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Hawassa (Ethiopia)

Aim

In 2015, Urolink received funding from the British Journal of Urology International (BJUI) to advance urological training and care in Hawassa through targeted education and professional exchange programmes that aimed to develop urological services.

Since that time, Urolink has helped provide some training in safe surgical practice, stores management and the use and maintenance of equipment. In common with other centres in sub-Saharan Africa, endoscopic surgery has been a major requirement, as well as help with complex reconstruction and paediatric problems. 

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BACKGROUND:

Ethiopia is located in the “Horn of Africa” and has a total area of about 1.1 million square kilometres. With a rapidly expanding population of nearly 110 million, it is one of the most populous countries in sub-Saharan Africa; more than 85% of the people live in rural areas. Life expectancy in Ethiopia is low (55 years for men, and 58 for women). 40% of the population are under 14 years of age; infant mortality is 39 per 1,000 live births. ** (see below for UK comparison

Ethiopia's healthcare system is among the least developed in sub-Saharan Africa and is not, at present, able to cope with the significant health problems facing the country. The government has recognised that ill-health in a rapidly-growing population is a major problem, and has committed to salvaging the country's failing health system. They have chosen to strengthen primary health care, because of the lack of physical access to basic health care facilities in rural areas. There are < 50 urologists and no paediatric urologists to support this population. There were 0.1 doctors per 1,000 people (2018). ** (see below for UK comparison)

Widespread poverty, poor nutritional status, low education levels and poor access to health services have contributed to the high burden of ill health in the country. Malaria is the primary health problem; it is the leading cause of outpatient visits and is responsible for 8 to 10 million clinical cases each year, with a significant mortality. Up to 80% of the health problems in the country are due to preventable, communicable or nutritional diseases.

Hawassa University Comprehensive Specialised Hospital (HUCSH) started health delivery services in 2006. It provides diversity of both outpatient and inpatient services for about 15 million people from all over the Southern Nations of Ethiopia and neighbouring regions. Currently, HUCSH has over 400 beds and provides high quality patient care, in a broad range of services, to over approximately 90,200 outpatients, 18,116 hospitalised patients and 1,092 emergency cases each year.


** UK population: 67 million (2019) - UK area: 242,500 sq Km - Life expectancy: M80 / F84 years (2020) - Age demographic: 18% < 14 years (2019) - Infant mortality: 4 per 1,000 (2018) - Doctors per 1,000 population: 2.8 (2018) - https://data.worldbank.org
UROLOGY DEPT: The Urology Department is part of the Department of Surgery, and was established as a unit approximately eleven years ago. It is managed by two urological surgeons, soon to be expanded, and three urological nurses. The unit also receives a general surgical resident, and interns, every couple of months as part of their training. The department runs a post-graduate programme in general surgery and currently has 35 residents from first to fourth years.
HISTORY: Shekhar Biyani made the first association with Hawassa in 2010 and has been a critical link person in maintaining the relationship with Aberra Gobeze, the general surgeon, later urologist, who helped found the hospital in 2003 and the urology department in 2009. Getaneh Tesfaye Teferi joined Aberra in 2019, and Tilaneh Leyeh is the latest addition to this expanding department.
OBJECTIVES:

To raise the profile of Hawassa University Referral Hospital in Ethiopia with a view to supporting its development as a training centre.

To assist with the development of endoscopic urological surgery especially TURP, TURBT and paediatric cystoscopy. To help with the introduction of urethroplasty especially for the management following complex pelvic fracture urethral distraction (PFUD) and previous hypospadias surgery. There is also a desire to increase collaboration with COSECSA.

NEEDS:
  • To continue strengthening the urology unit through an increase in dedicated, trained and trainee, urological personnel.
  • To provide sustainable supplies of durable and disposible equipment. 
  • To help support advanced training for consultants.
  • To provide training and workshops.
  • To develop the data and audit activity to improve outcomes.
  • To develop Internet access to support telemedicine for remote MDTs and operative mentoring.

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