Cameron Kneib, MD
Cameron Kneib, MD
Plastic Surgery · Seattle, WA

Scalable Microsurgery Education in Ethiopia

April 14th
Addis Ababa, Ethiopia

Project Description

The workshop I will conduct follows our prior introductory workshop with further intensive hands-on training, lectures, and microsurgery case support at the ALERT Hospital Plastic Surgery program in Addis Ababa, Ethiopia. Participants previously received practice and lecture materials for microsurgery education utilizing a smartphone setup and desk microscope to perform model microsurgery anastomoses. This training course will further refine microvascular techniques with local plastic surgeons and support local surgeons in performing peripheral nerve and free flap microvascular procedures. This one-week trip will help develop ReSurge International’s longitudinal microsurgery program within Ethiopia, thus supporting local plastic surgeons in performing comprehensive microsurgical care and educating trainees in microsurgery.

Population Served

Addis Ababa University has the most extensive Plastic Surgery training program in the College of Surgeons of East Central and Southern Africa (COSECSA), training the majority of plastic surgeons who care for the 120 million people living in Ethiopia as well as plastic surgeons throughout East Africa. ALERT Hospital’s Department of Plastic, Reconstructive, and Hand Surgery holds the distinction of over forty years of dedicated service to patients in Ethiopia. Originally established to provide free medical treatment for leprosy patients, it has become a national referral center for Plastic Reconstructive and Hand surgery and one of Ethiopia's primary sources of Plastic Surgery training. ALERT Hospital performs over 2000 reconstructive surgeries and 850 trauma reconstruction operations and sees an estimated 15,100 plastic surgery consultations annually from all over Ethiopia. This robust patient care program and the postgraduate teaching program provide plastic surgery care and education throughout Ethiopia. While nearly comprehensive in plastic surgery education, microsurgery is one area that has not been widely adopted within Ethiopia. Through this trip, we hope to take practice to patient care and help guide local surgeons through the intricacies of performing microsurgery / establishing a microsurgery program within Ethiopia.

Expected Impact

This workshop’s impact will be immediately evident in training 20 plastic and reconstructive surgeons in Ethiopia with intensive microsurgical anastomosis and nerve transfer skills. It marks a significant step towards creating sustainable microsurgery education in Ethiopia, with consultant faculty at ALERT Hospital being supported in performing advanced microsurgical techniques. Consultants plan to integrate microsurgery into resident education, case exposure, and competencies for graduation. This workshop will be one of the first to directly evaluate the effectiveness of smartphones as a tool for scalable microsurgery training in low- and middle-income countries (LMICs), as well as make significant steps toward creating sustainable approaches to identifying and overcome barriers to microsurgical care in LMICs. ReSurge plans to conduct follow-up visits and support long-term strategy planning to establish a reconstructive microsurgery program at ALERT Hospital.

Trip Photos & Recap

On this trip, I worked with the Residents of the Addis Ababa University / ALERT Hospital Plastic Surgery Program to improve microsurgical capabilities and to expand the breadth of nerve transfer surgery that they are currently offering. Since our initial trip 6 months ago, the faculty and residents have done their first microsurgery cases and have expanded the microsurgery program to encompass head and neck oncology reconstruction cases, extremity trauma reconstruction, and wound coverage. During this trip, we focused on expanding microsurgery to include nerve transfers and free functional muscle transfers, which is a significant step up in technical complexity and patient management logistics required to provide this high level of care. During this trip, we gave lectures and didactics teaching, assisted in technique instruction, and helped with improving patient care workflow in post-operative management, nursing education, and hand rehabilitation and therapy protocol development. Overall this education continues to make the ALERT Hospital program one of the most comprehensive plastic surgery education points in Sub-Saharan Africa and help to expand the procedures that this hospital can offer their patients into the future. These faculty and residents are incredibly hardworking and skilled, and they will continue to advance the next generation of future plastic surgeons in Africa. I hope to be able to come back again sometime soon and continue to collaborate with such stellar surgeons and dedicated clinicians!