Otolaryngology head and neck surgical care has been considered a luxury for most Low and Middle-Income Countries (LMICs). This is partly due to inadequate resources but also due to disabling shortage of trained personnel. There is a disproportionate ratio of Ear, Nose and Throat (ENT) surgeons per 100,000 population across the globe. For example, countries like the United Stated have 3 per 100,000 which is above the World Health Organization recommendation of 2 per 100,000. This is in contrast to LMICs whereby there are countries with less than 10 ENT surgeons for the entire population. Adding on to this problem is the limited number of training institutions and opportunities and the lack of standardization of these programs. Studies also demonstrate that trainees have also expressed a desire for more research opportunities, and note that these are not always supplied n training opportunities. Nonetheless, practicing ENT surgeons in LMICs are coming up with sustainable training models that are suitable for their countries to bridge the training gaps in their communities. For example. the internationally collaborative University of Cape Town Karl Storz Head and Neck Surgery Fellowship Program that was established to train surgeons across Africa. By 2019, the fellowship program had trained 14 head and neck surgeons who returned to practice in their home countries. Institutions have also been using stimulation and unique tools in order to learn surgical skills when other technology is unavailable; this has often been made possible by international collaboration. Another international collaboration across Africa led to the establishment of virtual rounds, to foster educational opportunities and discussion during the COVID-10 pandemic. With the COVID-10 pandemic, there was a disruption of traditional training as we know it, and this forced us to find ways to ensure learning continued. Webinars and videoconferencing now became the norm and these were open to all, transcending physical boundaries. From online didactic lectures to virtual tumor boards. trainees and practicing surgeons were able to share their experiences and learn from one another. This also brought about the aspect of regional and international collaborations which can be further explored for training purposes.
These changes may continue to build on the ongoing usage of technology to foster training and education in LMICs. For example, a collaborative training course between one Haitian and one USA institution resulted in an ongoing course with established modules using WhatsApp to make communication more accessible and feasible. Other studies have demonstrated interest internationally in using social media to make learning and research more accessible. Given the changes brought by the pandemic, perhaps this may be an important avenue forward.
Along with the numerous infrastructural, curricular and institutional avenues of change, there is also a need to grow the interest in the field internationally. For example, interest from medical students in OHNS mus be fostered internationally as well as trainee interest in subspecialties of need, such as pediatric OHNS. However, the future of OHNS training in LMICs appears to be trending in a positive direction, thanks to creative collaborations and interventions worldwide.
Valerie Salano, MBChB
ENT resident at Muhimbili National Hospital, Kenya
Praveen Rajaguru, MPH
Medical Student at Warren Alpert Medical School of Brown University, United States