26 WORLD GASTROENTEROLOGY NEWS JULY 2014 Editorial | Expert Point of View | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events Brijen Shah (USA), Ramou NJie (UK and Gambia), Maud Lemoine (UK), Andrew Veitch (British Society of Gastroenterology, UK), John Igoe (Canada), Suzanne Anderson (UK and MRC, The Gambia), Stephanie Bush-Goddard (USA), Damon Bizos (South Africa) and Nagi Checri (Karl Storz, Beirut). Our Karl Storz col-leagues based in Beirut, local nursing and house staff, ably supported us. The meeting was hosted by Professor James N’Dow (UK and The Gambia) of Horizons Trust UK and it was held in the Medical Research Coun-cil (UK) facility in The Gambia. We are most grateful to the director Dr. Umberto D’Alessandro for his sup-port and for allowing us to run the meeting at the MRC facility. About 40 patients underwent endoscopy. Varices were common which given the background Hepatitis B prevalence of 10% is not surpris-ing. What was a surprise was a high prevalence of PPI refractory non-ulcer dyspepsia but this may simply repre-sent patient selection. For those of us from outside Africa the learning curve was steep. Few of our clinical algorithms worked, primarily due to resource constraints. For example, in treating esophageal varices we brought in scopes and liga-tors but there were limited supplies of sedation, no sclerotherapy needles or sclerosant, no tissue glue, no plasma, no octreotide, no Sengstaken tubes, no ICU and no transplantation. The blood bank was a phone call to the local army barracks for volunteers. The normal safety nets with which we are used to performing were not there. An enduring feeling after the meet-ing was one of admiration for our colleagues who provide care in such difficult circumstances, and a little less complaining about our own western health systems. Although liver disease is common there is little banding being performed in the region, and we are organizing a follow up course in The Gambia in January 2015 with a focus on the treatment of end stage liver disease. Given that end stage liver disease is common in The Gambia and that transplantation is not available it is hoped that we can prolong life by treating some of the complications, which are not necessarily fatal, such as variceal hemorrhage. The mission of the WGO Train-ing Centers is to help local physi-cians deliver training to the future generations of providers. The WGO does not come in from outside and deliver care but focuses on teaching the teachers. We help local groups develop expertise and resources. There are very good local physicians in The Gambia but the physical resources are stretched. However the Horizons UK Trust hopes to build a healthcare facil-ity in The Gambia, which will deliver private and public health care and support the efforts of the Gambian government. The Gambia has a lot of positives, which make it an attractive site for a training hub. The country is safe, the people friendly and the government is supportive, as is the Gambian dias-pora. Air connections to Europe and North America are excellent and there are connections to airports within Af-rica. Importantly there is a strong re-search operation headed by the MRC, research on health care and outcomes in West Africa in GI is lacking, and growing this is very important. A question, which should be asked, is whether it is reasonable to work to-wards development of expensive tech-nologies like endoscopy when more basic needs, such as public health measures, need support and may have more impact. The answer is an un-equivocal yes. We saw a 12-year-old boy with an acute GI bleed second-ary to duodenal ulceration when we were there. The outcome may have been different without endoscopy and treatment. A country has to deliver basic comprehensive care if it is to maintain a healthy population, attract and retain investment, and grow its economy. For example The Gambia has a significant tourist industry with the UK, which is the same time zone. In order to grow this, the health services, including the ability to deal with a bleed, or a food bolus need to be in place. But it is not primarily about growing the economy. The local population should always be the focus and can be helped both by grow-ing direct care and by growing the national economy. There is a lot to be done. There is a need for endoscopy nurse training, for equipment at an affordable price, for training of junior physicians and much more. However, the enterprise is launched and we have shown that with the help of an international faculty and their local colleagues, the project can progress. In terms of what you as a physician, or nurse, or someone who is interested, the best option would be to connect with your national GI society and advocate for support of our peers in the developing world. To learn more about the work of the Horizons Trust, visit http:// www.thehorizonsclinic.com/
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