Sola Ogundipe
14 October 2008
The need for continuous recertification and retraining of doctors and other medical professionals in the country is one of the avenues through which they can be enabled to acquire newer skills as well as improving their competence and proficiency.
These were some of the resolutions taken recently in Lagos during a special training workshop for medical doctors on the utilisation and benefits of surgical staples, organised by Lagoon Hospitals, Lagos in partnership with Johnson and Johnson.
Prof. Ade Elebute, Chairman, Lagoon Hospitals illustrating a point to Dr.Kunle Onakoya, GMD, Lagoon Hospitals during the surgical staples workshop.
Surgeons from hospitals across the State attended the 2-day training, which was first in a series of surgical skills workshops aimed at improving skills of surgeons in Nigeria on novel techniques and procedures .
It was observed that surgeons in the country needed to be better positioned in the bid to align with improving the quality of surgical practice, in line with global standards.
The sessions which featured presentations and demonstrations including a "wet lab" session that included practical surgery and use of the stapling method on animal models and real surgical procedures was an eye-opener to the participants.
Speaking, Chairman, Lagoon Hospitals, Prof Ade Elebute remarked that there was need to be concerned about the quality of surgical practice in the country as a way of improving public confidence.
"When you walk into a hospital, you fully expect that the doctor is competent and able to deliver. In every other part of the world, doctors are continuously re-certified as competent. Currently what we have is a life-time certification and that is not good enough.
We need a system that enables the doctor to be continuously recertified and to demonstrate competence. The doctor himself should know the limits so that there can be more trust in the system."
Pointing out that there cannot be a price tag to life, Elebute opined that it should not be said that because somethings are expensive Nigerians should be denied access. "Cost cannot be an issue, for health rather it should be what level of health do our people deserve."
Coordinator of the training session and Group Medical Director of the hospital, Lagos, Dr. Kunle Onakoya told Good Health Weekly that surgical staples were one of the innovations in the medical field that Nigerians deserve to benefit from.
"These are skills available in other parts of the world and we are saying the Nigerian surgeon should also have these skills. Our surgeons are well trained but they are limited by the environment in which they practice.
He defined surgical conditions as conditions that require suture, incision, excision, manipulation, or other invasive procedures that usually, but not always, require local, regional, or general anesthesia.
"Surgical staples are to replace sutures in this instance. Surgical staples are devices that when used enable you to get to areas that are difficult to access that if you were to use your 10 fingers, it would be impossible to get access and if these cannot be accessed then the surgeon would be forced to remove only that which can be assessed.
In other words, the outcome is going to be sub-optimal, but when you use the surgical staples we are talking about there can be far greater access and greater integrity.It is a precision instrument.
Said Onakoya: "These are skills available in other parts of the world and we are saying the Nigerian surgeon should also have these skills. Our surgeons are well trained but they are limited by the environment in which they practice."
Good Health Weekly gathered that proper care of an incision begins with knowing what material or technique the surgeon used to close the cut. Traditionally, sutures, or stitches, are the oldest method still in use to close an incision.
The surgeon uses a sterilised thread, which may be made of natural materials (silk or catgut) or synthetic fibers, to stitch the edges of the cut together with a special curved needle. There are two major types of sutures, absorbable and nonabsorbable. Absorbable sutures are gradually broken down in the body, usually within two months.
Absorbable sutures do not have to be removed. They are used most commonly to close the deeper layers of tissue in a large incision or in such areas as the mouth. Nonabsorbable sutures are not broken down in the body and must be removed after the incision has healed. They are used most often to close the outer layers of skin or superficial cuts.
Sutures have several disadvantages. Because they are made of materials that are foreign to the body, they must be carefully sterilised and the skin around the incision cleansed.
There is a higher risk of scarring with sutures, particularly if the surgeon puts too much tension on the thread while stitching or selects thread that is too thick for the specific procedure.
Staples are less likely to cause infections than sutures, and they also take less time to use. They can, however, leave noticeable scars if the edges of the wound or incision have not been properly aligned. Staples also require a special instrument for removal.
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