A surgical consultant stands under a tree in a dusty courtyard, teaching a group of surgeons from a wobbly whiteboard. It’s dusty but less suffocating than the tiny room they had been in.
Dermot O’Flynn says this was the moment when he really understood what’s needed to bring the East African surgical system up to scratch – you need to go the extra mile, he says.
‘We go there voluntarily; we come in and do this kind of training. It’s ‘training the trainers’ really. These people we are training are the future of the health services,’ says the director of professional development at the Royal College of Surgeons Ireland (RCSI).
Mr O’Flynn is part of collaboration between the RCSI and the College of Surgeons in East, Central and Southern Africa (COSECSA). The African association covers nine countries including Uganda, Tanzania and Ethiopia.
This began because the president of the African group in 2007, Prof Krikor Erzingatsian, had trained in Dublin. When his friend Prof Gerry O’Sullivan became head of the Irish group in the same year, they came together to launch training programmes.
Since then the partnership, which recieves funding from Irish Aid, has evolved to include a strong online element as well as Train the Trainer courses.This extends to sponsoring satellite dishes in remote hospitals like St Mary's Hospital in Gulu, Northern Uganda.
‘We are setting up the training courses in Uganda now. I’ve been to Rwanda, Zambia and Zimbabwe,’ Mr O’Flynn says. He says on a 15-day trip, he might train over 80 people.
Online training provided through a ‘School for Surgeons’ website fills a gap in the regional programmes. In Uganda, for example, there are 175 surgeons for a population of 34 million. These low numbers mean that taking time to train interns is limited.
This is a stark contrast to the Irish situation where 495 surgeons work with less than five million people.
Using the Irish-designed website, schoolforsurgeons.net, gives interns access to much-needed theoretical work. Interns in countries like Uganda receive more practical experience than their Irish counterparts, Mr O’Flynn says, but they need support for academic work. This simply means better access.
Speaking in Mulago Hospital in Uganda, one surgical intern says a typical medical book could cost 200,000 USH. In a country where the average monthly wage is 300,000 USH (€100), it’s just not possible to fill a library with the books an Irish student might take for granted.
In addition, surgeons say the discipline has traditionally not received as much attention in the development world as HIV/AIDS or malaria.
Dr Frederick Mutyaba, former COSECA president and recently retired from Mulago Hospital says it is a struggle to get trauma onto the agenda.
Speaking in Kampala after a day of exams, he says fund-raising is hindered because it’s not in the Millennium Development Goals.
‘When we talk about non-communicable diseases, we don’t talk about injuries or trauma. But it’s on the rise because of road accidents,’ he says.
Dr Mutyaba says injuries following road-accidents impact on a family’s ability to survive. He says surgeons need to lift their heads from work and advocate more to raise awareness.
To this end, he praises the partnership with Ireland and says an increased number of surgeons can only be positive for the region.
‘The programme has had a useful impact in kick-starting training activity. Developing countries need more surgeons, many things are in their formative stages now,’ he said.
Although working in Uganda, he says these are problems shared across the nine COSECSA countries. In some areas, the problem is even more urgent – he says in Mozambique the population of almost 24 million is served by just three surgeons.
‘My hope is that students who take exams today will take over. We are ageing now, we need replacements. But we are hopeful, we have worked hard and now that is paying off,’ he says.
Niamh Griffin travelled to Uganda with support from the Simon Cumbers Media Fund The fund was set up in memory of Irish journalist Simon Cumbers. In June 2004, at the age of 36, Cumbers was shot dead in Saudi Arabia while working with the BBC.