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WGO Training Center Update

Malani, Joji MD

Journal of Clinical Gastroenterology: February 2011 - Volume 45 - Issue 2 - p 1–2
doi: 10.1097/MCG.0b013e3182073908
WGO News
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As Suva embarks on its third year as a World Gastroenterology Organisation (WGO) Training Center, it has taken the skills and knowledge of the participants toan even higher level. This year's program increased for a duration of 6 weeks allowing for more time and participation in academic teaching, endoscopy sessions, and participation in our Annual Fiji Medical Association seminar. The program has been designed similar to the earlier 2 years and built on the existing clinical program and academic modules in gastroenterology that address both Diploma and Master in Medicine. The nurses program, in its second year, has been a success and the skills of our nurses from the 2 areas of Fiji have been enormously elevated. In reviewing the short-term and long-term objectives set by the first group of gastroenterologists in 2008, the program has fulfilled most of these objectives but will continue to improve and maintain its standard.

The program can be divided into various components including academic and clinical. The clinical cases were from a wide range of medical conditions that are common in Fiji and include end stage liver disease with ascites, gastrointestinal bleeding, hepatomegaly, diarrheal illnesses with typhoid fever, and amoebic infections. The gastroenterology teachers also participated in programs such as weekly Continuing Medical Education, discussion of cases, a surgical trainee program, and bedside teachings.

The total numbers of gastroscopies was 108 and the total number of coloscopies was 75. This number is more than earlier programs and includes more interventional procedures. The capability of the various participants varied and although the senior candidates also conducted gastroscopies, they concentrated more on interventional gastroscopies and colonoscopies. The new candidates and registrars learned the basics of gastroscopies and various techniques. One new candidate learned from gastroscopy from having never done a gastroscopy to consistently reach the second part of the duodenum and perform biopsies within the 6-week period. Although there is little variation in gastroscopy techniques, there are some variations in colonoscopy techniques which produced very good results. The teachers are excellent in their skills and teaching capability, and have greatly improved our technique in gastroscopy, interventional gastroscopy, and particularly colonoscopy. The significant increase in the numbers of therapeutic endoscopy has improved our ability and confidence. This includes variceal banding, injection of ulcers, clipping, polyethylene glycol (1 case), and esophageal stricture dilatation. The teaching in this area has been very good particularly in taking us through the various steps of the different procedures.

The 2010 program, built on earlier programs has been a major success based on the short-term and long-term goals achieved and the evaluation of the candidates. In comparison with earlier years, the candidates have developed a sense of confidence with the improvement in their techniques. Both doctors and nurses have graded the program very highly and would like to see the program continue. The program is fortunate to have gastroenterology teachers of extensive experience and skills and the Gastroenterological Society of Australia should be commended for this contribution. As compared with earlier years, our endoscopic sessions have now continued daily and the load is similar to the patient load during the month of the gastroenterology program. We now have 3 centers in Fiji that do endoscopies (Lautoka, Labasa, and Suva) and the participants, both doctors and nurses, that participated in the program have returned and have uplifted the quality of their service.

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In 2008, the Gastroenterological Society of Australia partnered with the World Gastroenterology Organisation to develop the latest WGO Training Center at the Fiji School of Medicine (FSM). In close consultation with FSM, a program has been developed for integration into the School's postgraduate training in medicine. FSM is one of only 3 institutions in Fiji and the Pacific Island nations to offer local medical training in the region. With such limited training available and a regional population totaling approximately 1.7 million people, the ratio of doctors per 1000 population is at a mere 0.1 to 0.4 million. The shortage of doctors in nearby countries, such as Australia and New Zealand, has contributed to this “brain drain”, as local doctors seek employment abroad. From 1987 to 2002, 510 doctors left the government health service in Fiji, whereas during the same period, only 284 graduated from the Fiji School of Medicine.

Until recently, specialist training in the South Pacific was unavailable and has often been undertaken abroad, making it difficult for doctors who have become accustomed to life in their new environment to return home again once their training has been completed. Thus, the lack of local specialist training has been conducive to the “brain drain” being witnessed in the region. However, local postgraduate programs have been shown to help combat this trend in that doctors-in-training work for most of the time in their home country while learning to diagnose and treat disease with the resources available, thereby making them less likely to leave their home country once specialist qualification has been achieved.

This program has been created to address the need for local specialist training in Gastroenterology in the South Pacific, which had previously been absent in the region. The Gastroenterological Society of Australia's Fiji Training Team (GESAFiTT) members contribute to training in endoscopy, hepatology, and luminal gastroenterology. To further address the need for specialist training in the region, programs in gastrointestinal surgery and pediatric gastroenterology are also in development. The Suva training center is located in the Fiji School of Medicine, with an Endoscopy Unit having been inauguarated in August 2009.

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