GEEF2021 on SD_Featured Session on Feb. 4, 2021
The Global Engagement & Empowerment Forum(GEEF) 2021 on Sustainable Development (SD), is an annual international events, organized by the Institute for Global Engagement & Empowerment (IGEE), Yonsei University and the Ban Ki-moon Centre for Global Citizens, where all stakeholders, including global leaders and experts, convene to collaborate towards accomplishing the United Nations' 2030 Agenda for Sustainable Development.
Medical Mission Center, Yonsei Institute of Global Health held the Featured Session 5, "Global Partnership & Higher Education: Postgraduate Medical Education in Africa: the status quo and challenges"
Featured Session 5
Global Partnership & Higher Education
Postgraduate Medical Education in Africa: the status quo and challenges
• [Co-moderator] Dr. Chin Pak
Director, Medical Mission Center, Yonsei Institute for Global Health, Yonsei University Health System
• [Co-moderator] Dr. Paul Choi
Director, International Program, Medical Mission Center, Yonsei University Health System
• [Keynote Presenter] Dr. Mike Chupp
CEO, CMDA(Christian Medical Dental Association); former medical superintendent of Tenwek Hospital, Kenya; faculty for PAACS(Pan-African Academy of Christian Surgeons), General Surgeon
• Dr. Mark Oloo
General Surgeon, St. Luke Medical Centre, Kismu, Kenya
• Dr. Jin-Kyong Chun
Medical Director of Africa Future Foundation Zimbabwe; Volunteer Lecturer, Dept. of Paediatrics and Child Health, University of Zimbabwe, College of Health Sciences
• Dr. Betty Abbo Kasimo
Medical Officer Special Grade of Makerere University, Uganda; International fellow, Department of Pathology, Yonsei University Health System
• Dr. Dong-Won Kang
Representative of Africa Future Foundation Zimbabwe; Volunteer Lecturer, Dept. of Clinical Pharmacology, University of Zimbabwe, College of Health Sciences
Medical education consists of undergraduate and postgraduate training. Postgraduate training includes participating in residency training and continuing education programs. Postgraduate training is important for medical school graduates to develop their specialities. However, postgraduate training in Africa is not standardized in each country. Recently many domestic and international institutions started working together to improve postgraduate training in Africa. The speakers discussed the status quo and challenges of postgraduate training from the perspectives of a local professor, students, and international health workers. During the session, the speakers touched upon the impact of postgraduate training on the Christian medical mission and how COVID-19 has affected the postgraduate medical training in Africa.
Dr. Mike Chupp
“The mission of PAACS is to train and disciple African surgeons to glorify God and to provide excellent and compassionate care to those most in need.”
“Frankly, African nationals, in my experience, were usually better and more culturally sensitive to the care of their own people and what their own people culturally needed in care. There's a slow but steady nationalization of many department positions that occurs because of this training, graduate training.”
By the end of 2020, a post-graduate training program in surgery, called the Pan African Academy of Christian Surgeons (PAACS), a 501©3 organization based in the USA, had produced 117 fully trained surgeons in sub-Saharan Africa to reside and practice in sub-Saharan Africa. These post-graduate surgical training programs are found in 13 hospitals in 8 African countries: Kenya, Tanzania, Malawi, Ethiopia, Cameroon, Gabon, Niger, and Egypt. Most of the graduates completed a five-year training program in general surgery accredited by Adventist medical school, Loma Linda School of Medicine, Department of Surgery, in southern California, USA, but others completed specialty training in orthopedics, pediatric surgery, and head and neck Surgery. Newer training specialties include cardiac surgery and neurosurgery.
The PAACS program is a collaborative effort between Loma Linda University School of Medicine, PAACS, and thirteen Christian mission teaching hospitals across the Africa continent. Graduates in the East African programs have been examined and certified under the auspices of the College of Surgeons of East, Central and South Africa (COSECSA) and have been licensed by medical boards in the countries of the respective training programs. Teaching faculty came primarily from the USA as volunteers in the first decade of the program but African faculty, including many of the graduates, have played an increasing role as the programs have matured and reproduced with graduates taking leadership roles in the original training programs as well as other mission hospitals.
Graduates of the PAACS training program have remained on the continent and are actively providing surgical care in underserved populations of 21 Africa countries. New surgical specialty training programs are scheduled to start in 2021/22 in the specialties of obstetrics and gynecology, anesthesia, surgical endoscopy, and plastic surgery. The PAACS program envisions expanding to several other countries across the continent with the goal of having PAACS graduates in 36 countries by 2026.
Co-Moderator; Dr. Chin Pak
“I realized in the medical school that it’s not my 100% responsibility to be a good doctor. Then who shares the responsibility? My school, medical school and the Korean government shares the responsibility to provide curriculum and infrastructure and ecosystem.”
“We will not discuss how to push, how to force medical student to study hard to be a good doctor. But we will discuss how we can provide a good curriculum and good system to make competent doctor.”
Co-Moderator; Dr. Paul Choi
“How do you incorporate the motto of Tenwek Hospital ‘We treat. Jesus Heals’ into the PAACS program?”
Dr. Mark Oloo
“The greatest thing that you come to learn once you leave the PAACS program and learn to appreciate is it was a program that was brought up fundamentally, in the Christian basis. We did a lot of things that were leading towards taking care of the patient in a wholesome way.”
My post graduate training was under the umbrella of Pan African Academy of Christian Surgeons (PAACS) at Tenwek Hospital in Western Kenya. It is a training program that is associated with College of Surgeons of Eastern, Central and Southern Africa (COSECSA). The program is broken into 2 levels the membership (MCS) level and the Fellowship (FCS). On has to complete the membership level before advancing to the fellowship level. Before introduction of the fellowship model of postgraduate, all the postgraduate training in Kenya for medicine was through master’s programs in the universities.
The main challenges facing the trainees is availability of training positions. The country produces about 600 medical doctors from the undergraduate training but does not have adequate postgraduate positions to absorb them. In addition, some institutions may provide some programs but don’t have the basic capacity to run them. In a number of programs, the trainee has to pay fees and work on the side. During my stay at Yonsei University I noticed without a doubt that we in Africa lacked infrastructure. Availability of modern and sometimes basic equipment is a big issue. Funding remains a big problem especially for research and development. For specialized training, many of our trainees have to go out of the country for fellowships. I had a fellowship in laparoscopy at Yonsei University in mid 2019.
For the impact of the Christian Medical Mission, as time goes by missionary work has reduced in training, but this largely may be due to the impact of COVID-19. Fewer foreign visits thus fewer people with much required expertise. The pandemic also affected all the postgraduate master’s programs as all universities initially closed but have slowly opened for classes again.
Dr. Jin-Kyong Chun
“For the successful implications of postgraduate program, we must know each condition of the specific medical society and supply the 3 key components: adequate resources, manpower, and proper income.”
“A wholesome approach of building strong relationships, though it may take time, should be the first step.”
The need of postgraduate training is facing new challenge because of COVID-19 Pandemic. The supply of medical consumables, recently developed medications, and guarantee of living fee during training period are not enough in developing countries. My observation in Zimbabwe medical society urged me to attend this forum and I’d like to introduce real situation that I have experienced. Usually, we don’t know well about the tradition of targeting countries and approach the problem with our own method. However, this kind of effort might not be successful because the environment is totally different and multifactorial elements are involved in medical system.
When we implicate postgraduate training, three major determinants for improving clinical training system in Africa medical societies need to be considered. The first one is adequate resources to do clinical practice in line with up-to -date knowledge. The second one is manpower. For successful practice with high-level technology, meticulous patient care is required. Therefore, skillful nursing staff and on-call doctor system should be operated in cooperation. And the last one would be a proper income which guarantees stable practice and continuity of health workers. If economic situation is unstable, which is a usual situation of Africa, patients are not able to visit clinic for the treatment even with a persistent pool of patients. Therefore, after education, steadfast support is strictly required for the purpose of continuous clinical practice.
Dr. Betty Abbo Kasimo
“These challenges call for innovative approaches in medical education. … Collaborative approaches such as consortia formation by stakeholders, if met, will actually improve the efficiency and effectiveness in terms of training.”
The state of medical education in sub- Saharan Africa has been lagging behind. The region is extremely short of the required number of qualified health professionals. The challenges call for innovative approaches in medical education. Collaborative approaches such as consortia formation by stakeholders have been shown to improve efficiency and effectiveness. Collaboration among country’s medical school was not done in Africa and Uganda in particular in the past. This was seen as a challenge in the face of differing organizational cultural context. Up-to-date Ugandan universities still don’t have exchange programs.
The challenges faced during postgraduate are lack of adequate funding of basic and social services due to political mismanagement, inadequate salaries lead to brain drain, shortage of supervisors, and stringent regulatory environment regarding training of health workers. Other barriers include insufficient infrastructure such as internet shutdown in Uganda, and lack of modern diagnostic equipment.
The impact of postgraduate training on the mission is that gaps will be identified during the training. This will enable the mission to promote strong collaborative and provide mutual support, as well as sharing of resources for medical education to improve the quality of postgraduate training.
The effect of COVID-19 on postgraduate training have been serios. There is a lack of personal protective equipment, suspension of clinical clerkship and observation, reduction in the number of elective cases. The trainee’s mental health has been affected and online learning is often interrupted due to poor internet network.
Dr. Dong-Won Kang
“Provision of adequate research opportunities to postgraduate students may be accomplished through efforts to secure stable funding resources in African countries.”
“Establishment of more efficient networking bodies responsible for facilitation of connecting the available funding resources to the appropriate researchers is desirable. At the same time, further incessant efforts to recruit more research funds from various sources, like from those outside of the country, seem to be also required.”
Scientific and medical research is one of major areas where the health workers such as medical doctors and nurses must seek continuously throughout their profession because it is the basic, methodological norm through which whole medical knowledge is systematically standardized.
In area of clinical pharmacology, researches to find the possible candidates for medicinal products from the natural herbs are frequently tried by postgraduate students because there are ample targets in African environment that have been known to have medicinal effects for various diseases. However, one of the major obstacles for researches is the scarcity of funding resources. The individual postgraduate students have to find their funding resources to perform research by themselves, and this has been frequently the cause of delay in researches or failure of continuing researches.
Currently, some of the researches are supported from funds set up by South African Institutions or WHO although they are yet limited. To resolve the current situation, establishing more efficient networking body responsible for facilitation of matching the available funding resource to the appropriate researcher is necessary. At the same time, further incessant efforts to recruit more research funds from various sources like from outside of the country are also required.
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