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The future of surgery in Africa

There has been a subtle, slow development in the surgical healthcare industry on the continent
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There has been a subtle, slow development in the surgical healthcare industry. Technological advancements, which gave birth to the minimal invasive surgical (MIS) approach, have been a game-changer in this aspect of healthcare. Initiated by gynaecologists, MIS has spread throughout the general surgical practice as its benefits become indisputable. However, the uptake of that practice has taken time to reach the African market due to a lack of policy integration. The massive impacts of the MIS in surgical management are too significant to ignore, so here’s why African governments should be fast to deploy this game-changing technology.

Challenges in Africa’s surgical healthcare system

One thing the 21st century has taught African governments is that technology is an opportunity to bridge development gaps between the global South and the global North. This reality has been more evident in the last decade as approaches to national development have been radically innovative. In the healthcare sector, a few African countries (e.g., Senegal, Ghana, Rwanda, South Africa and Egypt) have been at the forefront of some of these strides with strategic moves geared towards local manufacturing of vaccines and knowledge transfer that directly benefit their populations with regard to the development of skills, the upscaling of logistics, the creation of jobs, etc.

With regard to surgical practice, however, African governments are underperforming. The failure of many of them to allocate 15% of national budgets to the health sector, as the Abuja Declaration demands, can be felt in the quality of healthcare, and even more so in the surgical field. Indeed, acquiring MIS instruments and integrating MIS training into the curriculum of medical colleges of public universities should be driven by the government, especially since medical education in Africa is, in most cases, provided by these universities.

In the absence of public support, private surgical associations across the continent have taken up the challenge of filling the gap and are heavily investing in and facilitating the incorporation of the MIS technology into the surgical healthcare system. Associations such as the College of Surgeons of East, Central, and Southern Africa (COSECSA), the West African College of Surgeons (WACS), the Pan-African Academy of Christian Surgeons (PAACS) and the Kenya Obstetrical and Gynecological Society (KOGS) have tried to keep pace with these developments by training their members and exposing them to the most recent MIS techniques. But this is not a sustainable and it is insufficient to address the long-term needs of Africans in this regard.

The importance of Minimal Invasive Surgery (MIS)

The MIS technique has revolutionised the surgical field globally. This technique uses scopes, monitors and specific instruments that are inserted through small holes into the targeted body area. As a result, it allows less bleeding during the surgery and provides better view and access to targeted lesions inside the body. It also means less pain for patients after the procedure, among its many advantages.

Although gynaecologists conceived MIS specifically for procedures involving the deep pelvic organs, the MIS was rapidly adopted by the rest of the surgical fields. This tool has birthed a completely new surgical practice that requires a specific skillset with a relatively long learning curve which can only be acquired through continuous practice. Suffice it to say that the MIS reshaped the perception surgeons had of the human anatomy, thereby shifting their approaches in terms of exposing and accessing targeted tissues and organs.

As a result, conditions that were hitherto impossible or painful to manage, such as endometriosis, abdominal tissue biopsy and many more, have become possible and bearable to the patient. More importantly, the MIS is the equaliser in terms of surgical care in the world, and Africa has yet another window of opportunity to take care of itself.

Already, some global South countries have become major MIS promoters thanks to a mix of public and (mostly) private initiatives. These are Kenya, Mexico, India and, more recently, Rwanda with the launch of the “Institut de Recherche contre les Cancers de l’Appareil Digestif” (IRCAD).

IRCAD Africa was officially launched on 7th October 2023 and commenced its first training on 10th January 2024. The Rwanda IRCAD division became the seventh IRCAD centre worldwide, joining France (IRCAD’s headquarters), Taiwan, Brazil, Lebanon, China and the US. Where African surgeons were travelling to Europe or South Asia for advanced training, IRCAD Rwanda will now serve as an advanced focal point for the growing demand for MIS training in Africa. In short, an avenue for collaboration has presented itself to African universities and surgical institutes across the continent.

Beyond the policy and technical aspects of the MIS technique, there is a very encouraging drive towards knowledge transfer in most of the important North-South collaborations.

The field of surgery has undergone various revolutions throughout history, from the discovery of the concept of the human circulatory system to the use of energy in surgical hemostasis. With the advent of the internet and, more recently, Artificial Intelligence, the use of smart instruments is slowly but surely and radically transforming the healthcare industry. If the MIS sounds futuristic, the significant rise of even more precise surgical instruments and techniques, such as robotic surgery in high-income countries, is yet another stride Africa has to be aware of. And MIS is a stepping stone in that direction.

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