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6 Paediatric Surgery Specialty and its Relevance to Africa

ing has been adversely affected by the lack of adequate facilities and locality of each paediatric surgeon will likely improve early referral,
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limited exposure to current techniques. particularly for life-threatening conditions. A pocket manual of com-
Increasing global partnerships provide an opportunity to mon paediatric surgery conditions has been specifically written with
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improve human and material capacity. Such partnerships could such personnel in mind. 40
involve exchange programmes with colleagues and trainees from Conclusion
developed countries, but also intraregional collaboration that could be
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incorporated into local residency training programmes. Skills transfer The paediatric surgery specialty is now indispensable in the overall
can be achieved by using novel methods, such as telesimulation and effort to relieve the disease burden in Africa and other developing
telementoring, where mentors or experts in other parts of the world can regions. However, for the practice to remain relevant in the coming
offer advice or direct real-time surgical procedures being performed in years, advocacy for funding and public health policies geared towards
resource-poor hospitals. 36 the needs of children must be intensified and maintained.
Several professional surgical societies have recently developed Although significant obstacles exist in the infrastructure and workforce,
global surgery initiatives that provide training opportunities for African paediatric surgeons must take the lead as advocates for children and in
surgeons, including the American College of Surgeons (ACS), the educating the public as well as policy makers on the need to recognize
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American Paediatric Surgical Association (APSA), and the Association surgical disease in children as a significant health problem. By focusing on
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for Academic Surgery (AAS). Efforts are under way to create a central clinical excellence, engaging in serious research, and adopting a training
clearinghouse where all available overseas training opportunities will be model that provides real mentorship, African paediatric surgeons can
made accessible to trainees in developing countries. provide the highest level of carepossible to their unique group of patients.
Leadership Evidence-Based Research
Although specialty organisations for paediatric surgeons are essential, Table 1.3 presents a study on the costs and DALYs averted by a hospital
it is important to be connected to the wider field of surgery. This can be in Sierra Leone.
achieved by ensuring that paediatric surgery remains an integral com-
ponent of the surgery department educational activities as well as mor- Table 1.3: Evidence-based research.
bidity and mortality conferences. Presentation of research work should Title Cost/DALY averted in a small hospital in Sierra Leone: what is
not be limited to specialty meetings; rather, a strong paediatric surgery the relative contribution of different services?
presence needs to be maintained in national and regional conferences Authors Gosselin RA, Thind A, Bellardinelli A
involving surgeons of different specialties. Furthermore, paediatric sur- Institution University of California, Berkeley, California, USA; University
geons should seek every opportunity to network and collaborate with of Western Ontario, London, Ontario, Canada; Emergency
Hospital, Goderich, Sierra Leone
paediatricians by organising joint educational activities and participat-
ing in paediatric meetings. This will give paediatric surgeons visibility Reference World J Surg 2006; 30(4):505–511
among their peers and facilitate public recognition of their vital role in Problem To estimate the cost/disability-adjusted life years (DALYs)
the provision of child health care. The surgical section of the American averted by health facilities, including surgery in adults and
children, thereby providing cost-effectiveness data to guide
Academy of Paediatrics is the prototype for such collaboration. resource allocation decisions in the developing world.
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Paediatric surgeons should strive to achieve leadership positions in Intervention Estimation of the costs and the DALYs averted by an entire
their surgery departments as well as in umbrella national and regional hospital in Sierra Leone.
surgical organisations to ensure that the interests of children and the Comparison/ Cost-effectiveness analysis is a complex undertaking, but the
specialty are well represented. Finally, paediatric surgeons in Africa control DALYs method is probably the best composite measure.
should maintain strong collaborative relationships with colleagues in (quality of
other parts of the world at personal, professional, and organisational evidence)
levels. The quality, reputation, and international recognition of local Outcome/ For the three-month study period, total costs were calculated
specialty certification would be enhanced by recruiting examiners effect as $369,774, with an estimate of 11,282 DALYs averted (cost/
from other parts of the world to participate at the various local DALY averted of $32.78). This compares favourably to other
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certification examinations. nonsurgical health interventions in developing countries.
Support for Nonsurgical Personnel Historical This study suggests that contrary to traditional dogma,
Given the dearth of trained paediatric surgeons, it is inevitable that the significance/ surgery in adults and children is a cost-effective public health
vast majority of children with paediatric surgical conditions will seek comments intervention, particularly in developing countries. If these
findings are confirmed by future studies, they provide strong
care from adult surgeons, nonsurgeon physicians, and nonphysician rationale for expanding paediatric surgery care in Africa.
health professionals. Many newborn infants die needlessly due to lack
of referral for surgical care. Educational programmes that enhance the
awareness and diagnostic abilities of health care personnel within the

Key Summary Points

1. Childhood surgical disease is an understated cause of 4. Paediatric surgeons must take the lead as advocates for children
morbidity and mortality in Africa. among the public and policy makers.
2. Paediatric surgery saves as many disability-adjusted life years 5. Training needs can be partly met by utilising global partnerships.
(DALYs) as other public health interventions.
3. African paediatric surgeons have made significant contributions
to the specialty.