Why we must increase the number of paediatric surgeons in Africa

Medics preparing for open heart surgery at Tenwek Mission Hospital. [Gilbert Kimutai, Standard]

Burundi does not have a single paediatric surgeon. The same is the case South Sudan, Liberia, Guinea Bissau, Cape Verde, Botswana, Lesotho, Eswatini, Seychelles and Comoros.

In East Africa, Sudan leads with the highest number of paediatric surgeons at 23, followed by Kenya with 14 as of 2019. Yet, in Africa, children comprise more than half of the population and 85 per cent are expected to require a surgical intervention by age 15.

Additionally, according to Lancet Commission on Global Surgery, 1.27 million more surgical healthcare workers will be required to provide minimal surgical workforce by 2030. Generally, however, in Africa, not a single country has sufficient paediatric surgical health work force.

What’s the implication? Disease burden to a country’s health care. Children break fingers, arms or legs and swallow objects every other day. Congenital diseases at birth such as a blocked rear or partially developed intestines are also common.

It is estimated that nine million infants are born annually with a defect that may kill them or result in lifelong disability. Complex children cases need specialised training which paediatric surgeons handle best.

A case in point is Dr Alliance Niyukuri who, in his practice as a general doctor, witnessed situations where he was almost powerless. “I saw a number of children with gastroschisis [a birth defect where intestines extend outside of the abdomen],” recalls Dr Niyukuri. “100 per cent of those children died from a condition that can be treated in a proper paediatric set-up (right equipment and specialised personnel).

This, however, is set to change as Dr Niyukuri and 11 other fellows are undergoing paediatric training under a scholarship by Kids Operating Room (KidsOR). Besides children comprising half the population, African countries have 25 per cent of the burden of the world’s diseases but only 1.3 per cent of the world’s health workforce.

Yet, a 2020 assessment by KidsOR shows that the average operations one paediatric surgeon in Africa can provide is about 600 annually. So what if every government hospital had two or five paediatric surgeons?

While other challenges have been attributed to low numbers of paediatric surgeons’ intake, financial burden required for training – for the speciality – cannot be ignored. Most medical degrees take five years and additional years in specialisation can take between five and six years. This has a huge financial implication.

Kids Operating Room has so far supported 22 surgeons across Africa into paediatric surgeons. The organisation aims to train approximately 120 paediatric surgeons; and 120 paediatric anaesthesiologists by 2030.

As we commemorate the fourth anniversary of International Day of Education, this is a call for more investment in children health system. Investing in doctors to specialise in paediatric ecosystem, in the long term, has profound economic returns.

Besides preventing deaths, it averts long-term disability in children, with implications throughout life, not only for the patient, but for the extended family and community as well.

Finally, without expanding and investing in health infrastructure and human resources, child-related targets of Sustainable Development Goals and Universal Health Care are unlikely to be met by 2030.