WEO Newsletter: Travel Report: The Maghreb

IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Purnima Bhat
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While the political capital is Rabat, the economic capital is the coastal city of Casablanca. The most populated city of Morocco, Casablanca is home to 3.2 million people.</p><p>There are several hundred endoscopists in Morocco, who offer standard diagnostic and therapeutic endoscopy, with ERCP available in most public hospitals and EUS in some. To increase health and sciences education and healthcare services in the country, Mohammed VI Foundation for sciences and health was created by the king. It is a non-profit semi-public foundation managing universities in Casablanca, Rabat and Dakhla and multiple healthcare facilities. The Foundation has a strong orientation toward collaboration with African countries.</p><p>Bordering Morocco to the east, Algeria is a modern country with an increasingly relaxed border policy that reflects its growing peaceful development. It took a little work to get an entry visa and a couple of hours in immigration to enter the country, but it was worth it. The initial connection came from Dr. Mohammed Omar, Chair of the WEO Middle East Committee who knew Dr. Imad Bougedouma. Just to prove that the world is a tiny place, I discovered over coffee that Imad had spent a week in Oslo for training and is known to Prof Aabakken, President of WEO, who has an Algerian sand painting in his office as proof.</p><p>An ex-colony of France, Algeria won its independence after a long and bloody war in 1962, but plunged into a decade-long destructive civil war until 2002. The last twenty-three years of peace has resulted in increasing social development including universal health care, universal education and a rapidly developing middle class.</p><p>GI training in Algeria is confined to the public hospital system alone and starts immediately after internship, continuing for four years with the final year focussed on endoscopy. There are three training public hospitals in Algiers, and only a few key hospitals around the country additionally. With the largest land mass of any country in Africa, Algeria has a significant shortage of proceduralists compounded by distance. For new skills acquisition, a shortage of trainers and centres is apparent. The medical system is two-tiered with private and public systems being separate: one cannot be a doctor in both systems simultaneously. Part-time training or part-time work is not possible and this is reflected in the paucity of female practising gastroenterologists, although 55–80% of trainees are women, as childcare responsibilities supersede full-time work.</p><p>Dr. Nour from Constantine phoned a friend and put me in contact with Tunisian gastroenterologist, Dr. Sami Boudabbous of Youtube Endoscopy streaming fame, and I now had an “in” to this fascinating and incredibly important key to the Maghreb: it has good diplomatic relations with Morocco and Algeria which includes travel permissions.</p><p>Tunisia, with its ancient roots in Hannibal and the empire of Carthage, is more recently recalled as the source of the “Arab spring”. A modern, tolerant and vibrant country, French is widely spoken, Arabic is the official language, and English is increasingly spoken among younger generations, particularly in medical education and academia.</p><p>Healthcare in Tunisia is delivered primarily through a public system, which handles most of the national caseload but remains overstretched. In contrast, a rapidly growing private sector offers more modern services though insurance coverage remains limited. There are four medical schools, each associated with a university hospital, offering a 5-year undergraduate medical degree, followed by a 5-year gastroenterology training program. GI trainees must maintain a certified logbook to qualify in both upper and lower endoscopy. On average, each centre hosts about six trainees that must rotate their training around the approved hospitals in the district. 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引用次数: 0

Abstract

WEO have successfully launched training centres throughout Sub-Saharan Africa, mostly in English-speaking countries. In 2023, a visit to Senegal resulted in establishment of our first francophone centre and highlighted the need for training in this region. Regional endoscopy training in Africa has been provided by groups from Egypt and South Africa, providing a model for continent-based training that are both socially and environmentally sustainable. With the aim of investigating both the need for training and the capabilities for provision of training in North Africa, we evaluated current state of endoscopy in the Maghreb: Morocco, Algeria, Tunis.

Morocco is a Mediterranean kingdom in north-west Africa, that gained its independence from the French in 1956. While the political capital is Rabat, the economic capital is the coastal city of Casablanca. The most populated city of Morocco, Casablanca is home to 3.2 million people.

There are several hundred endoscopists in Morocco, who offer standard diagnostic and therapeutic endoscopy, with ERCP available in most public hospitals and EUS in some. To increase health and sciences education and healthcare services in the country, Mohammed VI Foundation for sciences and health was created by the king. It is a non-profit semi-public foundation managing universities in Casablanca, Rabat and Dakhla and multiple healthcare facilities. The Foundation has a strong orientation toward collaboration with African countries.

Bordering Morocco to the east, Algeria is a modern country with an increasingly relaxed border policy that reflects its growing peaceful development. It took a little work to get an entry visa and a couple of hours in immigration to enter the country, but it was worth it. The initial connection came from Dr. Mohammed Omar, Chair of the WEO Middle East Committee who knew Dr. Imad Bougedouma. Just to prove that the world is a tiny place, I discovered over coffee that Imad had spent a week in Oslo for training and is known to Prof Aabakken, President of WEO, who has an Algerian sand painting in his office as proof.

An ex-colony of France, Algeria won its independence after a long and bloody war in 1962, but plunged into a decade-long destructive civil war until 2002. The last twenty-three years of peace has resulted in increasing social development including universal health care, universal education and a rapidly developing middle class.

GI training in Algeria is confined to the public hospital system alone and starts immediately after internship, continuing for four years with the final year focussed on endoscopy. There are three training public hospitals in Algiers, and only a few key hospitals around the country additionally. With the largest land mass of any country in Africa, Algeria has a significant shortage of proceduralists compounded by distance. For new skills acquisition, a shortage of trainers and centres is apparent. The medical system is two-tiered with private and public systems being separate: one cannot be a doctor in both systems simultaneously. Part-time training or part-time work is not possible and this is reflected in the paucity of female practising gastroenterologists, although 55–80% of trainees are women, as childcare responsibilities supersede full-time work.

Dr. Nour from Constantine phoned a friend and put me in contact with Tunisian gastroenterologist, Dr. Sami Boudabbous of Youtube Endoscopy streaming fame, and I now had an “in” to this fascinating and incredibly important key to the Maghreb: it has good diplomatic relations with Morocco and Algeria which includes travel permissions.

Tunisia, with its ancient roots in Hannibal and the empire of Carthage, is more recently recalled as the source of the “Arab spring”. A modern, tolerant and vibrant country, French is widely spoken, Arabic is the official language, and English is increasingly spoken among younger generations, particularly in medical education and academia.

Healthcare in Tunisia is delivered primarily through a public system, which handles most of the national caseload but remains overstretched. In contrast, a rapidly growing private sector offers more modern services though insurance coverage remains limited. There are four medical schools, each associated with a university hospital, offering a 5-year undergraduate medical degree, followed by a 5-year gastroenterology training program. GI trainees must maintain a certified logbook to qualify in both upper and lower endoscopy. On average, each centre hosts about six trainees that must rotate their training around the approved hospitals in the district. Advanced endoscopy training is limited and highly competitive, serving as a stepping stone to private sector practice.

As with Algeria, the public and private systems are deliberately separated to avoid perceptions of conflicts of interest. Public physicians may work privately only after five years of exclusive service in the public sector and are then restricted to two private sessions per week. There is no part-time work policy. This policy has contributed to a skilled workforce in public hospitals, but retention is a growing concern.

Tunisia has plans to launch a National Bowel Cancer Screening Program (NBCSP). An earlier trial had poor outcomes, and with participation rates low at under 17%. It is unclear whether that reflects true screening or symptomatic testing. Concerns have been raised about current workforce capacity and infrastructure to support national screening. Misallocation of endoscopy equipment by the central Ministry of Health further complicates matters, with units sometimes receiving equipment despite lacking trained endoscopists. Rural southern Tunisia has particularly poor access, with rotating physicians from Tunis delivering limited services.

In my travels through the Maghreb, I found an enthusiastic and talented group of gastroenterologists. Endoscopy in the region is systematically taught and is already at a sophisticated level in some regions. Deficits are mainly in developing capacity, quality measures and in advanced endoscopy.

WEO has the opportunity to aid in overcoming political and historical barriers in the regions to re-establish a Maghreb collaboration for training and research connections. At least initially, it is probably best served with Tunisia as a common, accessible centre to foster regional cooperation. Discussions are underway to include these centres into the WEO training centre program and potential co-host a WEO-Maghreb workshop in the next 12 months.

Abstract Image

世界经济展望组织通讯:旅行报告:马格里布
世界妇女组织在撒哈拉以南非洲各地成功地开办了培训中心,主要设在英语国家。2023年,我们访问了塞内加尔,建立了我们的第一个法语中心,并强调了在该地区进行培训的必要性。来自埃及和南非的团体在非洲提供了区域内窥镜检查培训,为在社会和环境上都可持续的基于大陆的培训提供了一种模式。为了调查北非培训的需求和提供培训的能力,我们评估了马格里布地区的内窥镜检查现状:摩洛哥、阿尔及利亚、突尼斯。摩洛哥是非洲西北部的一个地中海王国,1956年脱离法国独立。政治首都是拉巴特,经济首都是沿海城市卡萨布兰卡。卡萨布兰卡是摩洛哥人口最多的城市,拥有320万人口。摩洛哥有数百名内窥镜医生,他们提供标准的诊断和治疗性内窥镜检查,大多数公立医院提供ERCP,一些公立医院提供EUS。为了增加该国的健康和科学教育以及保健服务,国王创建了穆罕默德六世科学和健康基金会。它是一个非营利性的半公共基金会,管理着卡萨布兰卡、拉巴特和达赫拉的大学以及多个医疗机构。基金会强烈倾向于与非洲国家合作。阿尔及利亚东部与摩洛哥接壤,是一个现代化的国家,其边境政策日益宽松,反映了其日益和平发展。拿到入境签证花了一点时间,在移民局花了几个小时进入这个国家,但这一切都是值得的。最初的联系来自世界经济组织中东委员会主席Mohammed Omar博士,他认识Imad Bougedouma博士。为了证明世界是一个很小的地方,我在喝咖啡的时候发现,伊马德曾在奥斯陆花了一个星期的时间接受培训,并与世界经济组织主席阿巴肯教授相识,他的办公室里有一幅阿尔及利亚沙画作为证据。阿尔及利亚曾是法国的殖民地,在1962年经过一场漫长而血腥的战争后赢得了独立,但在2002年之前却陷入了长达十年的破坏性内战。过去23年的和平促进了社会发展,包括普及保健、普及教育和迅速发展的中产阶级。阿尔及利亚的GI培训仅限于公立医院系统,并在实习后立即开始,持续四年,最后一年侧重于内窥镜检查。阿尔及尔有三家培训公立医院,此外全国只有几家重点医院。阿尔及利亚是非洲国土面积最大的国家,由于距离遥远,程序主义者严重短缺。在获取新技能方面,显然缺乏培训师和培训中心。医疗系统是双层的,私人和公共系统是分开的:一个人不能同时在两个系统中当医生。兼职培训或兼职工作是不可能的,这反映在女性执业胃肠病学家很少,尽管55-80%的学员是女性,因为照顾孩子的责任取代了全职工作。来自康斯坦丁的努尔打电话给一个朋友,让我联系上突尼斯胃肠病学家萨米·布达布博士,他在Youtube内窥镜直播中出名,我现在有了一个“进入”这个迷人的、非常重要的马格里布的钥匙:它与摩洛哥和阿尔及利亚有良好的外交关系,包括旅行许可。突尼斯,其古老的根源在汉尼拔和迦太基帝国,最近被回忆为“阿拉伯之春”的源头。这是一个现代化、宽容和充满活力的国家,法语被广泛使用,阿拉伯语是官方语言,英语越来越多地在年轻一代中使用,特别是在医学教育和学术界。突尼斯的医疗保健主要通过公共系统提供,该系统处理全国大部分病例,但仍然超负荷。相比之下,快速增长的私营部门提供了更多的现代服务,尽管保险范围仍然有限。有四所医学院,每一所都与一所大学附属医院相关联,提供5年的本科医学学位,然后是5年的胃肠病学培训项目。GI受训者必须保持认证日志,以获得上、下内窥镜检查的资格。每个中心平均接待大约6名受训人员,他们必须在该地区经批准的医院轮流接受培训。高级内窥镜检查培训是有限的,竞争激烈,作为私营部门实践的垫脚石。与阿尔及利亚一样,公共和私人系统是故意分开的,以避免人们认为存在利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Digestive Endoscopy
Digestive Endoscopy 医学-外科
CiteScore
10.10
自引率
15.10%
发文量
291
审稿时长
6-12 weeks
期刊介绍: Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
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