MAP's impact: Developing surgical skills in Gaza

Blockade, separation, isolation, conflict, movement restriction, a lack of resources, socioeconomic decline, and power cuts… these are some of the constant challenges that the people of Gaza have suffered for more than a decade.

These issues impact all aspects of daily life, but their effects are most evident in the healthcare system. Patients from Gaza are regularly denied access to adequate healthcare, and health providers are also frequently denied the opportunity to travel to training and specialization opportunities outside Gaza which would enable them to fully meet the needs of their patients.

Despite this, Medical Aid for Palestinians (MAP) believes in the potential for Gaza’s health sector to develop, and works to tackle some of the many issues that are affecting the health system with the aim of preserving the health and dignity of Palestinians.

Behind the closure of Gaza, it is essential for health professionals to stay connected to the updates and technical developments of the outside world. MAP has been working for many years to bridge this gap through interventions that aim to improve the capacity and self-reliance of the health system. Where medical professionals struggle to get out of Gaza for training, we work to bring training opportunities into Gaza instead.

This month MAP hosted, for the second time, a team from the Royal College of Surgeons (RCS) consisting of three consultant surgeons. As well as running a Basic Surgical Skills (BSS) training, the delegation also launched a new Core Laparoscopic Surgical Skills (CLSS) training course.

Over three days RCS expert trainers (Dr Bijendra Patel, Prof Shafi Ahmed and Dr Nicholas Markham) trained 14 surgical residents on the technical skills required to perform the most common laparoscopic general surgical operations such as cholecystectomy, appendectomy, and the repair of perforated duodenal ulcers. The team also introduced participants to the theoretical principles of safe laparoscopic practice. Together, the UK surgeons and a faculty of senior surgeons from Gaza jointly supported junior surgeons to practice a simulation of the core laparoscopic surgeries. Here’s what some of the trainees and faculty members had to say about the course:

“The CLSS course is great, I’m happy that I finally practiced the technical surgical laparoscopic skills with my hands because usually we attend real surgeries as observers, and I noted my improved performance between the first and the third day” - Rami Alhindi, Surgical Resident (Year 3)

“The training has opened my eyes and broadened my horizon to new perspectives of the laparoscopic surgeries, considering the support and guidance I received from both UK and local faculty I wish I had attended this training before attending laparoscopic surgeries at the hospital”  - Helal Shaikh, Surgical Resident (Year 3)

I’m so happy to see the juniors’ enthusiasm to practice, it’s the first time for surgeons to get a chance to practice the laparoscopic skills with hands-on simulators instead of experiencing it for the first time on patients

“I’m so happy to see the juniors’ enthusiasm to practice, it’s the first time for surgeons to get a chance to practice the laparoscopic skills with hands-on simulators instead of experiencing it for the first time on patients” Dr. Nasser Radwan, Director of Gaza Faculty

The Basic Surgical Skills work began with a two-day training of trainers supervised by the visiting RCS team, so that the local Gaza faculty could run the course themselves. The Gaza faculty-run training then followed over the next two days, in which a new group of 20 surgical residents received a hands-on experience on safe operating techniques; gowning and gloving; surgical knots; handling of surgical instruments; suturing techniques; local anesthetic techniques; and an introduction to electrosurgery. The RCS team had high praise for the Gaza faculty’s running of the course and the skills they gave to the trainees.

“I finally learned to do things the right way, I’ve been participating in surgeries for 18 years and felt that I’m doing things the wrong way and there must be a best way to do it. The local faculty was very supportive” - Hana Hamarna, G. Obstetrician (R5)

As well as these training courses, the surgeons of Gaza collaboratively worked with RCS lead consultants to undertake complex laparoscopic surgeries for patients. That was an opportunity for the doctors to learn new operating techniques while treating complicated local cases.

Together, MAP and the RCS are not just helping ensure patients can get high-quality operations now, but also ensuring that senior health practitioners in Gaza have the capacity to deliver BSS and CSLS training courses locally and sustainably. Through this series of joint training activities, the RCS is handing over the desired training of trainer’s skills to senior Gaza surgeons, whom in turn will handle the basic surgical skills and core surgical laparoscopic skills trainings targeting junior surgeons and intern doctors.

In addition, MAP has supported the establishment of a permanent core surgical skills training center at the Human Resources Development Directorate (HRDD) at Al Shifa Hospital through the provision training equipment. The center will be accredited by the RCS at the end of the project.

If you would like to support MAP’s work in Gaza, please donate today:

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