Colostomy‌ ‌in‌ ‌Newborns‌

Our surgical training module will allow medical officers (non-specialist physicians) and general surgeons to become confident and competent in the gentle handling of the delicate tissues of infants to allow them to safely perform a colostomy in newborns in low to middle incomes countries (LMICs).

Our module uses simulation training models made from low-cost, locally available materials. We offer a previously used wet cigarette model to teach the learner to avoid undue tension and compression and prevent the creation of sutures that are too tight.  We use ultrasound blue gel sandwiched between two layers of clear, thin plastic to teach the learner to avoid crushing newborn tissue during electrocautery coagulation and while grasping tissue.

After completion, the models are inspected by the learner, reviewed using a checklist and can be photographed and saved by the learner on any cellphone with a camera for remote evaluation and feedback by an expert.

Our surgical training module provides text, images, and videos that cover these topics: (1) physical simulator set-up, (2) anatomical knowledge, (3) clinical decision-making, (4) pre-operative management, (5) key procedural steps, (6) psychomotor skills training, and (7) post-operative management.

Our low-cost, replicable, and self-assessed simulation-based training module does not require access to teachers, cadavers, animal models or expensive mannequins and uses locally available, low-cost materials to teach gentle tissue handling skills to allow learners to safely create a colostomy in a newborn. 

Our module enables learners to self-assess their own knowledge and psychomotor skills by completing digital quizzes, checklists, surveys, timed trials, and objective structured assessment of technical skills (OSATS) forms.

We plan to make our online training module available on an ultraportable, offline, energy-efficient Raspberry Pi with touchscreen display to provide self-assessed, validated surgical training in regions with limited or no access to the Internet, smartphones, and electricity.

The specific psychomotor skills that we are working to teach are:

• Gentle and delicate tissue handling
• Control of bleeding
• Avoiding crushing tissue
• Avoiding tight sutures
• Avoiding undue tension or pull

Children account for over 40% of the population in sub Saharan Africa and 25-30% in most LMICs. Performing surgery in this age group requires incredibly careful, gentle, and delicate handling of tissues to avoid complications and mortality. Handling neonatal tissue requires such psychomotor skills more than anywhere else and creating a safe colostomy (a very common procedure) is the most typical example where such skills are required.

In most of sub Saharan Africa and LMICs, there are very few pediatric surgeons and most neonates and children have no access to such specialized care. This means that surgery on children in most of these settings are performed by non-specialist physicians and general surgeons who have little or no training in the surgical care of children. Training these categories of staff in careful, gentle and delicate tissue handling would make it possible for them to perform emergency and essential surgical procedures in children in a safe manner, thereby, avoiding and minimizing complications and mortality.

Medical officers are fully trained physicians who have not undergone any additional formal surgical training yet, are required to perform (or are performing) surgical procedures in children in LMICs due to severe shortages of paediatric surgeons. General surgeons have undergone formal advanced training in the surgical care of adults but have not been trained to perform surgery on children. They are currently involved in providing surgical care for children in LMICs due to severe shortages of paediatric surgeons.

We have conducted a survey of paediatric surgeons around the world through the Global Initiative for Children’s Surgery (GICS) to identify the key psychomotor skills required to safely perform colostomy in the newborn. GICS has already engaged with these medical officers and general surgeons and created the Optimal Resources for Children’s Surgery (OReCS) which carefully lays out the skills required by these personnel to perform surgical procedures in children. The project will address their needs by teaching them preparation of a child for surgery, surgical decision-making in children, gentle tissue handling as well as postoperative care following surgery in children to ensure a safe outcome.

Team Lead/Clinician/Educator: Emmanuel A. Ameh, MBBS, FAWCS, FACS

Clinician/Educator: Paul Ssempebwa, MBchB

Educator/Technical Expert: Julielynn Y. Wong, MD, MPH, FACPM

Educator: Bob Dolan, PhD

Technical Experts: June Madete, PhD (Medical Engineering), Jason Tumusiime, BSc (Telecommunications Engineering), Jude Barnabas Kibwota, Ester Carrasco, MEng (Bioengineering and Biomedical Engineering), Owen Botelho, BEng (Mechanical Engineering), Dean Jin, PhD (Computer Science)

Technical Expert/Videographer: Filip Vukcevic

Technical Team Member: Saif Ali 

Biostatistician: William Fraser, MSc

Artists/UX Designers: Kseniia Shikhova, Laurissa Barnes-Roberts