MBARARA SEPTEMBER 2015 ENT FACULTY VISIT

MUST | OGSH HEAD AND NECK MODULE (September 28 – October 2, 2015)

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Dr. Mark Varvares lectures to residents Drs. Jamilah Nabukenya, Daniel Nyanzi, and Esther Nakasagga.

In late September, the Office of Global Surgery and Health (OGSH) at Mass Eye and Ear continued the onsite component of its academic partnership with the ENT Department at Mbarara University of Science and Technology (MUST) | Mbarara District Regional Referral Hospital (MRRH), leading its sixth faculty visit in the past two years. Mark Varvares, MD, a member of the Head and Neck surgical faculty at Mass Eye and Ear and Associate Chair of Otolaryngology at Harvard Medical School, led the academic module focused on oral cancer, building on the platform and findings of the preceding academic modules. Head and neck cancer represents a substantial part of ENT’s share of the surgical disease burden, an often very visible sign of the limits of current oncologic and surgical service. Patients regularly present in the ENT clinic at MRRH with advanced stage parotid, oral, oral-pharyngeal, or laryngeal tumors.

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Drs. Mack Cheney (OGSH), Mark Varvares (Mass Eye and Ear), Doreen Nakku (MUST), Victoria Nyaiteera (MUST), Gigi Osler (U of Manitoba), and Brian Westerberg (UBC) meet to discuss the ENT Academic Collaboration at MUST.

Dr. Evelyn Lovett, Dr. Doreen Nakku and Dr. Victoria Nyaiteera (who will join the ENT Faculty upon her return from fellowship this fall at the University of Manitoba in Winnipeg, Canada) hosted both the OGSH and the Canadian members of the collaboration during the first two weeks of October. Brian Westerberg, MD, and Gigi Osler, MD, led the Canadian faculty team, teaching a clinical officers’ training course with the MUST ENT faculty as well as an otology course during their second week. The timing of the faculty visits was organized to allow for strategic planning sessions for the collaboration and for both groups to be in Uganda for the GPAS Conference and for the installation of the new surgical skills lab at MUST. The new surgical skills lab was donated by Mass Eye and Ear, refurbished and shipped by IMEC, and funded by MUST. The OGSH coordinated the multi-partner project and Dr. Westerberg will be the first faculty for the inaugural temporal bone course to be taught next January for the ENT residents from both the MUST program and Makerere University.

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Dr. Daniel Nyanzi (1st year resident), Dr. Mack Cheney (OGSH), Dr. Esther Nakasagga (3rd year resident), Emmanuel Opolot, Dr. Mark Varvares (Mass Eye and Ear), Dr. Jamilah Nabukenya (3rd year resident), and Wendy Williams (OGSH).

For the past three academic modules Mass Eye and Ear faculty have taught at MUST (November 2014, March 2015, September 2015), the focus has been on developing capacity in head and neck cancer. In November 2014, Tessa Hadlock, MD, exposed the residents to protocols and techniques for identifying and saving the facial nerve during removal of parotid tumors. In March 2015, the focus was head and neck radiology, enhancing residents’ ability to read and interpret CT scans critical for constructing surgical plans through a radiology course taught by Mary Beth Cunnane, MD, a head and neck radiologist. During the September 2015 week, the residents performed a variety of cases under Dr. Varvares’ instruction including: parotidectomy with facial nerve sacrifice followed by a 5-7 nerve graft, examination and biopsy under general anesthesia of a tonsil tumor, excision of a preauricular sinus tract, marsupialization of a pediatric tongue cyst, pediatric tracheostomy tube change and tracheoscopy, and incisional biopsy of a parotid tumor.

Head and neck cancer offers an excellent starting point for developing comprehensive oncologic care, being extremely amenable to surgical treatment and allowing for considerable increases in survival rates and quality of life even without radiation therapy. Developing a head and neck service would require the formation of a multidisciplinary team of general surgeons, ENT surgeons, plastic surgeons, oncologists, as well as dental surgeons and the integration of such a service within hospital operations. It would also test the hospital’s capacity and provide a guide for necessary infrastructure improvements in advance of instituting more resource-demanding oncologic programs. Currently, ENT surgeons in Uganda have opportunities to study head and neck surgical techniques in regional surgical camps (biannual in Kenya) and a fellowship opportunity at Cape Town University (also soon to be in Cameroon).

The residents were incredibly engaged throughout the week: asking good questions and working well as a team in the operating room. Dr. Mark Varvares

During the week, Dr. Varvares noted substantial improvements in the residents’ comprehension and application of gained skills, demonstrated through an OSAT on administering a comprehensive head and neck exam and oral exams on different presentations of oral cancers. As always, the residents (3rd-years Dr. Jamilah Nabukenya and Dr. Esther Nakasagga and 1st year Dr. Danial Nyanzi) were heavily invested in the educational exchange and took advantage of the opportunity to discuss research design for their thesis projects.

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Dr. Esther Nakasagga participates in oral exam.

A core component of the OGSH program continues to be the administration of testing assessments during onsite visits. The primary testing methodologies – oral exams and OSATS – were chosen based upon their adaptability to specific topic areas and validated sensitivity to knowledge/skills transfer. Additionally, theses exams not only assess knowledge/skills transfer but actively contribute to it, emphasizing the integration of new information to clinical practice. Both tests are administered one-on-one, contributing to the relationship between faculty and resident as well as allowing faculty to develop a better understanding of potential knowledge gaps in resident training (e.g., radiology). The consistent structure of the examinations has also led to the senior residents, who have now taken the exams on 7 academic modules (the OGSH and Canadian programs have begun to utilize the same testing methodology in order to add consistency to the collaboration), becoming more confident in the testing format and carrying over information gained in previous modules to improve performance.

GPAS CONFERENCE (September 25-26, 2015)

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Dr. Doreen Nakku (MUST) presents at the GPAS Conference on the state of ENT in Uganda.

The OGSH|MUST faculty trip coincided with the Global Partners in Anesthesia and Surgery (GPAS) Conference on Surgical Collaboration, the third such conference and first to be held in Uganda. Hosted in Entebbe, the conference brought together surgeons and anesthesiologists from throughout Uganda for research dissemination and to discuss the current state and future of surgery and anesthesia in Uganda. Some of the issues highlighted during the conference include the continuing obstacle of systems-based issues (e.g., biomedical engineering support, supply chain management), the limitations of surgical treatment-specific initiatives (e.g., clubfoot), the challenge of developing a narrative to improving funding from both the donor sector and government, and the need for Ugandans to take over the lead roles as advocates for improving surgical infrastructure, education, and access in Uganda.

ENT in Uganda was represented by a delegation from Mbarara University of Science and Technology (MUST) with Dr. Doreen Nakku presenting the state of ENT in Uganda and Dr. Victoria Nyaiteera presenting her abstract on the use of iPad-based applications for pediatric hearing screening. Dr. Nakku emphasized the overlooked nature of the ENT surgical subspecialty and the need, especially, for capacity-building with only twenty ENT surgeons actively operating and fewer engaged in teaching activities. The conference offered an excellent opportunity for networking among Uganda surgeons and anesthesiologists and their international collaborators. It also highlighted successful innovations in medical devices and practice as well as new methods of collaboration for academic partnerships.

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