SURG-Africa is constantly working to improve the supervision model

SURG-Africa helps to address the constant flow of intestinal obstructions through practical workshops delivered by specialists from central hospitals for district clinicians. Parallel sessions included surgical nursing care and anaesthesia. Participants enjoyed hands-on practical sessions and interactions with their trainers.

​On the 21st of June the University of Malawi’s College of Medicine hosted a training event for SURG-Africa intervention district hospitals in Queens Elizabeth Central Hospital Skills Lab. The practical sessions included hands-on training in bowel anastomosis using animal soft tissues. The training included refreshers on suturing techniques and principles of surgical safety. In the afternoon participants shared their experience of the supervisory visits facilitated by SURG-Africa.

District clinicians practicing their skills in bowel anastomosis

The following day, specialists and district clinicians were joined by representatives from the Ministry of Health (MoH) to review project implementation to-date. The event brought to light results achieved and challenges encountered during the district visits.

​SURG-Africa researcher Gerald Mwapasa reported on the success of the WhatsApp-based clinical support network, which is now connecting over 59 district clinicians and 13 specialists and is still growing. Gerald explained that the network is very active, with good level of communication traffic and quick feedback times whenever a consultation is required. The main focus for now is on good referral management including sending detailed information from referring districts to receiving higher level facilities. By allowing district hospitals real time access to multi-specialist opinion free of charge, there is already evidence that the network is enhancing good practice, clinical decision-making, particularly in regards to avoidance of unnecessary referrals and improved case management at local level.

SURG-Africa Gerald Mwapasa describing the benefits of the clinical support network

​During the open floor discussions participants reported that unnecessary referrals are not always driven by lack of skills, but also by shortages of essential materials such as sutures and IV fluids. Unnecessary referrals cause serious congestion at central level, because referral facilities also face shortages of staff, infrastructure and supplies with no option of referring patients further. The SURG-Africa mobile network is helping clinicians to consider all alternatives before referring. The MoH representatives called for better planning practices at district level and more efficient supply chain from the central medical stores among the possible solutions to this problem.

Prof. Eric Borstein (SURG-Africa co-PI) added that visiting surgeons bring many benefits to the district hospitals. Apart from capacity building, they help district hospitals source basic supplies and equipment by facilitating redistribution across facilities when feasible. The supervisors also provide expert advice in addressing technical issues with the equipment. During a recent visit to Nsanje district hospital the SURG-Africa supervising anaesthesiologist was able to fix the local anaesthetic machines, so now both operating theatres are fully functional.

In their closing remarks MoH representative confirmed that the MoH is fully endorsing SURG-Africa and that the project should be seen as a ministry-led initiative which receives external support.