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Tankwanchi AS, Asabor EN, Vermund SH. Global Health Perspectives on Race in Research: Neocolonial Extraction and Local Marginalization. Int J Environ Res Public Health 2023; 20:6210. [PMID: 37444057 PMCID: PMC10341112 DOI: 10.3390/ijerph20136210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Best practices in global health training prioritize leadership and engagement from investigators from low- and middle-income countries (LMICs), along with conscientious community consultation and research that benefits local participants and autochthonous communities. However, well into the 20th century, international research and clinical care remain rife with paternalism, extractive practices, and racist ideation, with race presumed to explain vulnerability or protection from various diseases, despite scientific evidence for far more precise mechanisms for infectious disease. We highlight experiences in global research on health and illness among indigenous populations in LMICs, seeking to clarify what is both scientifically essential and ethically desirable in research with human subjects; we apply a critical view towards race and racism as historically distorting elements that must be acknowledged and overcome.
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Affiliation(s)
- Akhenaten Siankam Tankwanchi
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Emmanuella N. Asabor
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (E.N.A.); (S.H.V.)
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (E.N.A.); (S.H.V.)
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
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Hortsch M, Koney NKK, Oommen AM, Yohannan DG, Li Y, de Melo Leite ACR, Girão-Carmona VCC. Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real. Adv Exp Med Biol 2023; 1421:79-124. [PMID: 37524985 DOI: 10.1007/978-3-031-30379-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.
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Affiliation(s)
- Michael Hortsch
- Departments of Cell and Developmental Biology and of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.
| | - Nii Koney-Kwaku Koney
- Department of Anatomy, University of Ghana Medical School, University of Ghana, Korle Bu, Accra, Ghana
| | - Aswathy Maria Oommen
- Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Doris George Yohannan
- Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Yan Li
- Department of Anatomy, Histology and Embryology, Fudan University, Shanghai, China
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Kayamba V, Nzala S, Simuyemba MC, Zyambo C, Musenge E, Wahila R, Kalusopa VM, Mwiinga C, Kampata-Olowski L, Makukula MK, Katowa-Mukwato P, Kafumukache E, Goma F. Initiatives to enhance medical subspecialist training in Zambia: A cross-sectional analysis. Med J Zambia 2022; 49:67-74. [PMID: 37654444 PMCID: PMC10470851 DOI: 10.55320/mjz.49.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Introduction There is a significant shortage of medical subspecialists in Zambia. The government of Zambia, through programmes at the Ministry of Health, spends considerable resources to send patients outside the country for subspecialist medical treatment. The objective of this analysis was to evaluate the current situation pertaining to medical subspecialty training at the University of Zambia School of Medicine (UNZASOM) and to illustrate the new programmes that are to be introduced. Methods We collected data from formal desk reviews on the state of medical specialisation in Zambia, the UNZASOM graduation archives and patient referral records at the Ministry of Health (MoH). In addition, information on planned subspecialist programmes is presented. Results From the first graduates in 1986up to 2019,UNZASOM produced 351medical specialists, 63 (18%) in Internal Medicine, 77 (22%) in Obstetrics &Gynaecology, 82 (23%) in Paediatrics&Child Health, 68 (19%) in General Surgery, 17 (5%) in Anaesthesia & Critical Care, 20 (6%) in Orthopaedics &Trauma and 8 (2%) in Urology. The remaining graduates were in Ophthalmology, Psychiatry, Infectious Diseases, Paediatric Surgery and Pathology contributing 1% each. To enhance medical subspecialist training at UNZASOM, new curricula for Breast Surgery, Urology, Glaucoma, Vitreo-retinalSurgery, Adult Gastroenterology, Forensic Pathology, Dermatology & Venereology, Ophthalmology, Gynaecological Oncology and Paediatric anaesthesia, Infectious Diseases, and Gastroenterology were developed. Since 2013, only 44% of patients requiring subspecialist treatment out of Zambia got assisted with the remainder still on the waiting list or having had bad outcomes. Conclusions These programmes will provide an opportunity for accessible and affordable medical subspecialization training for Zambia and its neighbouring countries. With enhanced infrastructural support, the subspecialists will contribute toward enhanced healthcare provision and improvement in patient outcomes. They will also form a cohort of trainers to expand the space for quality training and skills building of specialists and subspecialists in the region and beyond.
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Affiliation(s)
- Violet Kayamba
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | - Selestine Nzala
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | | | - Cosmas Zyambo
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | - Emmanuel Musenge
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | - Ruth Wahila
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | | | - Christabel Mwiinga
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | - Linda Kampata-Olowski
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | | | | | - Elliot Kafumukache
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
| | - Fastone Goma
- University of Zambia School of Medicine, Nationalist Road, P.O. Box 50110, Lusaka, Zambia
- Eden University, P.O. Box 37727, Barlastone Park, Lusaka, Zambia
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Paluku J, Kitambala E, Furaha CM, Bulu Bobina R, Habamungu P, Camara BS, Sidibe S, Banze Kyongolwa DF, Tripathi V, Delamou A. Integrating Client Tracker Tool Into Fistula Management: Experience From the Fistula Care Plus Project in the Democratic Republic of Congo, 2017 to 2019. Front Public Health 2022; 10:902107. [PMID: 35757601 PMCID: PMC9218534 DOI: 10.3389/fpubh.2022.902107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
This study aimed to document the experience of integration and the contribution of the Client Tracker (CT) to female genital fistula (FGF) management and data quality in sites supported by the Fistula Care+ Project in the Democratic Republic of Congo (DRC), from 2017 to 2019. It was a parallel mixed methods study using routine quantitative data and qualitative data from in-depth interviews with the project staff. Quantitative findings indicated that CT forms were present in the medical records of 63% of patients; of these, 38% were completely filled out, and 29% were correctly filled out. Qualitative findings suggested that the level of use of CT in the management of FGF was associated with staff familiarity with the CT, staff understanding of concepts in the CT forms, and the CT-related additional workload. The CT has mainly contributed to improving data quality and reporting, quality of care, follow-up of fistula patients, and self-supervision of management activities. A possible simplification of the CT and/or harmonization of its content with existing routine forms, coupled with adequate continuous training of staff on record-keeping, would further contribute to maximizing CT effectiveness and sustainability.
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Affiliation(s)
| | | | | | | | | | - Bienvenu Salim Camara
- Africa Center of Excellence for Communicable Diseases Prevention and Control (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea.,Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Sidikiba Sidibe
- Africa Center of Excellence for Communicable Diseases Prevention and Control (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
| | | | | | - Alexandre Delamou
- Africa Center of Excellence for Communicable Diseases Prevention and Control (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea.,Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
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Broekhuizen H, Ifeanyichi M, Cheelo M, Drury G, Pittalis C, Rouwette E, Mbambiko M, Kachimba J, Brugha R, Gajewski J, Bijlmakers L. Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science. PLoS One 2021; 16:e0257597. [PMID: 34587196 PMCID: PMC8480833 DOI: 10.1371/journal.pone.0257597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach. METHODS Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method. RESULTS The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation. CONCLUSIONS Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders.
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Affiliation(s)
- Henk Broekhuizen
- Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Dept. Health and Society, Wageningen University and Research, Wageningen, The Netherlands
- * E-mail:
| | - Martilord Ifeanyichi
- Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- EMAI Health Systems and Health Services Consulting, Nijmegen, The Netherlands
| | - Mweene Cheelo
- Department of Surgery, Surgical Society of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Grace Drury
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Etiënne Rouwette
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Michael Mbambiko
- Department of Surgery, Surgical Society of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - John Kachimba
- Department of Surgery, Surgical Society of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Ruairí Brugha
- Department of Epidemiology & Public Health, Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Noormahomed EV, Mandane A, Cuambe A, Rodrigues MA, Noormahomed S, Carrilho C, Mocumbi AO, Ali M, Vintuar P, Ismail M, Guilundo C, Bickler S, Benson CA, Ferrão JL, Schooley RT. Design and Implementation of Postgraduate Programs in Health in a Resource-Limited Setting in Mozambique (The Lúrio University). Adv Med Educ Pract 2021; 12:399-412. [PMID: 33911914 PMCID: PMC8075734 DOI: 10.2147/amep.s291364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/22/2021] [Indexed: 05/06/2023]
Abstract
PURPOSE To describe the strategies used to design and implement three postgraduate programs at Lúrio University (UniLúrio), a resource-limited setting, in northern Mozambique. METHODS We conducted a longitudinal, descriptive case study from 2011 to 2018 in two phases: 1) needs assessment (2011-2012), 2) implementation strategies (2013-2018), taking into account innovations whenever necessary. RESULTS Several obstacles and barriers to the establishment of postgraduate programs were identified. These included a lack of a core curricula aimed at postgraduate programs, shortage of human resources for teaching and mentorship, limited teaching and research infrastructures, limited financial resources, and lack of administrative capacity. With the support of the Medical Education Partnership Initiative (MEPI), three Master degree programs were designed and implemented. During the period of 2013-2018, UniLúrio enrolled 202 students, distributed as follows: Master degree in Tropical Medicine and Global Health (55), Master degree in Health Professional Education (99), and Master degree in Nutrition and Food Security (48). Of those, 152 (75.2%) obtained a Postgraduate Diploma as they did not present a master dissertation, 89 (44.0%) obtained their Master degree, 30 (14.8%) dropped out, and 20 (9.9%) are awaiting decision. UniLurio's staff trained a Master's degree or a Postgraduate Diploma in 34 (16.8%) and 15 (7.4%), respectively. Our strategies allowed us to improve research capacity building, and set the basis for long-term sustainability by allowing for the establishment of other postgraduate programs, and offered UniLurio a strong role in its internationalization. CONCLUSION By sharing multiple resources, long-lasting partnerships were established with multiple institutions, and competency-based training and postgraduate studies management were developed. Research and eLearning were leveraged, retention and faculty development was enhanced, and some inequalities within the country were reduced. These strategies and innovations can be applied to other resource-limited settings, allowing the scaleup of health professional's training and research capacity building.
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Affiliation(s)
- Emília Virgínia Noormahomed
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Department of Medicine, Infectious Disease Division, School of Medicine, University of California, San Diego, CA, USA
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Amélia Mandane
- Department of Public Health, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | - Agnesse Cuambe
- Department of Public Health, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | | | - Sérgio Noormahomed
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ana Olga Mocumbi
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Chronic Diseases, National Institute of Health, Maputo, Mozambique
| | - Momade Ali
- Department of Public Health, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | - Pompilio Vintuar
- Department of Public Health, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | - Mamudo Ismail
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carvalho Guilundo
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Stephen Bickler
- Department of Surgery, School of Medicine, University of California, San Diego, CA, USA
| | - Constance A Benson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, California, USA
| | - Jorge Luis Ferrão
- Department of Public Health, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Office of the Rector, Maputo Pedagogic University, Maputo, Mozambique
| | - Robert T Schooley
- Department of Medicine, Infectious Disease Division, School of Medicine, University of California, San Diego, CA, USA
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Gajewski J, Monzer N, Pittalis C, Bijlmakers L, Cheelo M, Kachimba J, Brugha R. Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia. Hum Resour Health 2020; 18:25. [PMID: 32216789 PMCID: PMC7098155 DOI: 10.1186/s12960-020-00467-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/11/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. METHODS Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding. RESULTS Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision. CONCLUSION This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes.
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Affiliation(s)
- Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Nasser Monzer
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Chiara Pittalis
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Leon Bijlmakers
- Radboud University Medical Centre Netherlands, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, P.O. Box 50110, Lusaka, Zambia
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, P.O. Box 50110, Lusaka, Zambia
| | - Ruairi Brugha
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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