CAAP Needs You!

CAAP fulfills its mission supporting programs and faculty to mentor and disciple African Christian physicians to be consultants to, leaders of and educators for the primary health care team while providing excellent and compassionate wholistic care to those most in need. CAAP seeks to accomplish this mission through empowering the vast network of church hospitals in Africa as they seek to provide specialty training to Christian physicians in Family Medicine, Internal Medicine, Pediatrics and Emergency Medicine.

Developing Family Medicine as a specialty among church hospitals of Sub-Saharan Africa is of strategic importance to establish specialty level expertise in the vast majority of sub-Saharan church hospitals that are rural and modest size. Trying to staff these smaller facilities with groups of non-generalist specialists makes it difficult time to cover the wide-ranging call responsibilities with just two or three physicians. But all primary care specialties are needed at teaching hospitals that are usually larger to teach these family medicine residents and, where they exist, the internal medicine and other primary care residencies.

Internal Medicine training within CAAP affiliated hospitals began at Mbingo Hospital, Cameroon, in 2008 as the Christian Internal Medicine Specialization program. Graduates have assisted improvement of care in many hospitals of the Cameroon Baptist Convention. It is now being “discovered” by applicants from other countries. The Harpur Physician Training Program in Menouf Egypt is the latest program to be supported, starting 2023.

Emergency Medicine development is an inherent part of the role of the Family Medicine specialist but resources need to be expanded further by training other providers in this critical role. AIC Kijabe Hospital in Kenya has led the East Africa creation of the 18-month higher diploma called Emergency and Critical Care Clinical Officer program. These well-trained providers can provide consistent and quality service to emergency rooms and intensive care units in expanding hospitals. CAAP seeks to multiply this success to other sites.

Pediatrics programs have not yet been initiated but several of the largest hospitals that have developed multi-specialty staffs are in a position to consider them. Developing continent-appropriate mental health service cadres is another area that CAAP would heartily support as hospitals fulfill the promise of providing wholistic care across all domains of the Christian understanding of health and healing.

Your interest is welcome and your participation is needed in one of many varied opportunities to come alongside our African academic and clinician colleagues in this endeavor. We feel privileged to work together as part of something that is both important and kingdom building. You can bring much from your previous experience and education, in the spirit of humility and open hands to learn as well. Serving together, the resulting training programs are much richer because of our interactive contributions under African leadership.

Roles of service that are needed:

1. 1)  Clinical mentoring – the cornerstone of modeling wholistic, reflective, evidence-based practice.
2. 2)  Hospital medical directing and educational program leadership where no culture of medical education currently exists in a facility. Much work is often needed to develop the ethic of a continuous quality improvement expectation.
3. 3)  In countries where family medicine is not yet known, expatriate educationists are needed to be the founding departmental chair positions as an academic program begins.

For those seeking to serve from outside Africa, a past cross-cultural clinical experience is of course preferable given the importance of relationships and the teaching nature of these positions. You may want to come and “survey the landscape” during a shorter, several-week “visioning trip” to see the teaching sites and understand more fully what areas of clinical and education expertise you may need to strengthen before serving longer term. Across disciplines, infectious disease with HIV/AIDS experience is helpful. For Family Medicine, most programs do full range obstetrics, including C-sections, although expertise in these areas is not necessarily a requirement for a visiting faculty.

Because teaching and mentoring is done within relationship, it is important that you consider providing your service over a sufficient length of time, preferably at least six months to a year, to develop the relationships that are essential to effective mentorship. Longer terms always allow a better experience. Sabbatical length service from academic practice, although rarer these days, have worked well in the past.

CAAP’s overall mid-term goal is to ensure that family medicine (or other primary care) residencies are started at each of the church hospitals where Pan African Academy of Christian Surgeons (PAACS) are operating or being planned and to support already existing church-sponsored primary care residencies. Requests for consultation or other assistance from other sites will also be considered.

The following review prioritizes continued staffing needs of existing programs, then developing programs;
usually at the minimum level of three full-time faculty per site. The Program Director/Coordinator at each site
is usually half-time administration and half-time clinical duties. Clinical family medicine teaching positions
assume obstetrical skills unless noted. Educational administrative positions usually signify need to shepherd
a new program into existence. Representative Position Descriptions can be supplied upon request.

Sites of current or potential future CAAP involvement are presented in alphabetical order. Because staffing
needs are constantly changing, please contact us for more in depth conversations of current priorities.

Burundi

Country Situation: Burundi is considered one of the poorest countries in Africa with post-graduate-trained health care practitioners significantly limited in any sites outside of the capital city.

Hope Africa University and Kibuye Hope Hospital: A team of American physicians including Dr. Eric McLaughlin (FM, Serge) and Logan Banks (FM, Serge) teach medical students and have started Burundi’s first medical internship at Kibuye Hope Hospital, in the central highlands. After encouraging discussions with Ministry of Health leadership plans are developed for a family medicine residency to begin in early 2024. The main future expatriate program faculty priority is in community health.

Cameroon

Cameroon Baptist Convention Healthcare Ministries: Cameroon
The Cameroon Baptist Convention Health Services (CBCHS) comprises 7 hospitals, >25 integrated health centers and >50 primary health centers distributed over 6 of Cameroon’s 10 regions. Family Medicine is not yet started in the country.

Mbingo Baptist Hospital Internal Medicine Specialization (CIMS): Mbingo Baptist Hospital is a 300-bed referral hospital located in the Northwest Region of Cameroon; some 33km away from the Regional Capital, Bamenda. The services offered at Mbingo Baptist Hospital are :Ophthalmology, Orthopedics, Internal Medicine, General Surgery, Laboratory, Pharmacy, Technical, Community based Rehabilitation, Chaplaincy, Catering, among others. The hospital hosts 2 training programs: the PAACS and CIMS which started in 2007 and 2008 respectively. The CIMS program currently has 19 residents and 20 graduates many of whom are serving at other CBCHS facilities and others as CIMS faculty at Mbingo. There is a need for experts in different medicine sub-specialties to teach at the internal Medicine program.

North Africa

Country Situation: This family medicine residency program is located in a small city in an underserved region of North Africa. The program residents’ primary training location is at a small community hospital with associated clinics, both on site and at satellite locations. The program seeks to train national Christian physicians for rural and urban primary care and international medical work as well. Though the city is small, it is a livable city with options for outdoor activities, museums and historic sites. There is also an interactive small foreign community.

Two-three long-term faculty are currently needed. Expatriates are welcome. It would be preferred for long-term faculty to be board-certified in Family Medicine or Med-Peds, but accepted as well to be certified in Pediatrics, Internal Medicine, Emergency Medicine, or General Practice. There is also an urgent need for primary care physicians and specialists to serve as volunteers on a short-term basis (usually 1-4 weeks), where they can provide relief for long-term faculty and enhance education / mentorship by precepting residents and leading family medicine academic mornings and also by providing continuing medical education lectures to the national staff physicians in the evenings. More information can be obtained from [email protected]

Rwanda

Country Situation: The Rwandan FAMCO (Family Medicine and Community Health) postgraduate Family Medicine training graduated about 12 family doctors but has been put on hold for a time by the Ministry of Health. Drs. Maaike Flinkenflogel and Dr. Mieke Visser from The Netherlands head the undergraduate primary care teaching at National University of Rwanda.

Ruhengeri Provincial Hospital: is a 409-bed hospital in the NW part of the country near the famed parks where gorilla are found. Drs. Caleb (peds) and Louise King (int. med.) currently serve as the faculty coordinators but one family physician clinical mentor would be appreciated to join the Kings. Fiber-optic internet connection is planned soon.

Kabgayi Provincial Hospital: This is a previous family medicine 450-bed hospital in the south-central part of the country.

Rwinkwavu District Hospital: (http://www.pih.org/where/Rwanda/Rwanda.html) This 110-bed District Hospital in the east of Rwanda has been the site of a Partners in Health partnership with significant improvements in infrastructure, nurse training and HIV/AIDS care in the past few years.

Kibogora Regional Referral Hospital: (http://www.kibogora.org/Hospital.php) This 230-bed hospital is affiliated with the Free Methodist Church is in SW Rwanda The team of eight medical officers, led by Dr. Nsabimana Damien, is very interested to add family physicians and consider training in the future. There is potential that it could affiliate in the future with possible family medicine program at Hope Hospital in nearby Burundi. PAACS has considered potential training here.

South Sudan

Country Situation: South Sudan has emerged from decades of civil war as African’s newest nation as of July 2011 with continued civil unrest throughout 2014 with a peace accord signed in September 2015. Ten Sudanese doctors who had lived as refugees in Calgary, Canada have been assisted by SSHARE to return to the country in 2009 to assist the rebuilding: five work in Juba, the capital and five in Bor, capital of Jongelei State. Renewed civil strife from 2016 has meant most expatriate presence has had to be withdrawn.

Memorial Christian Hospital, Werkouk, Jongelei State: This 13-bed facility that serves a large surrounding population and supported logistically since founding in 2005 by the Partners in Compassionate Care. A well-equipped theatre allows emergency operations – 270 have been done since 2008. They hope to develop additional educational programs for nursing and other cadres in the future. Longer-term family doctors needed to assist continuing education of the clinical staff and support the ongoing clinical care. www.pccsudan.org

Bor District Hospital, Jongelei State: A physician assistant/ clinical officer training school, Institute of Health Sciences is being planned in conjunction with assistance by ICMDA to eventually teach 20 clinical officers and 20 midwives per year. There are only five nursing schools and one other clinical officer training sites in all of S. Sudan with 15 million people. The program began at Mengo Hospital in Uganda and has graduated the initial class in 2017. http://www.ucalgary.ca/uci/development/sshare and http://icmda.net/projects/sudan/

Uganda

Country situation: Family Medicine started in Uganda in 1989 and revitalized in 2002. An Association of Family Physicians of Uganda was formed in 2003. Ministry of Health has supported the programme, offered scholarships to its medical officers to attend, givers graduates similar salary as other specialists but full incorporation of the specialty into MoH terms of service and career development ladders is still developing.

Makerere University (Kampala)
The Family Medicine programme runs for three years and includes a thesis. Most of the teaching in the first two years is done at the huge national referral hospital, Mulago Hospital; rural teaching sites are utilized during the third year at Tororo District, Kiwoko (Church of Uganda) and Kasangati sub-District Hospitals. Additional “pilot” teaching sites are planned at Rugazi and Kiyeyi. Since 2003, the University of British Columbia and University of Wisconsin have been advising through an affiliation group called the Friends of Family Medicine (Uganda).

INFA-MED can make inquiries to get the latest faculty needs from the Program Director, Dr. Nomatovu http://chs.mak.ac.ug/medicine/

Mbarara University (Mbarara)
Mbarara is Uganda’s second medical school, located about four hours south and west of Kampala. It supported one cohort of 12 Family Medicine residents from 1999 -2004. It is now incorporating family medicine into the undergraduate curriculum. The Family Medicine Department at Mbarara would like to restart the residency programme utilizing rural district hospital sites and desires faculty. www.must.ac.ug/view_fac_ins.php?faculty_code=medicine

Kampala International University

This Kampala-based university has a medical school campus and 1000 bed teaching hospital an hour west of Mbarara at Ishaka. The current Family Medicine Department Chair is Dr. Ephraim Onokiojare Dafiewhare. He has the support of the Dean to begin a family medicine rotations in the medical school but needs assistance with curriculum writing and faculty to start a residency. He desires additional faculty. http://en.wikipedia.org/wiki/Kampala_International_University_School_of_Health_Sciences

Institute of Family Medicine

The Institute (INFA-MED for short) was formed in 1996 to sponsor family medicine training in Kenya. With the transfer of the program administration to Moi University in 2000, INFA-MED has continued its role of advocate and supporter of family medicine development in the region. Its specific aim role is to encourage and empower church hospitals to contribute to this critical task of family medicine education capacity building since these facilities are most often strategically placed in rural areas where the needs are greatest throughout sub-Saharan Africa. From the successful graduation of its first class of Moi U. family doctors in 2008, INFA-MED has now partnered with Kabarak University, a Christian university near Nakuru to begin a discipleship-based residency program at an initial three hospitals (see above under Kenya).

Concurrent with program development, INFA-MED has assisted initiation of the Kenya Association of Family Physicians in 2002 and its work of offering members quality practice-based learning groups continuing education materials. Continuing professional development has now become mandatory for re-licensure in many African countries. Another support for family physicians is providing emergency skills courses for doctors and other practitioners in obstetrics (INFA-MED sponsors Global ALSO courses since 2003). An integrated and comprehensive emergency skills training course for rural areas called CALS Essentials is introduced in December 2015 (www.calsprogram.org).

The Digital African Health Library is a concept to bring together important clinical information that can assist the family doctor to make the best decisions at the point of patient care. Results from the Kenya Point of Care Health Information Study, completed in 2009 with Webuye and Kijabe family medicine registrars, provided important information on the needs. Utilizing the power of available smart-phones, large amounts of information can be made available on this mobile platform but the resources need to be made relevant for use in the African context. The subscription version finally launched as of August 2015 in Kenya with plans to expand quickly to other Eastern Africa countries (www.digitalhealthlibrary.net).

Summary: African Medicine could use You

In order to assist medicine development in its broadest needs and geography, the biggest need is YOU, a capable practitioner of family medicine or other primary care specialty that has sensed the call to consider a contribution of significance in Africa. Like anything worth investing in, it is an investment of your time that matters most. These programs have varying sources of funding but what all rely on is a supply of family doctors who care. You can show that by investing a part of your career to help African medicine emerge to take its place to redress the huge inequities still present in the continent’s health care landscape.

Amongst the many opportunities out there, CAAP acts as a facilitator to help you find the right fit for your interests, skills and vision. CAAP is not a funding or sending agency but we know many of them and can point you to those that can assist you. If any of the above sites of service have piqued your interest, let us know. We would like to connect you on your rewarding service journey.

Contact information:
Bruce Dahlman MD MSHPE
CAAP Executive Team
E: [email protected]
US Cell: +1.218.940.9575
Kenya Mobile: +254