REPORT ON THE WFNS COURSE, MOMBASA, KENYA
The Mombasa WFNS Course, coordinated by the Neurosurgical Section of the Neurological Society of Kenya, under the auspices of the African Federation of Neurosurgical Societies (AFNS), and the Continental Association of African Neurosurgical Societies (CAANS), and held jointly with the Asian Congress of Neurological Surgeons (ACNS) and the WFNS Foundation, was held in Mombasa, Kenya from 30th November to 3rd December 2017.
Mombasa is the 2nd largest City in Kenya, population 1.2 million (2016 census), and serves the health care needs of a catchment population of over 4-5 Million. It had not had a neurosurgery service until a volunteer team commenced monthly neurosurgical missions in November 2001. Dr Mahmood Qureshi, with a volunteer team including an anesthesiologist, anesthetic assistant, operating room nurse and young doctors conducted clinics and carried out surgeries jointly with general surgical team at the Coast General hospital and Aga Khan hospital in Mombasa. The long-term objective of having a local neurosurgeon based in Mombasa was served by the NSK inviting a neurosurgeon who retired from the army and located to Coast General hospital in 2005. He later left public service to fully engage in private practice. The NSK identified a local surgeon who took up his neurosurgical training in the COSECSA training program. Dr Benjamin Okanga trained through this WFNS reference site for training and was employed by to the Coast General Hospital, in April 2016 and is a recipient of the WFNS Foundation Scholarship during his Fellowship training (2012 to 2015). He has also received support from the Yoko Kato Foundation, through the WFNS Foundation, which provided his new unit a Zeiss Pico operating Microscope. The WFNS Foundation, in 2017 has also provided his unit with a craniotomy set, a spinal surgery set, a set of Bipolar forceps and a motorized craniotomy to help patients in the public sector hospital.
It is with this background that the NSK, CAANS, and ACNS along with the WFNS Foundation decided to hold the Course in Mombasa, Kenya. The venue of the didactic.
Courses was the White sands Beach Hotel and Spa on the North Coast of Mombasa. Live surgery, along with a hands-on course in spine surgery and Microsurgery suturing techniques was held at the Coast General Hospital on 2nd and 3rd December.
The course attracted 29 senior faculty from the WFNS Neuroanatomy Committee led by its two Co-Chairmen, Prof Vladimir Benes and Prof Imad Kanaan, who invited a host of international Faculty. The list of Faculty is outlined in the attached Program brochure. Faculty from the ACNS region, including Japan, India, Pakistan, Nepal, United Kingdom, Czech republic,. Saudi Arabia, joined CAANS Faculty from Algeria, South Africa, Kenya, led by the CAANS President, Prof. Abderahmanne Sidi Said. The didactic Course was held at the White sands Hotel conference room. The lectures and discussions were live steamed, via Neurosurgical TV, courtesy of Dr John Bennett (USA) and Dr Iype Cherian (Nepal). Audiences across Africa, Europe and beyond were invited to join in the proceedings and the observe the live surgical teaching sessions.
Fifty two participants, that included Young Neurosurgeons and Trainees (junior, middle grade and senior residents) participated in the course. The participants were drawn from 7 African countries across the East, Central and Southern African region, including Sudan, Ethiopia, Uganda, Tanzania, Mozumbique, South Africa and Kenya, reflecting the high level of interest in this WFNS/ACNS/CAANS supported Course. Their participation was encouraging and vibrant, with all participants as well as Faculty remaining in the conference rooms well into the late evenings, on Thursday 30th November and 1st December.
The Didactic courses were very well received, and continued into Saturday morning, 2nd December, in the Coast General Hospitals’ Seminar room. The hospital Administration made special efforts to renovate the seminar room and arrange the live streaming of surgeries from the operating rooms
The feed back from the participants was very positive. The Young neurosurgeons appreciated the high quality of presentations and the operative videos. Some participants however, were concerned that the focus in some presentations was to demonstrate to other faculty, the surgeries that the lecturers performed, rather that provide a “take home message” for the YNS. The Junior and Middle grade residents felt that some lectures was beyond their level, and they were unable to get a clear message of how they could use this new knowledge upon return to their units. Others recommended that the lectures, allotted a period of 15 minutes, should perhaps not take up the format of a discussion group session; in their view some faculty took up much longer time than their allotted period, opting to commence “a question and answer session”, rather than a focused lecture. The participants suggested that this be left for the discussion session format rather than during the lecture format. Some faculty were unable to give their talks due to others taking more than their allotted time. It is advisable that future Courses take up such recommendations:
LIVE SURGERY PROGRAM
This, too, was a highly successful program. Dr Yoko and the local organizing team negotiated the support of the Zeiss Company, who airfreighted a Pentero microscope for the live surgeries as well as 6 Pico Technoscopes for the microsurgery hands-on workshop. Suturing techniques using a 10 O nylon suture were taught by Dr Kitahara as well as by a YNS Dr Aamir Qureshi.
A short coming was that the cases were not placed in a format where faculty and participants could all review the cases and have an interactive pre-operative discussion on the possible surgical approaches, the surgical anatomy, positioning of patient, anticipated challenges etc. This would have been very valuable exercise for the YNS and trainees. During the live surgery Seminar, challenging cases were operated upon in the two Operating rooms over 2nd and 3rd December weekend. The hospital along with the local neurosurgeon, Dr Okanga had made special arrangements for the staff to avail themselves over the holiday weekend. This was very encouraging and appreciated. The cases were operated by visiting Faculty, along with local Young NS and senior residents who were encouraged able to scrub-in for the cases. The cases included:
The participants were very appreciative of the live surgery demonstration. Surgeries continued late into Saturday night and completed in time on Sunday evening
An enjoyable social evening Gala Dinner was held on the Beach front of the Whitesands Hotel on Saturday 2nd December.
On Sunday 4th December, Faculty went on a Dhow Seafood and Vegetarian dinner aboard the Tamarind Dhow, which sailed into the Indian Ocean Creek off the Island of Mombasa. Some Faculty were able to demonstrate their dancing skills!!
The WFNS Foundation Course in Mombasa was a very successful and valuable event. It demonstrated the vision of the WFNS Foundation in its support of training a YNS in a local training program and then helping to set up the unit, thus benefitting patients outside the main cities. The College of Surgeons of East Central and Southern Africa, was represented by its in-coming President, Prof Pankaj Jani, was equally gratified as the College used this opportunity to evaluate the Coast General Hospital, as a site for neurosurgical training. The hospital has been successful in its bid to be accredited as a Training site within the COSECSA neurosurgery training program The Mombasa site therefore joins the Consortium of Collaborative Neurosurgical Training Sites of the East Central and Southern Africa Region (C-CNS-ECSAR), in the WFNS accredited Reference Site for training.
During the opening day, a video message sent by WFNS President, Franco Servadei was delivered to the audience. Dr Servadei, who was unable to join the meeting due to prior commitments, reiterated the importance of the meeting. His message indicated the commitment of the WFNS in supporting such meetings, as they demonstrated the development agenda of the Federation. This message was particularly encouraging to all the young Neurosurgeons who were attending the meeting....”
Local Organiser, Coordinator, C-CNS-ECSAR Chairman, NSK
Member, WFNS Foundation Advisory Board