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Promoting training units for laparoscopic surgery at the College of Medicine and at the Ministry of Health

Laparoscopic surgery, or minimal access surgery, belongs to one of the great achievements in modern surgery as it is conducted through small skin incisions with operations being performed far from their location in the body. This technique produces clear benefits towards conventional open surgeries, such as less postoperative pain, shorter recovery times for the patients reducing hospitals stays and therewith related costs, early return of patients to normal activities, reduced risks of infections, improved diagnosis for some medical conditions and improved cosmetics due to barely visible scars.

In most developed countries, laparoscopic surgery is routinely performed. However in low-income countries, such as Malawi, this technique is not well established due to financial and technological limitations. Inaccessibility to equipment and training programs and low numbers of trained surgeons have resulted in under practice of laparoscopic surgery.

The successful performance of laparoscopy requires both the availability of necessary equipment and the technical know-how on how to operate and maintain laparoscopic equipment. Malawi started early to invest in this field with necessary equipment being in place at the Queen Elisabeth Central Hospital in Blantyre since the late 1980s. Also the Kamuzu Central Hospital, aside from a few essential hand instruments missing, disposes of some equipment to perform laparoscopic surgeries. This in spite, the first successful laparoscopic surgery in Malawi was performed in 2011 by foreign specialists, using their own hand instruments.

In the past, donations and technical assistance from various international partners such as Norad (ultrasound), GIZ (lightening and training on ultrasound performance) and Centre for Disease Control and Prevention (human resource support) could contribute to the set-up of operational entities for training and case performance on minimal access surgery. In 2014, the University of North Carolina donated laparoscopic equipment such as a monitor, camera, light source, processor, and an insufflator.  However, the lack of hand instruments used to perform the actual surgery, outdated technical devices, and defiances in equipment maintenance are still significant challenges preventing the actual application of laparoscopic techniques in Malawi.

laparoscopic surgery1To overcome challenges with regard to human capacities, practitioners from the departments of gynaecology and surgery of the College of Medicine  are continuously working on improving their skills and on finding ways to pass on their knowledge to post-graduate students during their specialised training. In this regard, affiliates from the respective departments participated in a two-week fellowship training on minimal access surgery at the World Laparoscopic Hospital in Delhi, India from February 1st to February 14th, 2016. The internationally accredited hospital provides trainings to specialised medical practitioners from across the world. The fellowship training encompasses theoretic teaching and rigorous hands on training, in the operationalization of re-usable equipment specifically developed for resource poor settings where health sector investments are limited. Training participants gained experience and confidence in performing this highly skilled type of surgery. After the completion of the training, freely accessible study material and post training online support for one year succeeding the course completion enable the participants to continuously follow up on their newly acquired skills.

 

laparoscopic surgery2Returning from this training in India, Malawian participants from the CoM departments of gynaecology and surgery and Ministry of Health staff are highly motivated to promote the operationalization of training units on laparoscopy. Both departments pursue a joint approach, planning the set-up of a common training unit while at the same time envisioning two separate training units in the long run. As a short term vision, a common training site would reduce investments costs while setting up separate laparoscopic training centres at Queen Elisabeth Central Hospital and Kamuzu Central Hospital on the long term would have the advantage for patients not to be transferred.

In order for this vision to become reality, a training room has already been identified. Further requirements identified by the gynaecology and surgery departments comprise the replacement of equipment in line with the state-of-the-art laparoscopic technology, training on the use of laparoscopic devices for all medical and para-medical staff involved and enhanced training on minimal access surgery within the framework of a two weeks diploma training at the World Laparoscopic Hospital in India building on the skills already acquired during the fellowship in February this year.

In this regard, one project proposal has been sent to the Centre for Disease Control and Prevention and Norad requesting for technical assistance in advanced laparoscopic surgery. While this will enable further specialization of staff in laparoscopic surgery, lack of access to state-of-the-art equipment (specifically hand instruments allowing for the actual performance of the operation) still poses a major challenge to laparoscopic surgery practice in Malawi.

22nd April 2016

Malawi’s first Pharmacovigilance Centre under development at the College of Medicine

Medicine or drug use is one of the most commonly used medical intervention globally. In order for all medicinal products to be considered for human use, their safety, quality and efficacy has to be established. One of the challenges is drug safety, because some safety issues cannot be identified during clinical trial period and therefore continuous monitoring throughout its life cycle is important. Most countries have established drug safety monitoring centres, however Malawi is yet to establish one. “The importance of establishing such a centre in Malawi cannot be under-estimated due to the fact that apart from standard safety monitoring of registered drugs, there are higher incidences of counterfeit and sub-standard drugs available in the market which make drug safety monitoring even more complex. Another challenge is the diseases burden Malawi is facing from both communicable and non-communicable diseases especially diseases like HIV/AIDS which due to the nature of the illness, patients are required to take more than one drug, over a long period of time. Efficacy and safety of these drugs needs to be constantly monitored in order to protect patients from possible harm from the drugs which are supposed to treat them. The only way of ensuring that patients are protected is through pharmacovigilance”, says Ms. Frider Chimimba, Lecturer at the Department of Pharmacy and part-time academic staff at the PV Centre.

In order to address the above challenges, the Pharmacy, Medicines and Poisons Board (PMPB), the Ministry of Health (MOH) and the College of Medicine (COM) recently signed a Memorandum of understanding on the establishment of a Pharmacovigilance Centre. “The main purpose of the Pharmacovigilance Centre will be to function as a drug safety monitoring centre where information about adverse drug reactions are gathered, evaluated and stored. Data collected can then be used to make decisions based on the outcome of the expert panel review and reports from other countries through the WHO collaborating centre in Uppsala, Sweden. Depending on the review, the product in question can be re-labelled, rescheduled, withdrawn or issued with special warnings” says Ms. Chimimba.

According to Ms. Nettie Dzabala, Head of Pharmacy Department and part-time academic staff at the PV Centre, the initial activity was to identify office space, which was kindly offered by College of Medicine on the top floor of the library at the College of Medicine Blantyre Campus. At present, the Centre has two part-time academic staff but is expected to employ two full-time staff members; a data officer and an administrative assistant.

The Australian Government financed the partitioning of the Pharmacovigilance Centre.PVCWith support from the German Development Cooperation (GIZ), the Pharmacovigilance Centre has been able to purchase office equipment such as laptops, printers, telephones and furniture such as desks, chairs and storage facilities, which will ensure full functionality of the Pharmacovigilance Centre, once certified by the WHO Collaborating Centre for Advocacy and Training in Ghana, Ms. Chimimba further elaborates.

 

 

 

PVC equipment

Besides the furniture and equipment, GIZ provided financial support enabling two academic staff from the Pharmacy Department to participate in a 2-weeks training in May and September 2015 on pharmacovigilance and vaccine pharmacovigilance in Sweden and Ghana, respectively.

One person who has been Instrumental in setting up the Pharmacovigilance Centre was a German pharmacy professor from the University of Tübingen, who acted as a seconded member of staff at the Department of Pharmacy for two years from early 2014 until early 2016. The seconded member of staff assisted the department in preparing fund applications for equipment, furniture as well as secured funds for the pharmacovigilance training of departmental staff and the visiting lecturer from Cardiff University, UK. The funding was secured from GIZ, says Ms. Dzabala.

Also a visiting lecturer from Cardiff University, UK has been involved in the establishment of the Pharmacovigilance Centre by working with COM staff involved in PV on drafting proposals for the base-line and the pilot studies. In addition, the pharmacist held lectures on pharmacovigilance to students for different courses (ie Pharmacy, Medicine, Physiotherapy and MLS) at COM as well as giving a talk at the research centre on PV to academic staff. She also assisted in drafting the Pharmacovigilance curriculum that will be taught at different modules throughout the 4-year Pharmacy education.

The first activity for the PV Centre is to conduct a pilot study. One sub-component of this project is a base-line study that will assess baseline knowledge of health care professionals on pharmacovigilance. “It will in particular look into health care professionals’ knowledge about adverse drug reactions (ADRs) and play a significant role in identifying knowledge gaps with regards to monitoring and reporting ADRs, drug management, distribution processes and patient care at ART (Anti-Retroviral Therapy) clinics in Blantyre and its satellite clinics”, says Ms. Chimimba and continues: “The base-line study will be carried out from February until June 2016 and will be followed by a pilot study on adverse drug reaction reporting systems. Besides disseminating information about functions of the Pharmacovigilance Centre, the pilot will also conduct training of health care professionals and patients at the ART clinics on how ADRs are reported and on the importance of reporting ADRs. It will also roll out a number of reporting tools, starting with ADR reporting forms which will be used by HCP and SMS texting to be used mainly by patients. Both the base-line and the pilot study are funded by CDC/PEPFAR, as part of the ‘Improving Medical Education in Malawi’ (IMEM) project”.

Ms. Chimimba hopes that once the pharmacovigilance centre is up and running, hospital costs due to admissions and treatment of ADRs will be reduced and patients will be protected from possible harm.

2nd March 2016