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SICOT e-Newsletter

Issue No. 6 - March 2009

Assiut University/SICOT Training Fellowship Report

Dr Ikpeme Asanye Ikpeme
Training Fellow - September 2008-February 2009

Preamble

I was informed of my selection for the Training Fellowship in May 2008; the 10th Nigerian to be offered the opportunity. I arrived in Assiut on 31 August 2008 and commenced the posting with an introduction to the Head of Department on 1 September 2008. My postings involved a rotation through the 3 units in the Department as well as the Trauma unit of the hospital.

Strengths/advantages of the training

The training fellowship at Assiut University has various basic strengths:

  1. The Faculty: The Faculty consists of a large majority of staff members willing to teach. There is a high degree of accessibility to the staff and information and this makes learning easy. Teaching is conducted under an atmosphere of mutual respect and participation in cases is always welcome. This makes the Fellowship unique compared with many other training fellowships which restrict trainees to observe only. Besides the Faculty staff, the Assistant Lecturers and Residents are very friendly and also willing to pass on information to participating Fellows.
  2. The specialties: The Department has well-developed specialties. This offers participating fellows a broad and varied range of training opportunities in Orthopaedic and Trauma surgery. The quality of practice is high and comparable to standards elsewhere. In a sub-continent where basic orthopaedic care is still rudimentary, the opportunity to rotate through many specialties while paying attention to a trainee’s specialty of interest ultimately results in an improved quality of service and care upon the return home.
  3. Number and variability of cases: The first thrilling experience of most Fellows taking part in the training must be the number and rich variety of cases done on any 3rd floor list, as well as in the trauma unit on any working day. This provides repeated exposure to many procedures and reinforces learning. At the end of the first month, a trainee basically develops the confidence to tackle a variety of cases. Even in those cases where the trainee has had some experience, he sees things done in a way that may point out his mistakes in the past and the repeated exposure positively reinforces the new tactics and methods to which he has been exposed.
  4. Academic/practice materials: There is a rich and standard variety of academic teaching material available to the trainee. The materials are either available free or at a token fee from the nearby bookshop. The trainee also has the opportunity to acquire good but comparatively cheap instrument sets from local manufacturers.
  5. Developing world setting: Perhaps the greatest advantage of the Assiut University/SICOT Training Fellowship for the African trainee is that the training and surgeries are taking place in a setting much akin to what he faces at home. The challenges of poverty are the same; yet things get done, and properly too. in the training centres of Europe and other parts of the developed world, the African trainee may encounter a culture shock and may become disillusioned, believing he cannot apply the benefits of his training at home because of a lack of the very high-tech equipments considered “basic” in the developed world. In a resource-scarce setting, he is challenged to replicate the skills he has acquired using the barest of equipments and the skills of improvisation. The trainee learns to improvise and use very basic equipment to achieve good results in orthopaedic and trauma care. He feels confident in doing this and in providing improved service (the cardinal aim of the training programme) because he has seen it done in a similar setting.

Weaknesses of the training

The programme has two surmountable weaknesses:

  1. Communication: The basic language of communication in Egypt is Arabic and academic discussions may veer from English to Arabic. English-speaking Fellows have to repeatedly draw attention to the communication issues to gain maximally from academic discourse.
  2. Accommodation: The accommodation at Nila Khatoun is basic and located at a short walking distance from the hospital. Boarding hygiene can be improved upon.

Recommendations

Every working system can benefit from changes to ensure improvement. Therefore, I wish to recommend as follows:

  1. A consistent effort to always encourage the use of English language as the medium of communication at Departmental academic activities and teaching sessions at all times.
  2. A possible review of the accommodation of Fellows participating in the programme. If in any way possible, Fellows may be accommodated within the hospital. This will make it easier for them to stay till the early hours of the morning in the trauma unit. There is so much to be learnt from the unit.

Appreciation

I wish to thank the International Society of Orthopaedic Surgery and Traumatology (SICOT), Prof Galal Zaki Said, the management and staff of the Assiut University Hospitals; Prof Essam El-Sherif and the entire staff and members of the Department of Orthopaedics and Traumatology for this opportunity. I also wish to thank our housekeepers who made us comfortable at Nila Khatoun. In the course of our stay, the Head Housekeeper, Mr Ragheb, passed on suddenly. He was a good, friendly and peaceable man, who treated us like his own. May his soul find peace in Paradise.

Conclusion

My overall impressions and experiences during the last six months have been very positive. The Assiut University/SICOT Training Fellowship will remain a useful and valuable training opportunity for orthopaedic surgeons from Africa for a long time to come. This Training Fellowship is, in my opinion, perhaps the greatest contribution from any group to the improvement of orthopaedic and trauma care in Africa. I hope to keep the friendships I built during my stay and pray I will be a good ambassador of this programme.