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Moshi (Tanzania)

Aim

The primary aim for collaboration with Moshi has been to introduce a modern stone management service, help with the development of adult and paediatric reconstructive surgery, and develop KCMC as a regional training centre so that this expertise can be rolled out to other countries in East Africa.

Urolink helps provide support and guidance in acquiring equipment, making the best use of the existing facilities, and facilitating education and training for the local urologists to deliver a high-quality service to the local population. Ultimately, this has helped equip the local KCMC consultants with the knowledge and expertise to disseminate that education to the local urology trainees as well as those coming to KCMC from other countries for advanced tuition. 

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BACKGROUND: Tanzania is a constitutional republic in coastal East Africa with an area of 945,000 square kilometres. It has a population of 60 million, two-thirds of whom live in rural communities. Average life expectancy is 64 for men and 68 for women. 44% of the population are under 14 years of age; infant mortality is 38 per 1,000 live births. ** (see below for UK comparison)

The Tanzanian health system is decentralized, and framed most explicitly by its National Health Policy. The policy appears to be driven primarily by the objective to provide access to quality primary health care for all citizens. Explicitly linked to the health-related Millennium Development Goals (MDG) is the policy’s identification of, and focus on, resources towards an essential healthcare package, which is “an integrated collection of cost-effective interventions that address the main diseases, injuries and risk factors” in the country. Community health promotion and disease prevention through environmental sanitation and management of occupational health services are recognized as key components. There were 0.05 doctors per 1,000 people (2012). ** (see below for UK comparison)

The 2019 Tanzania Mainland Poverty Assessment notes that poverty decreased by eight percentage points in 10 years, down from 34.4% in 2007 to 26.4% in 2018. Along with the reduction in poverty, the country is showing signs of a structural transformationMore people are moving towards industry and services, reducing the overall share of employment in agriculture. Those who stay in agriculture are also diversifying towards non-farm wage and self-employment.” Malaria and HIV are major health concerns.

Kilimanjaro Christian Medical Centre (KCMC) is located in the foothills of the snow-capped, Mount Kilimanjaro, Tanzania (pictured above). It was opened in March 1971 by the Good Samaritan Foundation, who planned and raised large funds to build and equip it. The urology department was significantly expanded in 2005 with Urolink's assistance.

KCMC is a referral hospital for over 15 million people in Northern Tanzania. The hospital is a huge complex with 500 - 800 inpatients in 630 official beds, 90 canvas, 40 baby Incubators. There are 1,852 students, 1,300 staff, and 1,000 visitors (plus companions) daily.
** 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 Institute of Urology at KCMC is one of the leading centres for urological surgery in Africa. It is also an important training centre for urologists in East Africa. There are up to 12 Registrars attached to the unit, together with trainees from surrounding countries (including Malawi, Rwanda, Uganda & Kenya) and from other regions of Tanzania. Delegates at conferences include general surgeons and urologists from across Tanzania and neighbouring countries, with trainees and students from the Medical School at KCMC.
HISTORY: Lester Eshelman (1921 - 2009) devoted much of his life to developing urological services in East Africa and at KCMC in particular. Since Lester's death in 2009 a workshop bearing his name has been run at KCMC biennially to perpetuate his concept of continuing education. The theme for the most recent workshop was "Paediatric Urology, Reconstructive Urology & Bipolar TURP". 

This workshop has been convened under the auspices of COSECSA / ASEA and generously supported by BAUS Urolink, ANANSE Foundation Holland, the Global Philanthropic Committee (of the SIU, EAU & AUA), Olympus Surgical Technologies and The Oak Foundation. These worshops have seen significant developments in Trainee participation, with audit, case presentation and operative assistance being of great benefit to their future careers, whilst preparing them for the COSECSA FCS exams.
OBJECTIVES: To promote the development of Urology at KCMC, by establishing a sustainable and self-perpetuating cycle of training, and by equipping urological surgeons.

Surgeons will be trained in the techniques of ureteroscopy, percutaneous nephrolithotomy and posterior urethroplasty. The role of the radiologist in the team will be explored and their expertise will be included, as required. The Theatre team will be involved in training for their role in surgical procedures but, in particular, will be instructed in the handling, care and sterilisation of delicate equipment.  
NEEDS:
  • To continue with ongoing audit/data collection;
  • The centre would benefit from a UK surgeon spending four to six weeks with clear objectives; 
  • To develop telemedicine for remote MDTs and operative mentoring.
  • Future funding to consider short-term observerships for local urologists & residents, as well as approaching interested UK urologists to consider longer visits; and, 
  • To provide equipment for percutaneous nephrolithotomy, ureteroscopy and mechanical stone fragmentation.

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