Mercy Ships (MS) is a global Christian charity that follows the 2000-year-old model of Jesus to bring hope and healing to those suffering from disability, disfigurement, and disease. This article by Professor Diallo and Drs Ugai and Conde, details a project established in partnership between the Guinean Government and MS to create a training centre in patients with disfiguring craniofacial disease. It was presented to the Global OHNS working group at the beginning of 2021. It is an example of the need for a multidisciplinary approach in global health. The example and approach displayed here is applicable to all surgical specialties; in particular, ENT.
Non-Governmental Organisations (NGOs) are defined by the World Bank as “private organizations that carry out activities to alleviate suffering etc.” [1]. According to the Human Development Report [2], in 2002 there were more than 37,000 NGOs in the world. NGOs contribute to the delivery of curative health services developing joint projects with the government [3]. Mercy Ships (MS) is an NGO providing specialised elective surgery using hospital ships. This NGO has carried out periodic missions in Guinea since 1998. Despite the efforts of this NGO in the sub-region, the observation that emerges after analysis is that the number of patients suffering from maxillofacial pathologies, in particular tumours seen at late stages, is increasing. To remedy this and improve the management of these pathologies, MS was asked to get involved in training dental students in Guinea and improving the local curriculum, equipment and infrastructure.
“The training programme has been adapted and the MS team participates in the theoretical and practical training of the students of the department, first on simulators and later on patients”
Method
The context: Guinea is a country in West Africa with an estimated population of 12,771,246 [4]. The organisation of the health system is pyramidal, with community health centres at the base followed by prefectural hospitals, regional hospitals and national hospitals. The health budget is 2.5% of the global budget of the country. There are 8.3 doctors per 100,000 inhabitants [5]. All specialists work in national hospitals. In such a country with limited resources, oral and maxillofacial diseases are not a priority and, therefore, collaboration with NGOs is of capital interest.
Figure 1. Tripartite Agreement with emphasis on Upstream & Preventative Approach.
Description of the collaboration project
In 2019, a project was drafted with the following objectives:
- Create a forum for consultation between MS, the Ministries of Higher Education and Health (tri partite collaboration – see Figure 1).
- Ensure the renovation and equipment of the Department of Dentistry at the University of Conakry.
- Participate in the practical training of students to improve and facilitate the acquisition of skills.
- Create a sub-regional centre of Oral and Maxillofacial Surgery (OMFS) – this has been drafted. This centre will have as vocation: the management of maxillofacial pathologies and the training of specialists in OMFS.
Results
Over a period of 18 months, three of the objectives were achieved: Mercy Ships signed a headquarters agreement with the Guinean Government.
Objective 1: A memorandum of understanding has been signed between the Ministries of Health, Higher Education and MS.
Objective 2: The Dentistry Department of Gamal Abdel Nasser University of Conakry (GANUC) has been completely renovated and equipped by MS.
Objective 3: The training programme has been adapted and the MS team participates in the theoretical and practical training of the students of the department, first on simulators and later on patients: 121 students have received clinical training and mentoring.
Ten graduate students were selected to follow patients through a one-year clinical training programme. Additional renovations were made to accommodate the future needs of the dental school, including a reception, waiting room, locker rooms and office for MS. Graduate students in dentistry, trained through the partnership between MS and GANUC, now supervise the next classes of dental students. As part of the very forthcoming creation of the sub-regional centre, we have integrated other specialties into this project: anaesthesiologists and technicians.
“This is the first study of this kind within the framework of the collaboration between Guinea and MS since 1998”
Figure 2. Objective 2: Department of Dentistry before and after rennovation by MS.
Figure 3. Dental classroom before and after.
Figure 4: Dental School clinics were renovated and equipped.
Figure 5. Objective 3: online training of students.
Discussion
This is the first study of this kind within the framework of the collaboration between Guinea and MS since 1998. Guinea has only 50 dental surgeons [5], for a population of 12,771,246 inhabitants, [4]. In view of this situation, a tripartite collaborative approach involving the Ministries of Higher Education, Health and MS was established. This approach put the students of the Department of Dentistry at the centre of the reflection. Emphasis was thus placed on theoretical and practical training in order to acquire the required skills. Thus, after the signing of the tripartite agreement, Mercy Ships renovated and equipped the building of the Department of Dentistry. In agreement with the authorities of the GANUC, a mentoring programme has been set up. Groups composed of four students were formed. This programme allows students to undergo theoretical and practical training for six months in order to develop their clinical skills and their leadership qualities. During their mentorship, these students performed 5554 dental procedures on 1270 patients.
“This programme allows students to undergo theoretical and practical training for six months in order to develop their clinical skills and their leadership qualities”
The dental clinic was inaugurated on 19 March 2020 by GANUC. Students from the dental school have started their first consultations with patients. But COVID-19 has led to its temporary closure. In Guinea, graduate students from the dentistry department, trained through the partnership between MS and GANUC, are now supervising students in other promotions. Today, despite COVID, MS is still active in Guinea. The collaboration with GANUC continues to develop. To meet health requirements and ensure a healthy environment, the NGO has created separation boxes in the dental school clinic dedicated to patient care and student training. At the same time, Mercy Ships actively contributes to give education for the ten resident students during this time. Using a digital screen, teachers at other universities provide classroom and practical training live via video conferencing.
Conclusion
After 18 months of implementation, the tripartite collaboration programME has contributed to improving the infrastructure and equipment of the Odontology Department of GANUC, thus creating better learning conditions for students and working conditions for students and teachers. In the long term, this programme will make it possible to provide Guinea with well-educated dentists, which will significantly reduce morbidity and mortality due to oral diseases. Further studies are needed to assess the impact of this collaboration on the training and the health of the Guinean population.
References
1. Delisle H, Roberts JH, Munro M, et al. The role of NGOs in global health research for development. Health Res Policy Sys 2005;3(3).
2. Human Development Report 2002: Deepening Democracy in a Fragmented World. New York, USA; 2002
3. Yagub AIA. Collaboration between government and Non-Governmental Organizations (NGOs) in the provision of curative health services in North Darfur State, Sudan - a national report. Iran J Public Health 2014;43(5):561-71.
4. Division de la population des Nations Unies – OMS 2019.
5. Ministère de la Santé et de l’Hygiène Publique. Bureau de stratégie et de développement. Exercice 2019.
