From the Editor: In this new section of Diseases of the Colon & Rectum, you will be able to read reports of individuals who have received travel scholarships from the International Committee of the American Society of Colon & Rectal Surgeons. We hope that you will find this interesting reading. We have asked our scholarship recipients to list their greatest needs in the hope that some of our readers will be able to help them either by volunteering their time and skill, perhaps by donating supplies, or hosting them on future trips to North America.
This is a report from Ayesiga Herman, MD (Fig. 1), a recipient of the 2017 International Travel Scholarship offered by the American Society of Colon & Rectal Surgeons (ASCRS).
BACKGROUND, TRAINING, AND CURRENT POSITION
After completing medical school (Fig. 2) and an internship, I worked for 1 year in the general surgical department after which I joined the residency program for 4 years. I was awarded a Master’s in Medicine for General Surgery (M.Med. G/Surgery). I have been working as a general surgeon for 2 years.
SURGERY TRAINING IN TANZANIA AND SPECIALTY TRAINING IN COLON AND RECTAL SURGERY
Surgical training in Tanzania usually follows a period of working as a registrar where one is exposed to surgical conditions, usually in the district hospitals. From there, one can join a residency program. During residency, one is developed into a general surgeon. Colorectal surgery is just a part of what a general surgeon is expected to be conversant with at completion of residency. Currently, there is no colon and rectal surgery specialty as an independent entity.
HEALTH CARE IN TANZANIA
The health system is structured into 5 levels of health care services, starting with dispensaries, health centers, district hospitals, regional referral hospitals, and zonal referral hospitals. There are 4 zones, and I work at one of the zonal referral hospitals. Patients may be seen at dispensaries and health centers, and those with simple surgical cases may be handled at district and regional hospitals. Others that require specialized care are usually referred to zonal hospitals. At health centers and dispensaries, patients are seen by clinical and assistant medical officers. Fully trained general surgeons work at district levels, regional levels, and zonal levels.
The health system is funded largely by the government through the health budget. There are health insurance schemes, but the majority of people are not insured. Also, both private and public sectors participate in the provision of health care.
CHALLENGES TREATING COLON AND RECTAL DISEASE IN TANZANIA
We have a wide variety of colon and rectal disease. According to what we observe at our hospital and the published studies from different centers in the country, more than 90% of patients present late in the course of their disease. This occurs most frequently in patients with colon and rectal malignancies, which have been observed to be on the rise in recent years.
In my country, colorectal diseases are widely managed by general surgeons. Training for colorectal surgery is not offered as a specialty on its own by most of the colleges in our country. Colon and rectal diseases, therefore, are considered in the general pool with other surgical diseases. With the already overstretched system because of the large burden of surgical diseases, there is a lack of emphasis on colorectal diseases. From my visit to the United States, it is clear to me that we need to place more emphasis on colorectal diseases and embark more on research and training in this field.
KNOWLEDGE GAINED FROM ATTENDING THE ASCRS ANNUAL SCIENTIFIC MEETING
There were a lot of educational sessions. I learned about new updates in the management of colon and rectal diseases that will be beneficial to me and my colleagues at my center (Fig. 3). The annual subscription to the journal Diseases of Colon & Rectum will help me disseminate the knowledge through teaching and journal clubs. I believe this will build our capacity managing these diseases, ignite our minds to research, and emphasize further training in this field.
GREATEST NEEDS FOR PERSONAL AND PROFESSIONAL DEVELOPMENT AS A SURGEON
I need to train as a colorectal surgeon. The means for this are to find training opportunities with scholarships and sponsorships. I would like to spearhead the development of colorectal services in my country by creating awareness, initiating collaborations, and creating partnerships in research and training of our junior colleagues into this highly needed specialty.
WISHLIST: MY DEPARTMENT’S AND HOSPITAL’S GREATEST NEEDS
These are things that can help with patient management:
- Endoscopic equipment (eg, monitors, light sources, scopes, biopsy forceps) to help with the examination and diagnosis of patients with various colorectal conditions and to enable us to perform some of the basic therapeutic procedures;
- A laparoscopic tower/laparoscopic equipment;
- An energy source for surgery (eg, diathermy machines).
I would like to thank the International Committee for the opportunity for the award and their excellent arrangements. Special thanks to ASCRS staff for their tireless coordination of my visit. It was made smooth and enjoyable.