For decades, Fellows of the American College of Surgeons (ACS) have been engaged in humanitarian work, providing surgical care to underserved populations worldwide. In recent years, the ACS and the College of Surgeons of East, Central and Southern Africa (COSECSA) have been developing strategic partnerships to improve surgical education, address workforce shortages, and build a sustainable health care system. COSECSA is one of the sub-Saharan surgical colleges. This organization has approximately 2,000 members in 12 African countries, who serve a population of more than 350 million. COSECSA is responsible for the training and credentialing of surgeons.
In February 2016, the ACS Board of Regents had a retreat to develop strategies to address challenges in global surgical care. The Regents agreed to support efforts aimed at surgical workforce development in low-income countries, focusing initially on sub-Saharan Africa.
Although several ACS Fellows have been actively working in the region, a formal initial discussion between ACS and COSECSA leadership occurred during a visit by Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services, and Girma Tefera, MD, FACS, Medical Director, Operation Giving Back (OGB), in July 2016. Since then, based on COSECSA priorities, the ACS and COSECSA have engaged in several collaborative activities, including providing scholarships for graduating women residents, access to the ACS leadership training programs, access to limited educational resources, twinning of scientific journals, and recruitment of volunteers as external examiners and providers of surgical services at COSECSA training sites.
With institutions working in silos, duplicative efforts and wasted resources have resulted amid many global surgery efforts. As more centers launched global surgery programs over the past years, the problem magnified. OGB’s Committee on Global Engagement therefore recommended a pilot project to establish a centralized surgical training hub in sub-Saharan Africa where the quality of surgical training could be improved, and the number of trainees could be scaled up.
A series of situational analysis surveys were sent to 30 African institutions; 16 responded. Of these, three were short listed and two underwent a site visit. Hawassa University—a 480-bed hospital that serves an area with nearly 18−20 million people—was chosen as the pilot site for the ACS-COSECSA Surgical Training Collaborative. University Teaching Hospital, Lusaka was chosen as the second site.
Departments of surgery at 13 U.S. hospitals with global surgery programs agreed to form a consortium and join hands to participate in this effort. A project planning meeting that included Hawassa University, the ACS, and the partner U.S. surgery departments met in July 2018 to develop shared goals and to devise a work plan for the coming years, focusing on ways to strengthen the education, clinical service, quality, and research infrastructure at Hawassa University. The ultimate goal of this project is to improve the quality of surgical training and increase the number of trainees. This endeavor opened up a great opportunity for U.S. residents and students to work and learn under supervision.
Based on lessons learned in Hawassa, OGB formed the second hub at the University Teaching Hospital in Lusaka, Zambia alongside ten U.S. hospitals in October 2020. This opportunity to scale up surgical training hubs will increase the number of surgical trainees to grow the surgical workforce in the continent and help reduce the global burden of surgical diseases.