Team reports

The NIHT visited Masanga Hospital in Sierra Leone to organize a hernia camp in collaboration with CapaCare. This was a preparatory project under the Norwegian Research Council’s “Global Surgery Collaboration” initiative. The main goals were to: 1.Gain deeper insight into Sierra Leone’s healthcare and training environment 2.Train local providers in inguinal hernia surgery 3.Pilot interventions from the upcoming research project using the Alfred Surgery platform Hernia Camp Organization A high-volume training model was used to maximize feedback in a short time. This approach was effective for planning future project activities but may not be the preferred model for long-term educational efforts. About 40 patients received surgery over five days across two operating theatres. Staffing was increased and a dedicated hernia ward established. Participants included 10 Surgical Training Program (STP) students and 3 Surgical Assistant Community Health Officers (SACHOs). Hands-on training focused on the SACHOs, who are expected to train future STP students. Their high baseline skills allowed them to approach proficiency in the Lichtenstein technique during the week. Learning Culture One of the most prominent observations was the strong learning culture cultivated by the CapaCare team over the years. Students, SACHOs, nurses, and local doctors were all highly motivated to participate. Paper-based checklists and assessment forms are already in use, providing a strong foundation for integrating digital tools in future efforts. Pre-course Training All STP students and SACHOs received access to the online Lichtenstein training module three weeks before the course. The program covered theoretical background, anatomy, indications, a step-by-step technical guide, and a knowledge test. A pre-course surgical skill evaluation was also completed. The online training program was evaluated through personal interviews with the course participants. Availability of the content through 3G connection was good, and most students were studying from different locations in between tasks or in the evenings. Students were generally well-prepared for hands-on practice. However, challenges included account setup issues, lack of mobile phone compatibility, and slow streaming of high-definition videos. These limitations are being addressed in future updates. Use of Digital Assessment Forms Digital assessment forms were piloted with several SACHOs and local doctors. These forms supported structured evaluation and helped define clear learning objectives for each procedure. We did experience issues with internet connectivity, which will be critical for broader implementation in future projects. Digital Clinical Checklist While the training was well-prepared by the CapaCare team, the introduction of structured digital checklists could add further value. The hospital relies on paper files and supported by unstructured mobile phone notes, making it difficult to maintain a complete overview of patient care. We believe digital checklists via the Alfred Surgery platform could improve accuracy, continuity, and error prevention and could be used to support the paper system. Future Models for Education The pre-project demonstrated that standardized training via Alfred Surgery can be applied both in continuous programs and intensive courses. Masanga Hospital expressed a strong need for standardized hernia training. For STP students, training would be spread over a longer duration and could incorporate digital training modules and structured feedback tools. Additionally, there is interest in hosting dedicated hernia camps for SACHOs across Sierra Leone, with Masanga acting as a central training center. The tested model—pre-course training, pre-course evaluation, digital feedback tools, hands-on training, and post-course assessment—would be effective in this setting. The NIHT will be highly motivated to support conducting such training courses. Standardization Standardized techniques are essential to ensure safe and effective surgical training. During the training week, we performed Modified Bassini, Desarda, and Lichtenstein repairs. These techniques could be embedded into the Alfred Surgery platform and used as a basis for future research. Involving local doctors in defining these standards is crucial for relevance and acceptance. Conclusion The pre-project provided valuable insights into Masanga’s healthcare and training systems. CapaCare’s strong learning culture is a major asset. The Alfred Surgery platform is feasible with minor adjustments. There is a clear need for standardized surgical training, and collaboration among NIHT, CapaCare, Masanga Hospital, and Alfred Surgery will be vital for the main project’s success. June 8-15, 2025