International exchange can solve the problem of lack of surgical training

We have read the articles in Läkartidningen with great interest [1, 2] About the difficulty for prospective surgeons to obtain sufficient surgical training to be able to work as independent surgeons. One reason for this is stated to be that the craft has diversified when new techniques have to be mastered alongside traditional open surgery, for example robot-assisted laparoscopy and endovascular procedures. Undoubtedly, these techniques have brought great benefits to surgical patients, but at the same time they have meant that open surgery, which can be crucial in severe complications or trauma, has sometimes been given less space.

Within the training of surgeons in the Östergötland region, we have developed improved training in open surgery. The International Medical Program at the University Hospital in Linköping, together with the Thoracic and Vascular Clinic in Linköping and the Surgical Clinics in Linköping and Norrköping, has been running bilateral exchange projects with two hospitals in Ethiopia for several years. The aim was to contribute to the development of surgery in the low-income country of Ethiopia, but also to provide the opportunity to train in open vascular surgery and traumatology for ST doctors in the Östergötland region and young specialists.

The vascular surgical exchange with the leading hospital in Ethiopia, Tekur Anbesa Specialized Hospital in Addis Ababa, has been ongoing since 2017. The strong reason is that the need for vascular surgical expertise is increasing in Ethiopia and Sub-Saharan Africa due to the increasing vascular diseases in the country. With longevity and increased incidence of diabetes [3]. Another reason is that vascular surgery in Sweden is now dominated by endovascular procedures, while open vascular procedures are in the minority. [4]. On the other hand, in Ethiopia, all interventions are open, as they are necessary from a health and economic perspective and the only option is to make vascular surgery available to wide population groups in the long term. [5]. Contributing to the development of vascular surgery in Ethiopia opens opportunities for Swedish ST doctors to actively participate in open surgeries.

The exchange included training potential Ethiopian vascular surgeons in Linköping in particular, while ST doctors worked with senior colleagues from the Östergötland region in Addis Ababa so that they could transfer their knowledge adapted to local conditions. For the Swedish part, the exchange project means that ST doctors have been exposed to open vascular surgery to an extent that would not be possible in terms of time in the Swedish clinical context.

Another similar project has been underway since 2019 with Gondar University Teaching and Referral Hospital in northern Ethiopia. For Gundar, the focus has been on colorectal cancer, and in the Östergötland region on trauma treatment. The need for surgery in oncological diseases is increasing in low-income countries like Ethiopia, at the same time as knowledge of traumatology, an area with high infection rates in Ethiopia, is increasing. [6-8]Needs improvement in Sweden. Ethiopian surgeons participated in colorectal operations at Linköping and Norrköping hospitals, while ST doctors stayed in Gondar and Addis Ababa for a month's training in traumatology.

We would like to draw attention to the fact that bilateral exchanges with low-income countries represent an opportunity for Swedish ST doctors in surgery to increase their experience in open operations, a technique that the independent surgeon needs to master in critical situations. In the worst cases, open surgery can be the only available and resource-efficient surgical method during crises or disasters.

Our experiences with exchange work have been only good, and the mutual benefit has been great, but the business requires commitment, long-term planning and, not least, an understanding of the manager's need for financial support.

Lakartidningen.se 01-03-2024