St Lucia Workshop October 2015

Dr Sulleman M Moreea

In 2008 during a visit to St Lucia I met with the Medical Director of St Jude Hospital, Dr Sylvestre Francois, who invited me to teach GI endoscopy at St Jude Hospital.

In 2009 I set up the Endoscopy Unit at St Jude hospital with a generous donation of a Pentax stack, four gastroscopes and three colonoscopes from the Yorkshire Clinic, Bingley, UK. Sadly, the surgical wing of that hospital burnt down only 10 days after the unit was set up with the loss of all the equipment. There were three casualties during this fire. I set out to obtain more equipment to restart that unit and fortunately Olympus kindly donated a stack with two gastroscopes and two colonoscopes. In addition, through a generous gift from one of the banks in St Lucia along with my personal contribution, another refurbished Pentax stack was acquired with two gastroscopes, two colonoscopes and one duodenoscope for St Jude.

The Ministry of Health of St Lucia, in the meantime, acquired an Olympus stack, one gastroscope and one colonoscope for Victoria hospital.

In 2013, I helped to set up the endoscopy units at both Victoria hospital and St Jude hospital. In 2014 I ran another workshop for both hospitals. This work was done in my own personal time along with one of the endoscopy sisters from Bradford and an endoscopy nurse from Mauritius.

As the demand for training grew, I realised that I needed help to continue this work, and I hence applied for a grant from the BSG.

Outcomes of the GI endoscopy workshop:

  1. Reinforcement of diagnostic skills and training of therapeutic skills for 6 doctors - as described above
  2. One physician taken through his first 20 gastroscopies with a plan for further training
  3. 10 nurses trained to support diagnostic and therapeutic upper and lower GI endoscopy
  4. Introduction to training the trainers for doctors and nurses
  5. Involvement of the Minister of Health to help expand GI endoscopy in St Lucia

Endoscopy Training at Kamuzu Central Hospital (KCH) Endoscopy Unit - Lilongwe-Blackpool Endoscopy Link May 11th-15th 2015

Supported by Grant from the British Society of Gastroenterology

Previous visits by Dr M T Hendrickse and other colleagues had established an endoscopy training programme at Kamuzu Central Hospital ( see previous reports on visits in 2013, 2014 and presentation at Annual British Society Of Gastroenterology meeting June 2013 .)

Basic skills and enhanced /refresher courses have been run with Dr Hendrickse as a visiting trainer with Gift Mulima as a fully trained local endoscopist and trainer.

It was recognised that in order for the endoscopy service to expand, there is a requirement to develop further trainees to become independent endoscopists and potential trainers.

In addition, it was recognised that the endoscopy unit needs further technical support , due to old endoscopes now malfunctioning and restructuring of the unit with a new rebuild.

Aims of current visit:

  1. To assess endoscopy training requirements of current trainees at Kamuzu central hospital.
  2. To assess / support current trainees with endoscopy experience with a refresher / enhanced course
  3. Evaluate the current endoscopy service at Kamuzu central hospital, and the progress in development of a new endoscopy unit as part of the restructuring of ITU, HDU services at Kamazu central hospital
  4. Through separate funding Dr Hendrickse has purchased an Olympus stack and two 260 series scopes (gastroscope and colonoscope) which was being delivered by freight through Glasgow council.

Foundation Course Report: Upper Gastrointestinal Endoscopy

The course was well received by all the delegates who felt it was a "well run course with excellent instructors" and provided a "very good taster to endoscopy". The International delegates reported being "hugely grateful for the trainers, organisers and the local staff" for the opportunity to attend the course.

Delegates attending the course demonstrated an improvement in their knowledge base following the course, felt the course met their training needs and was of relevance to their future careers. In certain cases in appeared to inspire some delegates who were equivocal about an endoscopy career prior to the course "I am inspired to perform endoscopies. I will be under supervision for first sessions when I get back. Aiming to do 100 cases by the next training session." Several trainees expressed a wish to "attend a future course".

BSG Sponsored Bangladesh Endoscopy Training Project 2015

A group of four ABMU Health Board staff (Consultants, Dr Paul Duane, Dr Umakant Dave, Dr Mesbah Rahman and endoscopy staff nurse, Mr Mark Hillier) and a senior technician/ tutor (Mr Stuart Goddard) from Cardiff University visited Bangladesh between 12th and 18th of February 2015 to conduct GI endoscopy and ERCP training workshops. ABM University Health Board, British Society of Gastroenterology (BSG) and Bangladesh Gastroenterology Society (BGS) support this project. This was second visit by the group. We performed a full day of live ERCP workshop (video linked between endoscopy unit and a meeting hall) and a hand-on workshop for ERCP assistants. A high level of excitement was created by use of plastic and animal tissue models for participants to practice both upper & lower GI endoscopic therapies and ERCP techniques. This was the first workshop using such models in Bangladesh and was described as a "milestone and ground breaking for endoscopy training in Bangladesh" by the President & General Secretary of BGS. The feedback received from the participants after the events were excellent or very good.

A visit of the Welsh Endoscopy Training Network to Erbil, Kurdistsan

Erbil is situated in the Kurdistan Region of Northern Iraq. We submitted a successful proposal to the British Society of Gastroenterology for a multi-disciplinary team visit to provide an evaluation of local endoscopy services and provide hands-on simulation training. The visit was preceded by an online national survey of the Endoscopy Services in Iraq. The findings of this survey informed the strategic aims and objectives of the visit. In preparation for the visit a novel flexible, lightweight animal model for endoscopy – the FLAME model – was developed to support a planned hands-on 'Training the Trainer' style course.

The travelling party left for Erbil in Iraq at the end of February 2014 and comprised a multi-disciplinary group consisting of three consultant gastroenterologists, all with experience of endoscopy training, two senior nurses, a senior laboratory technician, a specialist registrar and Dr Moayed Aziz, President of the Iraqi Medical Society International. The party engaged in visits to the Hawler Medical School, Hawler University, Hawler School of Nursing, the Rizgary Government Hospital and private clinics to gain an understanding of the training pathways and environment for endoscopy trainees and staff leading the services.

The group delivered a two day hands-on 'Training the Trainers' course on the 25th and 26th February and completed an initial evaluation of the FLAME model. Feedback from the course was extremely positive. In conjunction with the Iraqi Medical Society International on the 27th and 28th February the visiting faculty delivered a two day conference on 'Quality, Safety and Training in GI Endoscopy' which sought to promote discussion on areas of quality assurance of the endoscopy services in Iraq and debate around how to improve training in endoscopy and nurse skills, in addition to providing updates on a number of other areas of endoscopic practice. The conference attracted 180 delegates including local members of parliament, representatives of academic institutions and consultant gastroenterologists, GI surgeons and trainees from across all regions of Iraq. The feedback from the delegates was again extremely positive.

The group have identified a number of potential areas for future collaboration. These include; work around nurse training and developing specific skills required by endoscopy nurses in collaboration with Swansea University; collaboration with the endoscopy training programme directors for the Kurdistan region (Erbil and Sulaymaniyah) with a possible future visit to support the development of their regional training; development and validation of online training tools that can be readily accessed in Iraq; and the continuing development and validation of animal models by the Welsh Institute of Minimal Access Therapy (WIMAT) to support any future hands-on model training.

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