EAU supports urology training in Tanzania to enhance residents' knowledge and understanding of modern urology

Since 2015/16, with support from the Global Philanthropic Committee (GPC), Prof. Christopher Chapple (GB) as Secretary General of the EAU, and Mr. Reinhard Zentner (DE) as managing director of Olympus, the donor of the equipment, a major effort has been made to improve the urology training and health care delivery at the Institute of Urology at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. To facilitate this, Prof. Magnus Grabe (SE) and Dr. Jacques Bogdanowicz (NL, TZ) initiated and developed the Intensive Interactive Training Programme (IITP) designed to enhance theoretical and practical knowledge, oral presentation techniques, basic research methodology, and surgical skills by focusing intensively on the individual resident in training.

KCMC is the major specialist health care provider in Northern Tanzania, supporting the needs of some 15 million people. Tanzania is a low-resource country with many demands on these limited resources. The practice of modern urology is a high-tech area of surgery which in this situation depends on support from the international community. The role of KCMC as the premier training centre not only for Tanzania, but also for East Africa means that support for this unit plays a significant part in the improvement of urological health care for the whole region. Residents in training (approximately 10 - 15 per group) come from all over East and Central Africa; the majority from Tanzania, but also from Ethiopia, Kenya, Malawi, Madagascar, Namibia, Rwanda, and Uganda.

To support these efforts, the endoscopic equipment has been modernised. A bipolar transurethral resection option was set up with the corresponding need for its introduction under careful individual supervision. In response to this need, the IITP was developed. This approach to education proved so successful that the programme was extended to include endoscopic stone treatment (facilitated by Dr. Aasem Chaudry, GB), shortly followed by programmes in urethra reconstructive surgery (Prof. Ruud Bosch, NL), and most recently in paediatric reconstructive surgery (Dr. Barbara Kortmann and Dr. Liesbeth De Wall, both NL). Up to the present, eleven IITPs have been held with the following main topics: transurethral resections, urethra reconstructions, endoscopic stone management, URS, PNL, paediatric reconstruction, uro-oncology, and neurogenic bladder dysfunction.

Dr. Barbara Kortmann and Dr. Liesbeth De Wall perform surgery during the IITP in paediatrics.

Avoiding brain drain

An IITP is structured around experts from abroad, most of whom are of high academic standing and/or possess expert practical experience in a specialised field. Typically, both visiting faculty and residents present and discuss various topics of importance, followed by practical hands-on surgery with close supervision and instruction provided by the experts. This approach to training brings the expertise to the trainee and avoids the necessity of travelling abroad which might lead to brain drain; a recurring issue for health care in Africa.

The support of the EAU, GPC, and Olympus has greatly facilitated the improved educational quality at the Institute of Urology. Group discussions and personal one-to-one coaching have shown that residents are most enthusiastic about the format of the IITP and suggest extending it with further topics. Due to the upgraded endoscopic and surgical facilities and the intensive training programmes, the residents have obtained a better understanding of modern urology. The quality of both their theoretical knowledge and practical skills has improved.

Future plans

This progress needs to be maintained. A goal for the short/medium-term is to restructure one of the operating theatres to make it suitable for X-ray use. Furthermore, modernisation of the ultrasound equipment is necessary. Other objectives are to set up flexible cystoscopy for use in out-patients and to further develop the IITP, making it available not only to our residents, but also to specialist urologists in the region as part of continuing medical education. The Institute of Urology at KCMC already plays a major role in the education of doctors and medical specialists, and it aims, with some ongoing financial support from GPC, to continue this into the future.