African Unification Front
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2001
SURGERY FOR AFRICA
AUGMENTING THE AFRICAN SURGICAL REGIME
There is a severe lack of surgeons in the African Union. It is important to cut short the time that it takes to train African surgeons without the loss or reduction of high quality surgical skills. This is possible to achieve because surgeons in Africa will get more caseloads to work with in order to become more proficient. At last count Malawi had two African surgeons, the rest being expatriates from Europe. Because there are hundreds of African surgeons in Diaspora, the scarcity in Africa is administrative and structural and is amenable to a limited corrected in the very short-term (simply by making it easier for African specialist surgeons abroad to work in the Africa Union more often). Currently, for example, the number of practicing neural surgeons in Africa is too small. Ghana has only three, including Dr. Mohmud Dakurah.
Using as a model program the Essential Surgical Skills course given by the Canadian Network for International Surgery, in conjuction with the Association of Surgeons of East Africa ASEA, Africa's largest surgical association, the Malian Association of Surgeons, or the Ethiopian Association of Surgeons, it is possible to train hundreds of thousands of medical and non-medical personnel in basic surgical technique within a relatively short-time (months). A short course administered by medical schools across the African Union will last one week, and will qualify thousands of medical students to do emergency surgery. If these courses are augmented with more time, and a follow-up procedures established, it is possible to raise the number of qualified surgeons to hundreds of thousands in order to match the demand in the African Union.
The massive use of emergency surgical training techniques by medical students and general practitioners would alleviate the shortage of surgeons for non-specialist surgical procedures that are more prevalent than other surgical disorders (Surgical Fundamentals, Anesthesia & Life Support, Gastrointestinal Emergencies Obstetrical & Genital Urinary Emergencies Orthopedics & Traumatology).
HOSPITALS IN AFRICA
The Red Cross War Memorial Children's Hospital was built in 1956 is the only freely available, dedicated paediatric hospital in southern Africa, and indeed, in Africa south of Cairo. Its mission is to be the foremost centre of excellence for specialist paediatric services in Africa, and to provide comprehensive health care of the highest quality to children and adolescents in a nurturing and friendly environment.
The Hospital cares for some 250,000 children each year. It has built up enormous expertise in many areas of paediatric diagnostics and health care delivery. As a result, children with particular problems are referred to the Hospital from all over South Africa and from many other countries in the region.
Affiliated to the University of Cape Town, the Red Cross Children's Hospital is the centre at which undergraduate and postgraduate medical students receive their core training in paediatric disciplines. Specialist paediatric nurses and allied paediatric health care providers, such as physiotherapists, child psychologists, speech and occupational therapists are also trained there.
The Hospital is active in preventative health care, and plays a critical role in educating community health workers, thereby facilitating the exportation of models of good practice to the community. Several services are provided, including education of children, parents and community health care workers in, for example, HIV, Aids, family planning and contraception, rehydration and nutrition. The Hospital has also established and maintains three significant national information database resources, viz.
The Poisons Information Service; The Childcare Information Centre; and The Childhood Accident Prevention Foundation of South Africa (CAPFSA).
The Red Cross Children's Hospital is internationally renowned for the standard of its paediatric care, as well as for its research and training programmes. In the area of paediatric care, the hospital can proudly claim a number of significant "firsts", including:
[1] The first open heart surgery on a child in South Africa and the first paediatric heart transplant in South Africa. The success rate in heart surgery, where there are between 4 and 6 operations a week excluding emergencies stands at around 86%.
[2] The first liver transplant in a child in South Africa. Indeed, the hospital is the only centre for paediatric liver transplantation in the country, and children and parents often have to relocate to avail of this service. Since the Liver Transplantation programme was commenced in 1991, 28 children have undergone liver transplants, and most are now living completely normal lives and enjoying a childhood.
[3] The first combined liver and kidney transplant on a child in South Africa. The child that received this life-saving treatment, Wilmot Africa, is doing very well.
[4] The Hospital has performed more separations of conjoined twins than any other institution in the world.
[5] The first neonatal surgery unit in South Africa.
[6] The first implantation of a windpipe in a child in the world.
[7] The first, and only, centre for childhood accident prevention in South Africa (CAPFSA).
[8] The first, and only, paediatric trauma Centre in South Africa.
[9] The first Poisons information centre in South Africa.
[10] The first children's cancer service in South Africa. The Cancer Ward has a cure rate of up to 80% in certain types of cancers.
[11] The first, and only tracheostomy home care management programme in South Africa has enabled children with these problems to be managed at home for the first time ever.
CONDITIONS AT THE HOSPITAL
The Red Cross Children's Hospital sees over a quarter of a million children each year from throughout South and Southern Africa, providing a standard of care that has become the benchmark for paediatric practice in Africa. It is probably, however, the Hospital’s overwhelming success that has lead to its current crisis.
Originally designed to cope with 220 inpatient beds, the Hospital is operating some 300 beds year round. At the same time, the Specialist Outpatients and Emergency Services Department, that alone treats some 200,000 children each year, is currently operating out of pre-fabricated structures that were originally put up as an ad-hoc temporary solution some 30 years ago. These are not only leaking in many areas, they are also desperately overcrowded and inadequate, with the random layout of these structures inhibiting efficient patient flow. Corrugated iron roofing means they are baking hot in the summer and freezing cold in the winter – making the examination of small sick children very difficult.
Despite this, our doctors and nurses work around the clock to ensure that our little patients get better as quickly as possible. Children usually recover more quickly with the loving care and help of their parents and in the security of their own home. The ethos governing the Specialist Outpatients Department underlines this fact and staff thus attend to all children's medical health needs while striving to keep them out of Hospital whenever possible.
FUNDING
However, while the Hospital's running costs are met by the Department of Health, the Government's current financial focus is on establishing primary, rather than tertiary, health care services. At the same time, free health care for all children under the age of 6 years as well as increasing urbanisation of the population, has meant that the demands on the Hospital’s resources have increased. Since, in addition, the majority of children treated at the Hospital come from underprivileged communities, patient fees actually received represent less than 5% of the Hospital's annual running costs. The bottom line is that the Government has no funds available for the required capital redevelopment.
Overall, and in order to meet its mission in South and Southern Africa, the Hospital desperately need to be redeveloped. The expansion and upgrading of the general and specialist outpatient services department is, indeed, critical if the Hospital is to be able to treat sick children and deliver lasting health benefits to the children under its care. This upgrade would also leave the Hospital better placed to link with health services in the community, thereby enabling the development of preventative programmes and strategies designed to solve children’s medical problems before they start. Remember "In hospital children survive. At home they thrive". Help us send them home.
Click for: MAJOR HOSITALS IN THE AFRICAN UNION
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