I left Nigeria, West Africa in 2007 to pursue my goal of becoming a surgeon in the United States. Being chosen a decade later as the 2017 Association for Academic Surgery (AAS)/West African College of Surgeons (WACS) International Visiting Professorship was therefore a great honor. The 2017 Annual meeting of the WACS was scheduled to take place in the capital city of Ouagadougou, Burkina Faso. This host country is a landlocked Francophone country of less than 20 million people in West Africa and bordered by six other countries.
My trip started in Kansas City on Saturday, February 25, and we landed in Ouagadougou the next evening of February 26th. As with most developing countries, proceeding through immigration was quite interesting. The language barrier was in itself a minor challenge, but moving through multiple passports checks was somewhat confusing but anxiety-provoking at the same time, since I could not figure out what some of the additional stops were for. All in all, it was rather uneventful. You truly learn the value of patience and slowing down right from the airport. It’s almost like a subtle way of saying “Welcome, we do things a little bit differently here”. The meeting started on Monday morning with the procession and messages from the President of WACS, other Presidents of Sister Colleges of Surgeons in Africa and the President du Faso, Roch Marc Christian Kaboré. The conference then separated into different sessions by Faculty. Unlike the American College of Surgeons (ACS), WACS combines the comparative role of ABS, ACGME and ACS together into one. WACS also has various faculties, which represent different specialties including Surgery, Anesthesia, Dental Surgery, Ophthalmology, Otorhinolaryngology, Radiology and Obstetrics & Gynecology. The focus of the annual conference was health care financing in the Sub-Saharan region and this was a recurring theme in most sessions. I attended the Surgery Faculty session where surgery training programs and board pass rates were discussed, among other duties of the college.
An interesting concept that is currently in evolution within WACS is an exit pathway for residents who have completed the junior years of residency with an option to proceed to higher level training. This way, they earn membership of the WCS (MWACS) and can practice in underserved areas. This training also incorporates a rural or underserved rotation as a mandatory component before successfully getting the award of MWACS. This is in no way a novel idea, as a comparative degree, the MRCS, exist in UK surgical colleges. For West Africa, this is unique because it helps address problems that are very local and region based. It provides an avenue to train more surgeons in community based hospitals with supervision who can then fill needs for surgeons in different rural and underserved areas. It is a local solution to a region problem. The Presidential session of the WACS meeting had varied keynote speakers from the United States and across the West African Region. Sir Murray Brennan, the Vice President for International Programs and Benno C. Schmidt Chair in Clinical Oncology at the Memorial Sloan Kettering Cancer Center in New York was the keynote speaker. His talk was very motivating as he encouraged data driven, locally sourced solutions to regional problems in cancer care. Two different sessions, same message. It was quite interesting to see a focus on population based surgical delivery being emphasized, as this was not the case when I trained and practiced in Nigeria years ago. This aligned very well with my presentation in the pediatric surgery break out session on quality improvement through database research with a focus on population health.
At the end of my trip, I learned some core lessons about global and international surgery. Though I practice in a developed and high income country, solutions from these countries do not necessarily solve problems in LMIC countries. Encouraging data-driven research to identify local problems, investing in very innovative, region-tailored solutions to problems, even if adapted from other countries, seems like a more successful approach. Seeing the local surgeons as partners in the delivery of better surgical care to the patients they serve is a start, and understanding our roles as collaborators rather than lead surgeons in these efforts will be more fruitful. Being back in the United States, I have been encouraged to approach problems and challenges the same way. Identify the problem with data and seek adoptable solutions tailored to my local population and patients that I serve. Hopefully, this will be the goal of most collaborations in international surgery.