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      The impact of long term institutional collaboration in surgical training on trauma care in Malawi

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          Abstract

          Background

          Attempts to address the huge, and unmet, need for surgical services in Africa by training surgical specialists in well established training programmes in high-income countries have resulted in brain drain, as most trainees do not return home on completion of training for various reasons. Local postgraduate training is key to retaining specialists in their home countries. International institutional collaborations have enabled Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, to start training their own surgical specialists from 2009.

          Results and discussion

          The direct impact of this has been an increase in Malawian staff from none at all to 12 medical doctors in 2014 in addition to increased foreign faculty. We have also seen improved quality of care as illustrated by a clear reduction in the amputation rate after trauma at KCH, from nearly every fourth orthopaedic operation being an amputation in 2008 to only 4 % in 2014. Over the years the training program at KCH has, with the help from its international partners, merged with the College of Medicine in Blantyre, Malawi, into a national training programme for surgery.

          Conclusions

          Our experiences from this on-going international institutional collaboration to increase the capacity for training surgeons in Malawi show that long-term institutional collaboration in the training of surgeons in low-income countries can be done as a sustainable and up-scalable model with great potential to reduce mortality and prevent disability in young people. Despite the obvious and necessary focus on the rural poor in low-income countries, stakeholders must start to see the value of strengthening teaching hospitals to sustainably meet the growing burden of trauma and surgical disease.

          Methods

          Annual operating data from Kamuzu Central Hospital’s Main Operating Theatre log book for the years 2008–2014 was collected. Observed annual numbers were presented as graphs for easy visualization. Linear regression curve estimations were calculated and plotted as trend lines on the graphs.

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          Most cited references8

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          Global Supply of Health Professionals

          New England Journal of Medicine, 370(10), 950-957
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            Injury patterns in rural and urban Uganda.

            To describe and contrast injury patterns in rural and urban Uganda. One rural and one urban community in Uganda. Community health workers interviewed adult respondents in households selected by multistage sampling, using a standardized questionnaire. In the rural setting, 1,673 households, with 7,427 persons, were surveyed. Injuries had an annual mortality rate of 92/100,000 persons, and disabilities a prevalence proportion of 0.7%. In the urban setting 2,322 households, with 10,982 people, were surveyed. Injuries had an annual mortality rate of 217/100,000, and injury disabilities a prevalence proportion of 2.8%. The total incidence of fatal, disabling, and recovered injuries was 116/1,000/year. Leading causes of death were drowning in the rural setting, and road traffic in the city. Injuries are a substantial burden in Uganda, with much higher rates than those in most Western countries. The urban population is at a higher risk than the rural population, and the patterns of injury differ. Interventions to control injuries should be a priority in Uganda.
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              Global status report on road safety: Time for action

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                Author and article information

                Contributors
                +265 (0)991279219 , svenyoung@gmail.com
                leonardbanza2014@gmail.com
                nmkandawire@medcol.mw
                Journal
                Springerplus
                Springerplus
                SpringerPlus
                Springer International Publishing (Cham )
                2193-1801
                5 April 2016
                5 April 2016
                2016
                : 5
                : 407
                Affiliations
                [ ]Department of Surgery, Kamuzu Central Hospital, P.O. Box 149, Lilongwe, Malawi
                [ ]Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
                [ ]Department of Orthopaedic Surgery, Haukeland University Hospital, 5021 Bergen, Norway
                [ ]Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi
                [ ]School of Medicine, Flinders University, Adelaide, SA Australia
                Article
                2050
                10.1186/s40064-016-2050-7
                4820415
                27069827
                9389e14a-9926-4a02-a9a6-0c47f9706339
                © Young et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 16 July 2015
                : 24 March 2016
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Uncategorized
                international institutional collaboration,trauma care,low-income countries,training of surgeons,amputations

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