1;269 (60.5) had no formal education; 881(42.1) were petty traders while 501(23.9) were full time housewives. Four hundred and seventy (22.4) had a positive family history of breast disease; 437 (20.9) had history of use of oral contraceptives; and 9 (0.4) had a previous breast biopsy. Four hundred and sixty one (22.0) complained of breast discomfort; 184 (8.8) complained of breast lumps; but only 95 (4.6) of them had lump on clinical breast examination; while a further 8 (0.4) lumps were found on breast imaging. One thousand nine hundred (90.7) had normal breast screening results; 166 (7.9) had benign breast diseases and 29 (1.4) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit

Violence in the emergency department: a multicentre survey of nurses' perceptions in Nigeria.

BACKGROUND: Emergency department (ED) violence is common and widespread. ED staff receive both verbal and physical abuse, with ED nurses bearing the brunt of this violence. The violence is becoming increasingly common and lethal and many institutions are still improperly prepared to deal with it. METHODS: A questionnaire based survey of the perception of violence among nurses working in six tertiary hospitals' EDs across five states in Nigeria was conducted. RESULTS: 81 nurses were interviewed with a male to female ratio of 1:4. Most were right about the definition of violence. About 88.6% of respondents have witnessed ED violence while 65.0% had been direct victims before. Nurses followed by doctors were the usual victims. The acts were carried out mostly by visitors to the ED. Men were usually responsible for the violence, which usually occurred in the evenings. Weapons were not commonly utilised: only 15.8% of the nurses had been threatened with a weapon over a 1-year period. The main perceived reasons for violence were overcrowded emergency rooms, long waiting time and inadequate system of security. All the institutions were lacking in basic strategies for prevention. While most of the nurses were not satisfied with the EDs that were considered not safe, few would wish for redeployment to other departments/units. CONCLUSIONS: There is a need to make the EDs safer for all users. This can be achieved by a deliberate management policy of 'zero' tolerance to workplace violence, effective reporting systems, adequate security and staff training on prevention of violence.

Skills acquisition for trainee urologists: are the Federal Medical Centers in Nigeria suitable?

BACKGROUND: Surgical training involves acquisition of knowledge and skills. The district hospitals are known to play complementary role in surgical training in many parts of the world; it is time to evaluate for the possible role Federal Medical Centers (FMC) in Nigeria can play to complement the training of urologists. Against this background, we retrospectively reviewed the relative frequency of urologic procedures performed in one of the FMC as a case study. MATERIALS AND METHODS: Hospital data were retrospectively reviewed from January 2007 to June 2010 and records of urologic procedures were extracted for analysis. The total numbers of operations done within same period were also recorded. RESULT: Urological procedures formed 24.6% of the surgical operation in the hospital during the study period. Uncomplicated prepuce, bladder outflow obstruction, uro-oncology and congenital urological lesion topped the list and accounted for 31.3%, 22.7%, 11.9%, and 11.0% of the cases, respectively. The most frequently performed urological operation in the center was circumcision. Nephrectomy, ureteroneocystostomy, pyeloplasty, cystectomy, and urinary diversion were other procedures performed. CONCLUSION: The varieties and volume of urologic cases recorded in this centre is comparable with those documented in other established training institutions and thus, it is recommended that the trainees should find time to visit some of these centers and acquaint themselves with hands-on surgical exposure.

Abdominal aortic aneurysm and the challenges of management in a developing country: a review of three cases.

There is an increase in the incidence of abdominal aortic aneurysm (AAA) over the last six decades, probably as a result of higher longevity and lifestyle changes witnessed in the years following World War II. Though earlier studies mainly from Southern Africa suggest abdominal aortic aneurysms as uncommon amongst black Africans, recent reports from Africa emphasized an increasing incidence of vascular diseases and its sequelae including AAA. There are, however, few documented case reports of AAA in our environment over the years suggesting the rarity of this disease. We report the management and outcome of three different types of infrarenal AAA with synthetic graft in a General Surgery Unit over a four-year period between 2001 and 2005. Follow-up evaluation confirmed a successful outcome in two patients. Abdominal aortic aneurysms may be occurring more frequently than reported in our environment and its management, using basic evaluation techniques, can be successfully achieved with reasonable outcome when performed in a non-specialized unit by General Surgeons in institutions with limited resources. Contrary to the popularly held view of rarity of AAA, the disease may be increasing in incidence amongst black African. Its evaluation and treatment is also feasible with the availability of reconstructive graft in a non-specialized surgical unit.

Management of postoperative enterocutaneous fistulae in children: a decade experience in a single centre.

BACKGROUND: Enterocutaneous fistula (ECF) in children poses a lot of management challenges due to sepsis, malnutrition, fluid and electrolyte deficits, which are frequent complications. Knowledge of prognostic factors of postoperative ECF is essential for therapeutic decision-making processes. This study examined the variables that relate to the outcomes of management of ECF in children. PATIENTS AND METHODS: Consecutive children who were managed for postoperative ECF in our unit between 2000 and 2009 were evaluated. Data were analysed for clinical features, management and its outcome. RESULTS: A total of 54 patients were managed for ECF. Majority of the fistulas were due to operation for infective causes, with typhoid intestinal perforation ranking the highest. Overall, spontaneous closure without operative intervention occurred in 29 (53.7%) patients. Twenty-one (38.9%) patients required restorative operations to close their fistulas, which was successful only in 12 (22.2%) patients. There was a strong correlation between high-output fistulas (jejunal location) and surgical closure (P<0.001). Hypoalbuminaemia and jejunal location profoundly resulted in non-spontaneous closure of ECF (P<0.001) and were associated with high morbidity (P<0.001). Thirteen (24.1%) patients died due to hypokalaemia, sepsis and hypoproteinaemia/hypoalbuminaemia. CONCLUSIONS: Majority of the ECF in children closed spontaneously following high-protein and high-carbohydrate nutrition. Hypoalbuminaemia and jejunal location were important prognostic variables resulting in non-spontaneous closure, while hypokalaemia, sepsis and hypoproteinaemia/hypoalbuminaemia were associated with high mortality in children with ECF.