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Lusaka (Zambia)

Aim

Urolink's aim in Lusaka is to support the education, training, development and equipping of urological surgeons at the University Teaching Hospital (UTH). The aim of the Urolink project is to work in partnership with UTH to improve urological surgery (endoscopic & open) through a package of training, ongoing support and mentorship which will lead to sustained changes in clinical practice.

Skills stransfer will strengthen the local health system and continue to build on the current work and success of previous visits by the Urolink team, and hence continue to improve the quality of urological care in Lusaka and, eventually, across the whole of Zambia.

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BACKGROUND: Zambia is a presidential, representative, democratic republic in Southern-Central Africa with an area of around 750,000 square kilometres. It is classified as a low-income country and has a population of 11.6 million. Zambia is also one of the most urbanised countries in sub-Saharan Africa, with approximately 38% of the population living in urban areas. Average life expectancy is 60 for men and 64 for women. 44% of the population are under 14 years of age; infant mortality is 34 per 1,000 live births. ** (see below for UK comnparison)

The public sector is the largest provider of healthcare. There are two ministries in health care delivery: the Ministry of Health and the Ministry of Community Development, Mother and Child Health that provide information about health and deliver health services. In 2010, public expenditure on healthcare was 3.4% of the GDP - among the lowest in southern Africa. There were 1.2 doctors per 1,000 people (2018). ** (see below for UK comparison)

The University Teaching Hospital (UTH) is the largest hospital in Zambia, located approximately 4km east of the city centre in the capital, Lusaka. It serves a local population of about 2 million but attracts referrals from the rest of Zambia. It is the principal medical training institution in the country for medical students, interns and post-graduate doctors. It also trains nurses (through the Nursing School within the hospital grounds) and Clinical Officers (through their college at Chainama Hills College Hospital). UTH has approximately 1,655 beds and 250 baby cots. It provides a full range of primary, secondary and tertiary care with both inpatient and outpatient services.
** 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, as such, has no designated ward for its patients; it operates within the general surgery facility where it is allocated approximately 25 beds. The department consists of three units which are headed up by Drs Nenad Spasojević, Bassem Yani and Victor Mapulanga.

The Department runs a post-graduate programme (MMed) and currently has 10 - 15 trainees.  Some trainees also participate in the COSECSA urology programme.
HISTORY: UTH has been associated with BAUS since around 2001, when Christine Evans first visited Mohammed Labib and established the link. After Christine's long association with Mohammed, Shekhar Biyani and Jaimin Bhatt have been regular visitors. They have assisted the MMed programme by helping with the provision of urology modules and developing the Management of Surgical Emergency (MSE) courses. 

Endoscopic surgery of both the upper and lower tract has become well established there over the last 20 years and, following a strong co-operation between Dr Spasojević, and Paul Anderson, UTH has become largely self-sufficient in dealing with complex urethral surgery.
OBJECTIVES: UTH is well established in Zambian healthcare as the national referral hospital and the centre for the training of healthcare workers. It has an important role in the development of specialist training in Southern Central Africa.

It needs lower level input, now, for the development of endoscopic urological services and all but the most complex of issues arising from urethral stricture disease. Urolink can help by providing ongoing support for urological training and education in Lusaka and beyond.
NEEDS:
  • To start 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; and,
  • Future funding to consider short-term observerships for local urologists & residents, as well as approaching interested UK urologists to consider longer visits.

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