Global Health Scholarship

GlobalThe COHNS Fund’s Global Health Scholarship

The Fund is now accepting applications for a new initiative, the Global Health Scholarship. Residents in otolaryngology-head and neck surgery programs in Canada are encouraged to apply. Two awards of $1,000 each will be given annually to successful Residents travelling to a low or middle income country, or an under-serviced area in Canada. The scholarships specifically will support travel expenses incurred for the purposes of furthering research in an under-resourced setting. The successful Resident will be expected to submit a report to the President of the Fund following completion of the trip and/or submit for presentation of the research results at the Annual Meeting of the CSOHNS.

Application Form (.docx)

Completed applications can be sent by regular mail, fax or electronically. Electronic applications must be sent as a PDF file via email (please put “Committee for Global Health Research Grant Application” in the subject line).

Please forward applications and queries to: Dr. Gigi Osler, Chair, Committee for Global Health c/o Donna Humphrey, 68 Gilkison Road, ELORA, ON N0B 1S0   Tel: 800-655-9533 / 519-846-0630;  Fax:  519-846-9529; Email: [email protected].

Outreach Activities

Uganda 2016 Trip Report

From left to right: Dr. Brian Westerberg (UBC), Dr. Gigi Osler (U of Manitoba), Professor Samuel Maling (Dean of Medicine, MUST), Dr. Doreen Nakku (MUST), Dr. Ron de Venecia

From left to right: Dr. Brian Westerberg (UBC), Dr. Gigi Osler (U of Manitoba), Professor Samuel Maling (Dean of Medicine, MUST), Dr. Doreen Nakku (MUST), Dr. Ron de Venecia

Surgery has been called the “neglected stepchild” of global public health and remains a low priority on many agendas despite the fact that 15-25% of the worldwide burden of disease can be treated with surgery. Uganda is an east African country with a population of 37.8 million people, the majority of whom live in a rural setting. The annual GDP is only 680USD. There are about 30 Otolaryngology-Head and Neck surgeons country-wide (some of whom do primarily administrative work and do not see patients) serving a total population of about 37 million (source: Uganda 2014 census). This works out to a ratio of 0.08 specialists: 100,000 people. In contrast, Canada has a ratio of 2.1 specialists: 100,000 people (source: 2015 CMA Masterfile).

Dr. Brian Westerberg from UBC, was part of the first trip to Uganda in 2001 to determine the prevalence and causes of hearing loss. Since then, the annual trips under the Hearing Health Care Program in Uganda have involved treating deaf or hard of hearing patients utilizing both medical and surgical means. The program’s mission is to collaborate with local Ugandan surgeons to build their educational infrastructure and expand their capacity to improve the quality of medical care. The program strives to create a sustainable benefit for the people of Uganda; it has expanded to include a broader range of health and educational services with the addition of surgeons from across Canada representing the various subspecialties (Pediatric Otolaryngology, Laryngology, Rhinology, Head and Neck Surgery) as well as experienced personnel in Nursing, Biomedical Engineering and Anesthesiology.

Mbarara is the largest urban center in the western region of Uganda with a rapidly growing population that has more than doubled in the last 4 years (from 82K to 195K according to the 2010 and 2014 Uganda censuses respectively). The city is home to one of the country’s three regional referral hospitals, Mbarara Regional Referral Hospital (Mbarara Hospital), which is affiliated with the medical school at Mbarara University of Science and Technology (MUST). Mbarara Hospital is a public hospital with over 600 beds that is often over capacity. The Department of Otolaryngology at MUST is dedicated to the task of overcoming the many challenges of providing high quality care to an underserved population in a low-income country with limited medical resources. The department consists of only three staff surgeons and is currently training three residents.

Along with UBC, MUST has partnered with Massachusetts Eye and Ear (MEE) to achieve their vision of a Center for Excellence in Otolaryngology for all of Uganda. The main tenets of this vision are:

• To develop capacity to offer the best public otolaryngology care for the people of Uganda
• To continue faculty excellence through professional and skills development
• To provide comprehensive training to faculty, the residency group and medical students

Dr. Westerberg teaching MUST resident at 2016 Temporal Bone course

Dr. Westerberg teaching MUST resident at 2016 Temporal Bone course

This vision included creation of a Temporal Bone Drilling and Surgical Simulation Centre. Learning how to perform temporal bone surgery on cadaveric bones in a skills laboratory is an important component in the training and maintenance of skills for a competent surgeon. Temporal bone labs are routinely found in Canadian universities with an Otolaryngology-Head and Neck Surgery residency-training program. Until recently, there was no such well-equipped facility in Uganda as the one attempt for such a lab at another hospital was limited by a lack of functional equipment. In the past, the Ugandan residents had generally learnt temporal bone anatomy and surgery skills through reading textbooks and clinical exposure in the operating room. It was identified that these residents had either very limited or no experience in using a drill to perform temporal bone surgery (such as a mastoidectomy) either on a cadaver or in a real-life clinical scenario. The identification of this gap in knowledge and skills prompted the creation of a surgical skills course.

Dr. Westerberg and Dr. Doreen Nakku, a MUST surgeon who completed an Otology and Neurotology fellowship at UBC under Dr. Westerberg’s supervision in 2013, led the inaugural course at MUST from January 19-21, 2016. Drs. Kimberly Luu (UBC resident), Gigi Osler (University of Manitoba), and Ron de Venecia (MEE) also contributed to course coordination. Participants included residents from Makerere University in Kampala and MUST residents and staff, and it was offered free of charge. The course included lectures and hands-on teaching in the lab and was developed with anticipated flexibility to align with learner needs. All trainees successfully completed the goals of canal wall up mastoidectomy, canal wall down mastoidectomy, transmastoid labyrinthectomy, endolymphatic sac decompression, facial nerve decompression, and translabyrinthine exposure of the internal auditory canal. Verbal and written feedback was collected from all participants at the end of the course. Overall, the feedback was very positive. All participants reported improvement in their knowledge and skills, and would recommend the course to a colleague.

The Ear Trainer, a low fidelity simulator developed at UBC, was also introduced throughout the 2.5-day course. This simple device mimics the ear canal and tympanic membrane to simulate surgery in the ear under a microscope. It was designed to facilitate the acquisition of hand-eye microsurgical skills outside of the operating room at low expense. All temporal bone course participants used the Ear Trainer to perform four tasks: removal of a foreign body, insertion of a tympanostomy tube, transcanal myringoplasty, and suture manipulation. Students then practiced these skills on the Ear Trainer. Their performance of the four tasks was evaluated before and after the practice. The Ear Trainer now remains in the temporal bone lab and can be used by medical students and residents at MUST to practice their microscopic and otologic surgery skills.

Temporal Bone course teaching staff, participants, and Dean

Temporal Bone course teaching staff, participants, and Dean

With this mutually rewarding Canada-Uganda collaboration and a successful first temporal bone course, the vision is to continue annual trips to MUST and use the lab to meet the goals of the MUST Otolaryngology department. Future directions will include:
• Continual learning and use by MUST residents and faculty
• Annual course for senior residents and faculty open to the entire east Africa region
• Collaboration to share the resource with Anesthesia (simulation lab), Ophthalmology, Orthopaedic Surgery and Neurosurgery (microscope)
• Eventual expansion of the space to include a wet lab for head and neck anatomical dissection or an endoscopic sinus surgery course
• Efficiencies and continuity of training by having same equipment in the operating theatres as well as in the lab setting

Appendix 1: Mbarara University of Science and Technology (MUST) Temporal Bone Drilling Course

Day 1 – Tuesday, January 19, 2016 (Full day)

• Welcome and Introductions (Nakku)
• Ribbon-cutting ceremony for MUST Temporal Bone Lab
• General overview of course Dr. Nakku
All in lab:
• Conduct and safety in lab and OR
• Use and care of the microscope and drill
• Use and care of microsurgical instruments
• Demonstration of “Power-up” and “Power-down” to avoid technical issues with equipment

Group 1 Group 2
Lab dissection Principles of canal wall up mastoidectomy
– Temporal bone anatomy
– Principles of temporal bone surgery including operating room set-up
Principles of canal wall up mastoidectomy Lab dissection
– Temporal bone anatomy
Principles of temporal bone surgery including operating room set-up
LAB: Getting use to instruments and drills. Completed canal wall up mastoidectomy

END OF DAY DEBRIEF (ALL)

Day 2 – Wednesday, January 20, 2016 (Full day)
Group Session: 0800-09:30
– Lectures: Principles of CWD mastoidectomy

BREAK
Group 1 Group 2
Lab dissection Peer learning by watching dissection of paired trainee in other group
LUNCH
Group 1 Group 2
Peer learning by watching dissection of paired trainee in other group Lab dissection
LAB: Complete canal wall down mastoidectomy, labyrinthectomy, exposure internal auditory canal

END OF DAY DEBRIEF (ALL)

Day 3 – Thursday, January 21, 2016 (Half day)
Group 1 Group 2
Lab dissection Tympanoplasty
– Directed question and answers
Tympanoplasty Lab dissection
– Directed question and answers
LAB: Fresh specimen: Complete canal-wall-down mastoidectomy, labyrinthectomy
HAND OUT COURSE DIPLOMAS

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