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Revolutionizing Surgical Practice

Healthcare Challenges in Bangladesh

Bangladesh is a low income country with shortages of healthcare professionals in every sector, surgical field is no exception. Surgeons are often posted in a remote place or with a very busy workload barring them to seek and avail necessary training to improve their skills. The world is moving fast with innovations and inclusion of newer technologies in the surgical practice which enhances surgical outcomes and also reduces surgery related patient sufferings. Minimal invasive surgery of which most frequently practiced is laparoscopy is one such addition. We are still lacking the facilities for Robotic Surgery.

Laparoscopic Surgery Landscape

Let’s focus on Laparoscopic surgery situation in Bangladesh. It was introduced by the Gynecologists in the 1970’s to perform tubal ligation. However, Professor Sarder A. Nayeem is considered as pioneer to introduce and popularize laparoscopy in Bangladesh starting with cholecystectomy in 1991. General surgeons rapidly picked up the mantle and spread the technology across the country. Gynecologists then took up and subsequently other specialties. Professor Md. Jafrul Hannan is credited with introducing laparoscopy in Children in 2005. Pediatric laparoscopy did not gain desired momentum in our country in comparison to general surgery and gynecology for several reasons:

  1. Limited availability of instruments for pediatric use.
  2. Inadequate training facilities – lack of experienced surgeons to offer training, the inability of the aspirant surgeons to spend long enough time with the trainers. Even some surgeons took training but returning back to their work place, could not start laparoscopy without necessary instruments and infrastructures and forgot what they have learnt.
  3. Due to very limited space in the body cavity of small children, hands on training during live surgeries carry a significant risk, causing the trainees to become frustrated and discourage them to pursue their aim. Solutions to this problem could be practice on animal models, availability of laparoscopic box trainers to the trainees to achieve hand-eye coordination and practicing on virtual training platform to attain sufficient expertise. Unfortunately, none of these exist in our realm. And it is not possible for the trainees to visit the trainer multiple times to renew their learning.

Professor Md. Jafrul Hannan

Professor Md. Jafrul Hannan has been offering laparoscopy training to the young pediatric surgeons for several years. Few gynecologists and general surgeons also took the opportunity, so also surgeons from Nepal, Hungary and Switzerland. Many surgeons go abroad for training and return with frustration, because they cannot participate in an operation, can only observe. There is another group who can manage hands-on training abroad, but do not return after completion, participating in the brain drain. Surgical missions from home and abroad can help training and collaboration. But year-round collaboration could be more beneficial.

Surgical Education Challenges

In our country there are more than 100 medical colleges. Eighty percent of those are understaffed and lack necessary infrastructure to offer expected surgical education to the clinical students, let alone laparoscopy. Open surgical techniques are taught to the students as per resources available. Unfortunately most of the medical students do not get any exposure to laparoscopy during their student life although many of them will pursue surgical career in future. The newly passed doctors aspiring to be surgeons are in the similar scenario.