Hope Africa University
Medical Strategy and Planning Conference
Essenhaus Inn -- Middlebury, Indiana
September 25, 2009
An ad hoc group of interested individuals met at the Essenhaus Conference Center to consider the opportunities and needs of developing the Frank Ogden School of Medicine at Hope Africa University in Bujumbura, Burundi. The concerns included, as well, the medically related sections of the University—the school of nursing and Kibuye Hospital soon to be turned over to the University as a teaching hospital. Seventeen physicians and three dentists were in attendance. The agenda and list of attendees is attached. David Crandall, chair, opened with welcome, led a hymn “To God Be the Glory” and in a time of prayer.
Gerald Bates introduced the schedule for the day, gave a summary of the medical and nursing programs at HAU including a brief organizational overview of Friends of Hope Africa University. Other board members of Friends of HAU present were David Bates, Marlene Bates, John Ellis, Wayne McCown, and Mark Whitlock.
Bates gave a brief history of HAU and discussed its mission and vision. He described the needs of the region, the dedication of the students and emphasized the boldly Christian mission of the university. He pointed out that the motto for HAU is “Facing African Realities.” Prominent among them are corruption, poverty, need for education in many fields, and poor medical and health care. He noted that the school has a current enrollment of about 2,800 students with more than 1,000 applications for intake to the spring semester beginning February 2010. Bates noted that the first nursing graduates will be honored in December 2009.
Dr Seleus Sibomana, Dean of the Frank Ogden School of Medicine, presented the current state of plans for the Bujumbura Clinic, the academic needs of the school and the strengths and expectations of the school as it goes forward. A sketch of HAU Bujumbura campus layout showing placement of the new clinic and operational flow diagrams were circulated.
Dr. Norm Wetterau presented ideas on how technology could be used in the medical training program. ADAM is a software tool used to teach anatomy and physiology without the need for cadavers. Flat screen TV’s should be used rather than digital projectors for lower cost and more durable equipment.
Many medical textbooks are now Internet based so the need for a reliable high-speed connection is very important.
Loma Linda and Duke have shown some interest in providing educational support for HAU.
New skills will be needed to manage all these new technologies: “librarians” to manage medical textbooks and teaching materials; an audiovisual expert to help develop med school support, and a stock room/learning center to manage equipment and resources..
Dr. Cedric Johnson presented thoughts on clinical education. He emphasized that teaching clinical medicine requires clinical practice. This can be difficult if student conferences are not part of the training program. Conferences get the students involved in recitations/presentations. Students need to learn to learn to summarize their thoughts and express ideas convincingly. Conferences allow you to do research without computers or other educational aids by learning from mentors how to do things better. Students must learn to look for errors of omission in the process.
Johnson emphasized that good clinical medicine requires a lot of physical contact with the patient by the doctor. A measure of progress is how seventh year students work with fifth year students. By year seven it is imperative that students know how to explain what they do and why. He also noted that one of the subspecialties in the sixth year is dentistry and we should consider how to provide training in dentistry. In all phases of good clinical training there is a strong need for mentors.
Darlene McCown, Head of the Nursing School reported on progress in this area. She noted that nurses in Burundi do both assessment and some treatment and so our training should prepare them for that. She proposed that a goal of the school would be to have open admission in the first year for general studies but then, after the second year, select for admission to nursing school. By being more selective at this point we would get smaller classes of better students to lead to a higher graduation rate and redirect others early in their studies.
McCown reported that there is adequate equipment available to use in teaching but most of the faculty are limited in knowing how to use it. The available faculty have never been exposed to modern equipment nor the training techniques possible with it. She reported that even though the library has lots of books they are older standard editions and the students are not accustomed to using them. A culture that emphasizes self-learning needs to be established. Also, when teaching at HAU, she discovered that the students lack dexterity to readily perform many of the manual skills that we take for granted in US classes. This comes from lack of experience with such things as utensils, toys and electronic and mechanical devices that western children begin to use from infancy. Teachers must understand this and account for a longer initial learning time when using modern equipment.
Needs and Plans in nursing education:
Teach professionalism – confidentiality, dignity of the caregiver, eliminate embarrassment when touching a patient.
Move from an aural/lecture learning style to self-learning style.
Develop a skills labs and equipment for the clinic; teach use of the microscopes.
Acquire more current text books.
Hire more trained faculty; $15,000 per year is needed to underwrite hiring nursing instructors.
Encourage more women to become nurses. “Men build structures; women build people,” says Dr. Darlene.
Dr. Frank Ogden was unable to attend the seminar but he sent a slide presentation with notes. These were presented by Dr. David Crandall. Some developments for Kibuye Hospital were identified. In summary:
There is the possibility that the nation of Japan will provide an OB unit.
Good clinical role models for the students are needed.
Kibuye Hospital is being turned over to HAU by the FM Church so it can become the teaching hospital for the school.
Needs: Dependable electricity
Reliable and safe water
Septic system
Laundry equipment for sterile cleaning
More up to date X-ray equipment
Dr. Sibomana showed a schematic of Kibuye Hospital development. He also discussed planned changes in organizational structure to make for clear and efficient operation of the hospital. The Kibuye Hospital has been chosen to become a district hospital so it will be responsible for 11 remote clinics serving about 250,000 people. The Director of the Hospital will normally be appointed the District Director for the region. The organizational diagram shows clearly the positions available to expatriate doctors. Two paths lead to such appointments: 1) through the University (since appointees to Kibuye Hospital will hold professor status in the University) and 2) through Free Methodist World Missions if career missionary appointment is pursued.
Discussion about Kibuye Hospital followed these presentations. Comments:
Regarding the grant from Japan for an OB unit, as far as is known nothing other than public recognition is expected in return for the gift. We will be expected to staff the facility appropriately.
We are in a period of bridging a gap from entrepreneurial missionary doctors to a mode of service which requires integration with the national realities and a university. Transitional period will be required to go from the 1970-past to the time now when we are training our own Christian doctors and nurses in our own schools. It will likely take 5 to 10 years to accomplish this complete changeover.
Stable and adequate basic infrastructure is critical (e.g. – electrical supply, water supply, sanitation, etc.). A well driller is at Mt. Hope and may be able to go to Kibuye.
How do we re-ignite the interest in missionary service by today’s western medical staff? The problem has been not just with the political interruptions in Africa but also the change of focus by the US evangelical church. Perhaps Urbana 2009 will start a new movement.
We must be careful about enlarging the hospital program without assuring basic services. Some of these problems are the result of unstable medical staffing of the hospital which in turn relates to the past war situation and problems of security. These matters seem to be behind us now so we should seek out skilled workers from within our denomination to go to assist in building the infrastructure for the hospital. It was noted that, rather than send people from North America for some levels of work, for the price of an airline ticket we could hire local craftsmen to do the work needed.
Elisina Chauke from Natal, South Africa, could be a resource person to help at HAU in public health training.
On motion: That the Free Methodist Medical Fellowship recruit and support a team of a surgeon and a primary care doctor to go to Kibuye and assist with upgrading there.
FMMF will work with young physicians to assemble a group to visit Burundi as part of our recruiting plan. Gerald Bates agreed to lead this recruiting visit if a sufficient number of interested individuals can be recruited.
The group broke up into Power Groups to address specific topics of interest. Reports followed.
Dr. Cedric Johnson reported for the group that addressed the medical school issues. *Paul Davenport is interested in teaching physiology.
*“How to get the word out about our needs?” Gerald Bates will get info on Free Methodist World Missions and the VISA program.
*Christian Medical and Dental Association should be a good resource to get visiting teachers. Use Friends of HAU as the avenue for this to contact.
Dr. Norm Wetterau reported for the group addressing teaching resources.
*Are virtual labs available on line? Will copyrights restrict use of online material?
*Services of a librarian will be needed for teaching aids in med school.
*We should track MD’s who are available to teach.
* Could we use IU lectures that are online for 1st and 2nd year classes?
John Ellis will contact IU re their Eldoret program and classes available.
* We need to know if the East African Union has requirements for clinical training.
Joel Miller reported for the group that reviewed the plans for the city clinic.
*A Needs Assessment should be made before starting to build to assure the necessary flexibility to care for a changing patient mix. “Who do we serve and how do we reach them?”
*Rotating specialty treatment by day of the week would help with staffing issues.
Would local doctors be willing to help at the clinic on a part time basis?
*The clinic should set an example for excellence in primary preventive healthcare and public health.
*Spiritual needs of the community should be considered. What role does the local church play? Should we have a chaplain?
Darlene McCown reported for the group that focused on nursing.
*Curriculum expansion needs to be considered.
*Harriet Bolodar will consider serving as a visiting nurse instructor.
John Ellis reported for the group that addressed the Kibuye Hospital as a teaching institution.
* Set up for success by capping the size of the medical school enrolment as determined by the number of teaching physicians available. All students that are enrolled would go through the first four years of the curriculum. Only the best students up to program capacity will be admitted for the fifth year and beyond.
*Professional staff for the hospital must be role models: Christians, able to treat and teach, willing to teach and learn from each other.
* Develop an overall master plan for the entire Kibuye complex to account for long term growth. This should include basic operational infrastructure (power, water, sanitation), housing for students, staff and visiting physicians, and locations for initial and subsequent buildings.
* Funding is needed for both repair of the existing facility and for expansion with new buildings.
*Equipment needs must account for 220 volt power standard and the difficulty of repair of complex systems.
Dr. David Crandall summarized the day by pointing out that we face many challenges from a practical point of view. We need a master plan for Kibuye Hospital for long term, changing needs and a growing program. We need non-medical support staff to come to help meet specific challenges in development. We need to identify contact persons for recruiting visiting staff, grant writing and fund raising. And we must coordinate all this work among he various interested parties, FMMF, Friends of HAU, FMWM, etc. We must understand and respect what is implied with the new relationship of the hospital with the university.
We must have faith that God has the resources to see success. We need to see our faith strengthened in order to be reliable partners.
Gerald Bates closed the day with prayer.
Facilities Needs:
Ultra-sound equipment for OB/GYN.
Biochemistry lab set up.
Computers
Digital and overhead projectors (220 v.)
X-Ray equipment.
Pulse oximeters
Physicians Desk References.
Anatomy and physiology models
EKG machine.
Delivery tables.
Solar system to heat water.
Commercial laundry equipment.
OR lights