Various Facets of Academic and Clinical Cooperation · Inappropriate anaesthesiology Pediatric Surgery for Yemen. Dr. Ali Al-Gamrah - Surgeon, Coordinator A personal initiative, started

Various Facets of Academic and

Clinical Cooperation

Here as an Example of Pediatric Surgery

Claus Petersen

Who I am, and why I´m here

Who am I? Working in West Africa

Academic career in pediatric surgery

Project 1: Pediatric Surgery for Yemen

Project 3: Building a pediatric burn center in Tunisia

Project 2: Bridging gaps in Pakistan

Clinical and basic research: international networking

Key-notes for future projects

Contents

My professional career

Residency training: surgery, obstetrics, tropical medicine

26 months in Bénin, West Africa

Speciality in general surgery and pediatric surgery

Who I am

Doing clinical and basic research

Under contract with the German Development Service (DED)

Now operating as GIZ (Gesellschaft für Internationale Zusammenarbeit)

26 months in Bénin, West Africa

Who I am

Mexico 6.5

Russia 6.2

China 7.5

Central African Republik 50.9

Bénin 24.4

http://www.globalhungerindex.org

Global Hunger Index (GHI): Bénin

General information

The Index ranks countries on a 100-point scale: 0 being

the best score (no hunger) and 100 being the worst

Bénin:CSD Cové (Centre Sanitaire de District)

Who I am

Districts: Cové, Zagnanado, Quinhi – about 100.00 inhabitants

1984 - ´86 no electricity, no tap water, no telephone,

next paved road 40 km away

Bénin: Les soins de santé primaires(Primary health care)

Who I am

Health education Vaccination

Antibiotics on the marketReferral system

In accordance with local health policy

Main findings from a rural project

Who I am

Pros

Cons

Close cooperation with individual counterparts

Volonteers were well integrated

Duration of project depends on political conditions

No sustainability and maintainance on long term basis

Training in general and pediatric surgery

Who I am

Disappointed and frustrated return

Starting an academic carrier

Building national, European and worldwide networks

on clinical and research basis

Hannover Medical School

Who I am

The Major areas of research are

MHH`s International Dimension

Transplantation and Regenerative Medicine

Infection and Immunity

Biomedical Engineering and Implants

Sub specialized in neonatal hepatobiliary surgery

and basic research

Who I am

Academic and clinical position today

Biliary atresia

Biliary atresia and related diseases –

Let´s stick together

Langenbeck-Virchow-Haus

Berlin 2014, October 16th and 17th

Who I am

168 attendees

40 countries

Who I am

Who I am

Academic and clinical networking

Biliary atresia and related diseases

www.bard-online.com

… it was time to return to the other side of the world

Who I am

When the kids have left the nest …

Pediatric surgery for Yemen:

teaching to train

Project 1: Pediatric Surgery for Yemen

What exactly was the problem?

Pediatric surgery was de facto non-existant

throughout the country

Mexico 6.5

Russia 6.2

China 7.5

Yemen 36.1


India 31.4


Global Hunger Index (GHI)

Pediatric Surgery for Yemen

Healthcare system in the Yemen

No health insurance

Rural areas: Primary healthcare

Health tourism

Urban areas: public hospitals

Urban areas: private hospitals


Children in the Yemen


Population: 28 Mill

Children < 15 years: 46%

Birth rate: 5.5 children/women

Infant mortality: 53/1000

Pediatric surgery in Yemen 2006

< 10 pediatric surgeons

No teaching at the University

No residency program

Scarcely equipped facilities

Inappropriate anaesthesiology


Dr. Ali Al-Gamrah - Surgeon, Coordinator

A personal initiative, started in 2004


Pediatric Surgery for the Yemen

University of

Sanaá

Chair for

Pediatric Surgery

Training of students

Professional education

Scientific cooperation

Hannover

Medical

School

DAAD

Sponsoring

Technical equipment

Supervision

Al Sabeen

Hospital

Professional training

(doctors, nurses)

Administration


University of

Sanaá

Chair for

Pediatric Surgery




Hannover

Medical

School

DAAD

Sponsoring

Technical equipment

Supervision

Al Sabeen

Hospital


(doctors, nurses)

Administration


University of

Sanaá

Chair for

Pediatric Surgery




Hannover

Medical

School

DAAD

Sponsoring

Technical equipment

Supervision

Al Sabeen

Hospital


(doctors, nurses)

Administration

Achievements after 7 years

First hospital for pediatric surgery

Training of Yemeni staff in

Germany, Egypt, Jordan and Tunisia


Chair for pediatric surgery at the University of Sana’a

Developing moduls of e-learning

(electronic Schoolbook™, teaching videos)

Curriculum for pediatric surgery

First international congress for

pediatric surgery in Sanaá, 2013

Then the war came over the country!!??...


© Khaled Abdullah / Reuters

Pediatric Surgery in Pakistan

Bridging the Gaps – Track 1

Project 2: Bridging gaps in Pakistan

What exactly is the problem?

Alarming imbalance between urban and

rural services in pediatric surgery

Mexico 6.5

Russia 6.2

China 7.5

Yemen 36.1

Central African Republik 50.9Ethiopia 32.3

India 31.4

Pakistan 32.6



Bridging gaps in Pakistan

Pakistan

Population: 200 Mill

Birth rate: >3.5 children/women

Infant mortality: < 1 (5) years: 61.4 (85.4)/1000

Incidence congenital malformations 18% - 20% (???)

Children < 16 years: 43%


Punjab


Punjab

Population: 110 Mill

Punjab is the most industrialised province of Pakistan

Punjab is a mineral-rich province with extensive

mineral deposits of coal, iron, gas, petrol, rock salt


Punjab Health System


Prof Muhammad Saleem

Dean faculty of paediatric surgery CPSP

College of Physicians and Surgeons

Pakistan (CPSP)


training facilities

computer courses

video conferences

telemedicine

Children´s Hospital Lahore, 1140 beds


monthly conferences

video monitoring

sterilisation unit

nursery

newborns after

maximal invasive

surgery

District Head Quarter (DHC) in

Sheikhupura (600 beds – 150 pediatrics)


no pediatric surgeon

no pediatric anaesthesiologist

sterilisation unit

nursery

4 babies and mothers per bed maximum

120.000

patients/month

Punjab: 6 Children´s hospitals with

pediatric surgery (none in DHCs)


Prof Muhammad Saleem

Dean faculty of paediatric surgery CPSP

!!!

Future needs in terms of increased number of pediatric surgeons: 427

How to approach this problem?

Actions to be taken by the governmental authorities:

Creating more positions for pediatric surgeons and

anesthesiologists in the DHCs

Providing adequate equipment for basic pediatric

surgery in the DHCs


Aligning incentives for pediatric surgeons and

anaesthesiologists to join and to stay in DHCs

How to approach this problem?

Intended application for an academic grant:

2-months-visits of pediatric surgeons at the MHH:


Training of “master trainers” to improve basic

Pediatric surgery on the DHC level

Creatin/updating diagnostic and therapeutic protocols

Creating teaching videos

Preparing and writing articles for the e-learning module

Visits and return visits (teaching staff)

Building a pediatric burn center in Tunisia

Project 3: pediatric burn center in Tunisia

What exactly is the problem?

Well equipped and highly sophisticated burn units

at the university of Tunis for adults but not for children

http://oberle-stiftung.de/

Mexico 6.5

Russia 6.2

China 7.5

Yemen 36.1


India 31.4

Pakistan 32.6



Tunisia 7.4

Pediatric burn center in Tunisia

Bénin 24.4

Academic cooperation with Tunisia

Personal commitment: Prof A. Nouri

Hosting and training Yemeni pediatric surgeons

in Monastir

Mutual invitations to national pediatric

surgical congresses

Recognizing local problems and bringing the right

people together


Academic cooperation with Tunisia

Prof A. Nouri invited us to the annual congress

Project 3: pediatric burn center in Tunisia

Dr. M. Sinnig, spezialist in sever burns and

reconstructive surgery, gave a lecture

Next steps

Drafting a memorandum of understanding for

Aaademic cooperation between the universities of

Tunis and Monastir and the MHH

Preparing a common application for an academic

grant:

Creating/updating diagnostic and therapeuic protocols

Creating teaching videos

Preparing and writing articles for the e-learning module


Looking for additional partners

NGOs, e.g. Interplast-Germany e. V.

medical companies

From my personal experience:

a top down/ bottom up planning process


a corporate-relevant framework and

An academic cooperations on health care requires

Key-notes for future academic projects

Describing the current situation on health care

Identifying strengths and weaknesses


Defining needs and requirements

Distinguishing between academic and clinical issues

Considering different conditions of

rural and urban communities

Framework and individual commitment

Memorandum of Understanding





Tehran University and Hannover Medical School, 2016



Designating medical fields and responsible persons


Connecting the counterparts

Drafting a project and its objectives

Looking for professional advice from experts

Academic-Medical-Projects

Teaching

stuff

Responsable persons




Urban-

rural-

transition

DAAD

Sponsoring

Technical equipment

Supervision

Infrastructure

Medical stuff

(doctors, nurses)

Administration

Teaching material


Teaching

stuff

Responsable persons




Urban-

rural-

transition

DAAD

Sponsoring

Technical equipment

Supervision

Infrastructure

Medical stuff

(doctors, nurses)

Administration

Teaching material


Teaching

stuff

Responsable persons




Urban-

rural-

transition

DAAD

Sponsoring

Technical equipment

Supervision

Infrastructure

Medical stuff

(doctors, nurses)

Administration

Teaching material

Essential criteria for applications

Defining the objectives

Setting a precise timetable and landmarks


Adjusting the project to governmental structures

and the local health care system

Determinating institutional evaluation (interval?)

Defining requirement specification for each partner

Don´t forget to refere to…

…maintainance


…additional support (sponsoring)

from third parties

…sustainability

Intention and support from

governmental and administrative authorities are ..

.. indispensable preconditions ..

.. but achievements and success

depend on individual engagement and staying power

of all persons involved!

Final remarks

And what is most important?

Documents

Various Facets of Academic and Clinical Cooperation · Inappropriate anaesthesiology Pediatric Surgery for Yemen. Dr. Ali Al-Gamrah - Surgeon, Coordinator A personal initiative, started