9h 30 : Welcome remarks by the president of RSS Prof AGABE NKUSI

9h 35 : Opening remarks by the guest of honor : Dr Patrick Ndimubanzi

• Surgery is an integral part of health care
• Health care providers is still scarce
• HRH working to introducing new training programs namely pediatric surgery, plastic surgery, …
• Need to train more surgeons and the multidisciplinary team required for quality surgical care
• Ensure the utmost collaboration and partnership by the MoH.
10h00 : Session III : Surgical education in Rwanda : an overview
By Prof Emile Rwamasirabo :

– Introduction to surgical training in Rwanda
– Large gap of specialist in surgery in Rwanda (> 30 yrs post independence without post graduate training).
– History of training of surgeons in Rwanda
– Local training is the most efficient solution

10h15 : • The surgical training at the University of Rwanda
By Prof Faustin Ntirenganya

An overview of the surgical department and training programs at the UR
– Opportunities and challenges available at UR
– Way forward

10h30 : Surgical training through COSECSA
By Dr Ntakiyiruta Legal Representative of COSECSA in RWANDA

– Programs offered by COSECSA
– Training methods used during the Cosecsa residency programs
– Requirements for joining the COSECSA training programs
– Current situation of COSECSA trainees and fellows in Rwanda
– Numerous scholarships and grants available at COSECSA.

10h50 : Preparing the future surgeons from undergraduate level
By Prof Abebe Bekele

– How to address the shortage of surgeons : train surgeons, empower general surgeons, train non surgeons (task shifting).
– Proper training of undergraduate students
– Policies and training should be tailored to LMICs needs and resources.
– To focus on emergencies for undergraduate student education ( as 90% of general practitioners practice).
– Need to challenge the status quo.
– To demystify complexities.

11h00 : Session III : Panel discussion
– Task sharing is what is needed to improve surgical care ( not task shifting)
– To focus on proper training of surgeons.
– There is a challenge to expose undergraduate students to core principles of surgery, rather than a fragmented exposure through surgical sub-specialties
– Train general surgeons to have skills for the various surgical sub-specialties.
– To consider the uniqueness of low income countries during setting curriculums of general surgery training.

Session IV : Panel discussion

Prof RWAMASIRABO Emile started the discussion at 11h 30 by welcoming the panel members.
They are discussing on the following topics :
11h35 : Topic 1 : National surgical obstetric anesthesia plan by Dr Parfait from MOH
• Need to strength surgical system from the governance
• Where they are for now
• They still more needs ;
 Capacity building to increase GP to perform surgeries
 Mortality rate tracking
• Support of hospital
11h50 : Topic 2 : Surgical education governance by Prof BYIRINGIRO Jean Claude
The discussion will be based on :
What education plan to be given and assessed to surgical trainees and remote area ? Said Prof RWAMASIRABO Emile
Matters regarding surgical education
– They are two levels medical schools in partnership with MOH
How do we assure surgical education governance by Prof Faustin addressed to Dr NTAGANDA from RSS
– each institution assure surgical trainees get fulfilled requirements to graduate
– challenge of few trainers in some beginning specialist eg : Plastic
What do you advise to attract women ? The question is addressed to Dr Natalie
a)Challenges
– they are involved in research but limited
– Challenge in mentorship
Inequality
Simulation training
b)Solution
– Improve research
– Set standard site for learning
– Work life balance

Session V : Panel discussion : The surgical trainings in Rwanda
Evidence based surgical practice

a)Cheetah trial : By Pro NTIRENGANYA FAUSTIN
Change of surgical gloves and instruments prior to abdominal closure reduces SSI in clean contaminated, contaminated and dirty wounds.
There is a need to include these findings in the clinical guidelines in order to reduce the burden of SSIs

b)FALCON Trial By Dr. MPIRIMBANYI Christophe

The trial did not show benefit from 2% alcoholic chlorhexidine skin preparation compared with povidone-iodine, or with triclosan-coated sutures compared with non-coated sutures, in preventing SSI in clean-contaminated or contaminated or diary surgical wounds. Both interventions are more expensive than alternatives, and these findings do not support recommendation for routine use.

c) Delphi prioritization by Dr TUBASIIME Donald

Delphi prioritization and development of global surgery guidelines for the prevention of surgical site infection : the process led to the development of a global surgery guideline for the prevention of SSI that is both clinically relevant and implementable in LMICs.

As Solution ;
– Antibiotics should be administrated 60 minutes before abdominal incision in contaminated, clean contaminated and dirty.
– Prophylactics of antibiotics for prevention of surgical site infection should not be given more than 24 hours.
– The study gives 12 recommendations for surgical site infection prevention in abdominal surgeries.

d)Feasibility and diagnostic accuracy of a telephone wound healing Questionnaire in detection of surgical site infection following abdominal surgery : by Dr BUCYIBARUTA George

A study within a trial in seven low and middle- income countries : Successful telephone contact was achieved in 90.3%. The study demonstrated feasibility and validity of telephone assessment for post discharge SSI diagnosis in low-resource environments.
As conclusion
– Telephone calls was successful in patients remote follow up
_we need to include community engagement in surgery

e)The WHO surgical safety checklist usage and compliance in Rwanda and Malawi : by Ngabo Espoir

Experienced theater users are more likely to comply with use of the checklist. Training, high education, availability of the team influences use of the checklist. However, further studies can be done to assess other factors influencing usage and compliance with the WHO surgical safety checklist.

– Surgical safety Checklist usage and compliance is more in RWANDA compared to MALAWI.
– The availability of Surgical safety Checklist is more in RWANDA than MALAWI
– Usage and compliance of Surgical safety Checklist was seen in high educated, experienced and trained theater team users.

BREAK TIME

Welcome back, sessions restart ;

Session VI : Laser technology in surgical practice By Mary from Biolitec

Image : Marry Najjuma from Biolitec

Session VII : Surgical practice and COVID-19

-Impact of COVID-19 on surgical care in Rwanda. Dr Christophe Mpirimbanyi

The COVID 19 pandemic, especially lockdowns, affected surgical care in Rwanda. However, the findings of this study suggest an overall resilience of surgical systems, which kept the usual and, in some instances, a superior workload despite COVID-19 constraints.

-Timing of surgery following SARS-CoV-2 infection : an international prospective cohort study. Mr Munyaneza Emmanuel.

In patients with a pre-operative SARS-Cov2 diagnosis, 30 day mortality was increased for patients operated within 6 weeks. Therefore, where possible, surgery should be delayed for at least 7 weeks following SARS-CoV2 infection.

-Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2. Dr Ncongoza Isaie.

Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV2 and are associated with high mortality. Therefore, the thresholds for surgery should be higher during the COVID 19 pandemic.

PROTECT-Surg Clinical Trial. Dr Ncogoza Isaie.

Details about how the ongoing trial is being conducted and the current progress.

Discussion :
Prof Ntirenganya called everyone to join collaborative research projects instead of focusing on individual research.

Global surgery research hub has a priority of community engagement during choosing and developing research projects.

15h27 : Current status of HIV, STI, VH program in Rwanda. Dr Tuyishimire Simeon

Session VIII : Free papers/ Education

15h 40 : Results of a Modified Delphi Process in Developing a Surgical Undergraduate Medical Curriculum in Rwanda by Dr IRADUKUNDA Jules

A modified Delphi process and consensus was able to identify essential topics to be included within a highly contextualized, regionally relevant surgical curriculum delivered in Rwanda.

Delivery of a district hospital-based junior surgical clerkship for undergraduate medical students in Rwanda : a mixed-methods review. Dr Iradukunda Jules.

A contextualized junior surgical clerkship delivered exclusively at a rural hospital in Rwanda was well received by most students and clinical faculty. Barriers to effective learning were identified.

Development of a “District Hospital Clinical Clerkship Framework” : lessons learned from delivery of an undergraduate junior surgical clerkship in Rwanda. Dr Iradukinda Jules.

The framework of delivering a contextualized undergraduate surgery clinical curriculum at district-level hospitals in rural sub-Saharan Africa can help ensure sufficient case mix and volume presence of appropriate surgical infrastructure, and effective clinical mentorship.

Assessment of Hospitals readiness in Implementing a non-technical skills for surgery training program, a cross-sectional study. Dr. Christophe Mpirimbanyi.

The study revealed that the domains that were most challenging were psychological safety, and resistance to change. Hospital leadership should create a safe environment for employees to learn and grow.

Assessment of preventable causes and predictors of Independent ambulation for cerebral palsy in Rwanda. Dr Eugene Uwizeyimana.

The majority of children with CP in the study were term babies. Many risk factors are preventable. The commonest cerebral palsy treatment mode was gait training. Establishment of preventive and management strategies in developing countries are highly needed.

Occipital encephalocele not covered with skin in a newborn at CHUK. Case report. Dr Clemence Mutoni.

Recommendations : Systematic antenatal ultrasound screening, to increase awareness and emphasize on preventive measures.

17h 10 : Wrap ups of the conference by Dr Natalie

Session XIV : Recommendations
– Strengthen mentorship in surgical residency
– Mentorship of medical students and involving them in research
– Early exposure of medical students to surgery during training
– Addressing other components of capacity building (other than human resources) such as infrastructures, equipment, etc.
– Outreach programs led by the RSS
– Encourage young general of surgeons to join clinical trials
– Organizing a survey for the conference feedback
– Motivation of general practitioners to join surgical training.
– To review the curriculum of training basic surgical knowledge and skills for junior surgical trainees before they join sub-specialties.

17h40 :
Closing remarks by the President of RSS, Prof Nkusi Emmanuel

Adding new executive committee members : Dr Munyaneza Robert, Dr Twambazimana Blandine, Medical student

Closing remarks by the Chair of NIHR Global Surgery Hub Rwanda, Prof Ntirenganya Faustin.

Group Photo