Abebe Bekele

University of Global Health Equity and Addis Ababa University · Professor of Surgery

Background: Safe surgery requires high-quality, reliable lighting of the surgical field. Little is reported on the quality or potential safety impact of surgical lighting in low-resource settings, where power failures are common and equipment and resources are limited. Methods: Members of the Lifebox Foundation created a novel, non-mandatory, 18...

Background: This study assesses the retention of specialist surgical graduates from training programmes across eight countries in East, Central and Southern Africa from 1974 to 2013. It addresses the gap in existing data by analysing retention rates of surgical graduates by comparing graduating institution to current location. Data were assessed b...

Introduction: While prior studies have evaluated surgical skills simulation and retention in highly resourced environments, there is paucity of data on the retention of surgical skills taught in simulation laboratory to undergraduate students, and virtually none from low-resource settings. We aimed to evaluate the trends in retention/decay of surg...

Background Worldwide, five billion people lack access to safe, affordable surgical, obstetric, and anaesthesia (SOA) care when needed. In many countries, a growing commitment to SOA care is culminating in the development of national surgical, obstetric, and anaesthesia plans (NSOAPs) that are fully embedded in the National Health Strategic Plan. Th...

Background With the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains...

Introduction Non-technical skills (NTS) including communication, teamwork, leadership, situational awareness, and decision making, are essential for enhancing surgical safety. Often perceived as tangential soft skills, NTS are many times not included in formal medical education curricula or continuing medical professional development. We aimed to e...

Background Equitable access to quality care after injury is an essential step for improved health outcomes in low- and middle-income countries (LMICs). We introduce the Equi-Injury project, in which we will use integrated frameworks to understand how to improve equitable access to quality care after injury in four LMICs: Ghana, Pakistan, Rwanda and...

Background Both anastomotic leak (AL) and conduit necrosis (CN) after oesophagectomy are associated with high morbidity and mortality. Therefore, the identification of preoperative, modifiable risk factors is desirable. The aim of this study was to generate a risk scoring model for AL and CN after oesophagectomy. Methods Patients undergoing curati...

Background Nonmalignant tracheal stenosis is a potentially life threatening conditions that develops as fibrotic healing from intubation, tracheostomy, caustic injury or chronic infection processes like tuberculosis. This is a report of our experience of its management with tracheostomy, rigid bronchoscopic dilation and surgery. Methods Retrospect...

Background Increasing surgical specialist workforce density in sub‐Saharan Africa is essential for improving access to surgical care. However, out‐migration creates a significant challenge to attaining provider targets. We aimed to determine the rates and trends of retention of surgeons in the College of Surgeons of East Central and Southern Africa...

Background Addressing childhood stunting is a priority and an important step in the attainment of Global Nutrition Targets for 2025 and Sustainable Development Goals (SDGs). In Rwanda, the prevalence of child stunting remains high despite concerted efforts to reduce it. Methods Utilizing the United Nations International Children’s Emergency Fund (...

Much innovation has taken place in the development of medical schools and licensure exam processes across the African continent. Still, little attention has been paid to education that enables the multidisciplinary, critical thinking needed to understand and help shape the larger social systems in which health care is delivered. Although more than...

Importance Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intens...

Background Breast self-examination (BSE) is considered one of the main screening methods in detecting earlier stages of breast cancer. It is a useful technique if practiced every month by women above 20 years considering that breast cancer among women globally contributed to 685,000 deaths in 2020. However, the practice of breast self-examination a...

Purpose Neonatal sepsis remains a significant cause of morbidity and mortality worldwide, particularly in low-resource settings. We explored the clinical presentation and bacteria causing fever and hypothermia among neonates at a rural district hospital in Rwanda. Methods Between 29th March to 7th October 2022, a total of 126 children were enrolled...

Background The objective of this study was to assess the costs, catastrophic out-of-pocket (OOP) health expenditure, impoverishment and coping mechanisms used to pay for surgical care in a predominantly rural area of Ethiopia. Methods We conducted a community-based, cross-sectional household survey of 182 people who had undergone a surgical procedu...

Much surgery in sub-Saharan Africa is provided by non-specialists who lack postgraduate surgical training. These can benefit from simulation-based learning (SBL) for essential surgery. Whilst SBL in high-income contexts, and for training surgical specialists, has been explored, SBL for surgical training during undergraduate medical education needs...

Background The Saving Lives Through Safe Surgery (SaLTS) project was launched in 2016 by the Ethiopian Ministry of Health to improve access and quality of surgical and anaesthesia care throughout Ethiopia. A key action of SaLTS was to develop a National Surgical, Obstetric and Anaesthesia Plan (NSOAP). The aim of this study was to explore barriers...

Objectives Using the ‘Four Delay’ framework, our study aimed to identify and explore barriers to accessing quality injury care from the injured patients’, caregivers’ and community leaders’ perspectives. Design A qualitative study assessing barriers to trauma care comprising 20 in-depth semistructured interviews and 4 focus group discussions was c...

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Background Operative experience is a necessary part of surgical training. The College of Surgeons of East, Central, and Southern Africa (COSECSA), which oversees general surgery training programs in the region, has implemented guidelines for the minimum necessary case volumes upon completion of two (Membership) and five (Fellowship) years of surgic...

Objectives This study aims to evaluate health systems governance for injury care in three sub-Saharan countries from policymakers’ and injury care providers’ perspectives. Setting Ghana, Rwanda and South Africa. Design Based on Siddiqi et al ’s framework for governance, we developed an online assessment tool for health system governance for injur...

Background Developing a contextually appropriate curriculum is critical to train physicians who can address surgical challenges in sub-Saharan Africa. An innovative modified Delphi process was used to identify contextually optimized curricular content to meet sub-Saharan Africa and Rwanda's surgical needs. Methods Participants were surgeons from Ea...

Background National surgical policies have been increasingly adopted by African countries over the past decade. This report is intended to provide an overview of the current state of adoption of national surgical healthcare policies in Africa, and to draw a variety of lessons from representative surgical plans in order to support transnational lear...

Objective: The resource-limited environment in Sub-Saharan countries, with a lack of expert trainers, impedes the progress of laparoscopic training. This study aimed to identify the opportunities and limitations of laparoscopic surgery training in the College of Surgeons of East, Central, and Southern Africa (COSECSA) countries. Design and settin...

Objective: We report on the development and implementation of a surgical simulation curriculum for undergraduate medical students in rural Rwanda. Design: This is a narrative report on the development of scenario and procedure-based content for a junior surgical clerkship simulation curriculum by an interdisciplinary team of simulation specialis...

Grappling with ethics in global surgery must begin with a willingness to acknowledge the power dynamics in the field of global health, irrespective of its idealistic roots. Global surgeons must pay attention to frameworks that can guide ethical engagement in trans-border surgical care delivery, education, research, and partnerships. Ethical tension...

Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in...

Background: Thoracotomy is a major surgical procedure requiring a thorough understanding of cardiorespirato-ry mechanics. Postoperative care requires a high-dependency environment and trained and well-experienced staff. The aim of this study was to determine the post-op outcomes, estimate the time to full post-op recovery, and identify predictors a...

Background To provide just equity in academic exchange, as well as to reduce prohibitive travel cost and address environmental concerns, the past paradigm of international student exchange has fundamentally shifted from one directional travel to mutually beneficial bidirectional remote communication between students all over the globe. Current anal...

Background An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy and assessed first-time user experience.Methods An interdisciplinary team of healthcare providers and simulation specialists a...

Background: To address the global need for accessible evidence-based tools for competency-based education, we developed ENTRUST, an innovative online virtual patient simulation platform to author and securely deploy case scenarios to assess surgical decision-making competence. Study design: In partnership with COSECSA, ENTRUST was piloted during...

There is limited understanding of the role of transcultural, cross-site educational partnerships for global surgery training between high- and low- or middle-income country (LMIC) institutions. We describe the development, delivery, and appraisal of a hybrid, synchronous, semester-long Global Surgical Care course by global health collaborators from...

“Global health experiences,” clinical and research learning opportunities where learners from high-income country (HIC) institutions travel to low- and middle-income countries (LMICs), are becoming increasingly popular and prolific in the health sciences. Increased interest has been well documented among medical, pharmacy, and nursing learners who...

Background Breast self-examination is considered one of the main screening methods in detecting earlier stages of breast cancer. It is a useful technique if practiced every month by women above 20 years since globally breast cancer among women contributed to 685,000 deaths in 2020. However, the practice of breast self-examination among healthcare p...

Background Breast self-examination is considered one of the main screening methods in detecting earlier stages of breast cancer. It is a useful technique if practiced every month by women above 20 years since globally breast cancer among women contributed to 685,000 deaths in 2020. However, the practice of breast self-examination among healthcare p...

Childhood stunting in its moderate and severe forms is a major global problem and an important indicator of child health. Rwanda has made progress in reducing the prevalence of stunting. However, the burden of stunting and its geographical disparities have precipitated the need to investigate its spatial clusters and attributable factors. Here, we...

Background The adoption and accessibility of laparoscopy have been serious issues in countries with limited resources, and for varied reasons. This study assessed resource capacity and barriers to the effective practice of laparoscopic surgery in training hospitals affiliated with the College of Surgeons of East, Central and Southern Africa (COSECS...

Child stunting is an important household, socio-economic, environmental and nutritional stress indicator. Nationally, 33% of children under 5 in Rwanda are stunted necessitating the need to identify factors perpetuating stunting for targeted interventions. Our study assessed the individual and community-level determinants of under-5 stunting essent...

Background: Surgical site infection (SSI) surveillance programs are recommended to be included in national infection prevention and control (IPC) programs, yet few exist in low- or middle-income countries (LMICs). Our goal was to identify components of surveillance in existing programs that could be replicated elsewhere and note opportunities for i...

Background The COVID-19 pandemic has had disproportionate impacts across race, social class, and geography. Insufficient attention has been paid to addressing the massive inequities worsened by COVID-19. In July 2020, Partners In Health (PIH) and the University of Global Health Equity (UGHE) delivered a four-module short course, ‘An Equity Approach...

Background: To provide just equity in academic exchange, as well as to reduce prohibitive travel cost and address environmental concerns, the past paradigm of international student exchange has fundamentally shifted from one directional travel to mutually beneficial bidirectional remote communication between students all over the globe. Current ana...

Multidisciplinary team-based simulation training in a rural district hospital to optimize surgical team capacity for quality and timely surgical care. A study of perceptions, knowledge gain, and confidence

The One Health approach considers the contribution of animals and the environment to health. Here we describe how the University of Global Health Equity in Rwanda is integrating One Health into its medical curriculum to train the next generation of doctors to respond to the health challenges of our changing planet. Bayisenge et al. describe teachin...

Background The implementation of simulation-based learning for surgical training in sub-Saharan Africa can help prepare trainees to address surgical burden. The current status of simulation for surgical skills training in undergraduate medical education in Africa South of the Sahara needs to be better defined. In this scoping review we aimed to ide...

Background: The Lancet Commission on Global Surgery has identified workforce development as an important component of National Surgical Plans to advance the treatment of surgical disease in low- and middle- income countries. The goal of our study is to identify priorities of surgeon educators in the region so that collaboration and intervention ma...

Background A well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers,...

Background The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual expenditure, or more than 40% of annual non-food household e...

Most cases of empyema thoracis are sequelae of severe pneumonia, but chest trauma and complications of chest tube insertion as cause are not uncommon in low-resource settings. Diagnosis is usually delayed due to delayed presentation to health care facilities, low index of suspicion among health care professionals, and inability to properly stage th...

The term "global health equity" has become more visible in recent years, yet we were unable to find a formal definition of the term. Our Viewpoint addresses this gap by offering a discussion of this need and proposing a definition. We define global health equity as mutually beneficial and power-balanced partnerships and processes leading to equitab...

Background Clinical practitioners are influential figures in the public’s health-seeking behavior. Therefore, understanding their attitudes toward the COVID-19 vaccine is critical for implementing successful vaccination programs. Our study aimed to investigate clinical practitioners’ acceptance of the COVID-19 vaccine and associated factors for evi...

Background This article presents a qualitative study of African anatomists and anatomy teachers on the Anatomage Table–a modern medical education technology and innovation, as an indicator of African anatomy medical and anatomy educators’ acceptance of EdTech. The Anatomage Table is used for digital dissection, prosection, functional anatomy demons...

Purpose of Review Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising...

Background The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual expenditure, or more than 40% of annual non-food household e...

We aimed to determine whether a Case-Based Collaborative Learning (CBCL) curriculum, developed from the clinical experience of U.S.-based clinicians in collaboration with Rwandan medical faculty, is acceptable, feasible to implement , and effective as a virtual educational tool for medical students in a resource limited , global health setting. In...

Background

This article presents the experience and reflections of medical educators following the introduction of the Anatomage table, an educational technology or EdTech to our medical school for the purpose of supporting the teaching of anatomy and related basic medical sciences to medical school. It was considered a critical need by the stakeholders inclu...

Injuries in low-income and middle-income countries are prevalent and their number is expected to increase. Death and disability after injury can be reduced if people reach healthcare facilities in a timely manner. Knowledge of barriers to access to quality injury care is necessary to intervene to improve outcomes. We combined a four-delay framework...

Objective:. We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA). Summary Background Data:. Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was...

Full text: https://journals.lww.com/aosopen/Fulltext/2022/03000/An_Online,_Modular_Curriculum_Enhances_Surgical.32.aspx?context=LatestArticles Objective: We aimed to determine the impact of a standardized curriculum on learning outcomes for surgical trainees in East, Central, and Southern Africa (ECSA). Background: As surgical education expands t...

We describe construction of an improvised, low-cost, negative-pressure, closed tube surgical drain constructed from an empty intravenous fluid container and an infusion giving set used in the low-resource rural context.

Background: The COVID-19 pandemic has caused substantial disruptions to surgical-care delivery mainly due to diversion of available resources from surgical to COVID-19 care, reduced flow of patients, supply-chain interruptions and social distancing and restriction measures. The purpose of this study was to understand the impact of the pandemic on...

Background: E-learning, or electronic learning, is the delivery of learning and training through digital resources. The department of Surgery, School of Medicine, Addis Ababa University, has recently been using digital E-learning strategies to supplement traditional methods of clinical teaching. This study was conducted to assess our clinical medic...

Background: In Ethiopia, a country where seeing medical errors is not rare, there is a lack of data concerning the overall awareness of medical malpractice issues among physicians. A recent study showed that 80% of malpractice claims in Ethiopia are related to some form of surgery or operation room activities. Methods: A cross-sectional survey w...

Background: Operating room (OR) efficiency is a measure of how well time and resources are used for their intended purposes in the operating room. Commonly used parameters are cancelation rate, first case start-time, turnover time, and utilization rate. While previous similar study from our hospital showed inefficient OR utilization , the differenc...

BACKGROUND: In Ethiopia, a country where seeing medical errors is not rare, there is a lack of data concerning the overall awareness of medical malpractice issues among physicians. A recent study showed that 80% of malpractice claims in Ethiopia are related to some form of surgery or operation room activities. METHODS: A cross-sectional survey was...

Superior mesenteric artery syndrome

Introduction: Ensuring that surgical training programmes in low- and middle-income countries (LMICs) provide high quality training, including adequate operative experience, is of crucial importance in meeting the goals set out in the Lancet Global Surgery 2030. Electronic logbooks (eLogbooks) have been adopted to monitor both individual trainee pr...

Background The Association of Surgeons of East Africa (ASEA) was formed in 1952. In 1996 a Steering Committee was formed to transform ASEA into a surgical college. The College of Surgeons of East Central and Southern Africa was officially launched in December 1999 in Nairobi, Kenya. Today the College consists of 14 constituent member countries but...

Stakeholders in the field of medical education globally would generally agree that sustaining medical education through the dark times of the covid-19 pandemic is worth celebrating. In the midst of the difficulties that were created generally by the covid-19 pandemic, sustaining medical education required persistence, strategy, courageous leadershi...

Background: Human papilloma virus (HPV) is involved in the development of cancer of the cervix, mouth and throat, anus, penis, vulva, or vagina, but it has not been much considered as a cause of breast cancer. Recently, a number of investigations have linked breast cancer to viral infections. High-risk HPV types, predominantly HPV types 16, 18, 31...

The teaching of Anatomy has to evolve in line with modern trends in training medical doctors and health professionals in general. High fidelity simulation [HFS] is a modern way to train doctors on body functions as well as clinical and surgical procedures. The ability of the HFS to mimic occurrences in living conditions and their aberrations as as...

Introduction: In a 2017 study, the incidence of glove perforation in Addis Ababa was found to be much higher than that of most publications—with an incidence of 60.14% for first surgeons. We hypothesized that poor surgical glove quality may have contributed to the high incidence of perforations. Method: We tested the integrity of six widely used br...

Background The COVID-19 pandemic has had disproportionate impacts across race, social class, and geography. Insufficient attention has been paid to addressing the massive inequities worsened by COVID-19. In July 2020, Partners In Health (PIH) and the University of Global Health Equity (UGHE) designed a four-module short course, “An Equity Approach...

On May 21, 2020, the Harvard Program in Global Surgery and Social Change (PGSSC) hosted a webinar as part of the Harvard Medical School Department of Global Health and Social Medicine’s COVID-19 webinar series. The goal of PGSSC’s virtual webinar was to share the experiences of surgical, anesthesia, and obstetric (SAO) providers on the frontlines o...

Introduction We aimed to search the literature for global surgical curricula, assess if published resources align with existing competency frameworks in global health and surgical education, and determine if there is consensus around a fundamental set of competencies for the developing field of academic global surgery. Methods We reviewed SciVerse...

This article is a descriptive and reflective piece on the strategic adaptations that facilitated and enabled the teaching of anatomy and related basic medical sciences to medical students in an African medical school that never shut down during the COVID-19 induced lockdown of the year 2020. The article considers the roles of educational technology...

Background No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. Method This international...

Background Healthcare facilities in Ethiopia are responsible for collecting samples for testing and treating COVID-19 patients, providing COVID-19 information to staff, establishment of response teams, and provision of adequate personal protective equipment (PPE). Working at the frontlines against the pandemic, health care providers’ level of knowl...