WHO trains surgeons in troubled Somalia

Wairagala Wakabi

A WHO initiative is helping Somalia’s health workers to build up their surgical skills and capacity to deal with the country’s violent conflict and humanitarian crisis. Wairagala Wakabi reports.

Amid continued fighting that has forced many health workers to flee Somalia or desert their work stations, WHO is sending surgeons to some of the most dangerous parts of the country to train local doctors in surgery and trauma management. Hundreds of health workers have already been trained in this initiative, which addresses crucial skills shortages in one of the world’s most desperate places.

Between March 21—26, 2010, WHO provided on-the-job training in trauma management and emergency obstetric care to 33 clinical staff (nine physicians, 11 nurses, and 13 midwives) at Banadir Hospital in the capital Mogadishu. The training was in response to escalating conflict in the city, where more than 700 conflict-related injuries and 30 deaths were reported at the three main hospitals during the first 3 weeks of March.

The two-decades civil war in Somalia has left the health system in tatters, with few doctors and insufficient medical supplies. Health workers often lack specialised training in trauma management and rarely receive additional training for medical and surgical advances. The recent flare-up in the conflict placed an additional burden on the already weak health system. With escalating levels of trauma, services were being stretched to the limit.

“The thing is that there is continuous insecurity, which comes with movements of internally displaced people (IDPs). And you find that health workers are among the IDPs, so the number of health workers starts to decrease”, Omar Saleh, the WHO surgeon who heads the training, explained to The Lancet. “There is a big shortage of manpower. Besides, although the doctors in Somalia are very good, medicine, surgery, and trauma management are always evolving, [and] many of the doctors in Somalia are not updated.”

Banadir Hospital, where last month’s training took place, used to be the national referral hospital for maternity care but from early this year it has registered an influx of casualties from the conflict. That necessitated training its staff, as well as those from other hospitals in the area, in trauma management. Nearly 1000 wounded people went to hospitals in the Mogadishu area as a result of the fighting in March, according to the UN.

Health staff are also at risk of death and injury amid the violence. On Dec 3, 2009, Somalia’s health minister, along with other officials of the interim government and graduating students at Banadir University’s medical school, were among 19 people killed in a bomb attack in Mogadishu.

Saleh said that when in December, 2009, they did the training at Buale Hospital, they received about 200 patients everyday with illness such as malnutrition, tuberculosis, trauma, and bullet wounds. WHO surgeons demonstrated surgical procedures such as removing benign tumours and bullets from children and adults. The training by WHO started in 2007. So far, more than 20 surgeons and 300 other health workers have been trained.

Marthe Everard, WHO representative to Somalia, said that there are about 250 doctors in Somalia, including 50 who are newly graduated from Mogadishu’s Banadir University. There are 861 qualified nurses, 116 midwives, and 1412 health facility auxiliaries and technicians serving 8·5 million people. “Training is crucial as it strengthens the skill levels of the very health staff who see on almost a daily basis victims of the conflict, as well as women needing emergency obstetric care”, said Everard.

“In an unstable and unsafe environment such as Somalia, medical staff in the few remaining hospitals are under a lot of pressure”, Valery Sasin, coordinator of the medical activities of the International Committee of the Red Cross in Somalia, said in a statement released on March 31, 2010. “When fighting breaks out, they have to deal with a massive influx of patients with very limited resources. You need to be thoroughly trained to be able to do your job as a surgeon in such harsh working conditions, adding to the stress and danger associated with a conflict zone.”

Source: The Lancet