The RAFT network
The main activities of the RAFT network will aim at setting up the people and technical infrastructure that will enable further deployment of tele-education and telemedicine activities. This “script” is based on the experience developed in several countries of Sub-Saharan Africa:
● Establish a coordination team with, at least, the focal point, a medical coordinator and a technical coordinator.
● Establish an initial deployment plan which should include at least one university hospital, which will serve as the reference for the national network, and one distant hospital, suitable for demonstrating the feasibility and the added-value of remote support of care professionals through continuing distance education and access to tele-expertise.
● Organize a national workshop to communicate and validate the deployment plan with the key stakeholders of the RAFT network in the country. These include the coordination team, the ministries of health, education and communication, health authorities, hospital directors, correspondents in remote hospitals. It is also useful to associate telecommunication companies and organize some media coverage.
● Formalize the institutional anchoring of the project through a memorandum of understanding between the official authorities, the national coordination team, and the central RAFT coordination.
● Train the coordination team to the appropriate usage of the RAFT tools as well as the correspondent(s) in the distant hospital(s). Usually, training is started remotely (online) and is finalized during (or around) the workshop.
● Deploy the necessary hardware, software and connectivity in the identified sites. Note that part of the deployment can start before the workshop.
● Start distance education activities by participating to weekly educational sessions. When judged appropriate, contribute by producing and webcasting educational sessions, either for the national audience or more widely for the RAFT partners.
● Register to the tele-expertise network and submit tele-expertise requests.
● Monitor activities and adjust training and communication activities accordingly.
Further activities include:
● Plan for the further deployment of the RAFT activities in the country.
● Consider setting up a national professional association for eHealth, telemedicine and health informatics professionals which will serve as a communication and capacity building platform.
The OESO Foundation
Access to the OESO Knowledge Interactive Information System
One of the innovations of the OESO Foundation in the field of Continuing Medical Education is the progressive building up of an evolutive Encyclopedia of Esophagology composed of a series of volumes published at regular intervals.
Each one proposes to the reader an in-depth dissection of a chosen subject in the realm of the upper digestive tract through several hundred successive small, precise questions, each followed by a didactic answer provided by one of the world's most qualified experts. These replies take the form of a structured scientific article supported by illustrations, tables and bibliographical references pertinent to the understanding of the text.
The Health on the Net Foundation (HON) contributed to structure this unparalleled network by means of "The OESO Knowledge Interactive Information System".
Today, the system includes a total of 7,500 pages of questions and answers with multiple means of access by words, by groups of words, by authors, or by references.
This wealth of information is accessible to all, and Its scientific value is maintained by regular, top level updates of the contents by their authors.
For this purpose, OESO has developed with HON a user-friendly original procedure designed to update the texts using an OESO-HON voice recorder. This system allows the author to comment on the initial text and to specify those modifications considered as significant.
Discussion of clinical cases
The constant help of the HON (Health On the Net Foundation) team is key to the dissemination of information to the 14,000 members of the OESO network.
The decision of the Foundation to implement a combination of its database with a monthly action disseminated twice among 14,000 people allows for fostering a kind of heartbeat of the OESO, the biennial Conferences remaining the scientific grounds witnessing the scientific weight of the repository.
Since 2010, a didactic clinical case is put up for discussion each month on a special Forum managed at the University of Vienna by a member of the Executive Committee of the OESO Foundation.
Month after month, the number of those connecting, mainly to observe the discussions, regularly increases, including representatives of new countries that were not formerly included in the OESO mailing list, especially in the Middle East.
The discussions proposed on the OESO Foundation website are not of interest for experts only, but also for general practitioners, and also for patients who can express their opinions that might not relate to the case, but to common questions dealing with digestive disease.
This incentive for patients, in addition to that already existing for physicians, represents a good opportunity for the OESO Foundation website to develop: indeed, the patient is usually left out of the dialogue, and is not represented in this kind of forum. In the days of social media, this initiative represents an important addition to the undertakings of the Foundation, giving an even broader perspective to them.
For the first time in 2010, a young surgeon from Yaoundé took part in a mission in France, in the framework of the exchanges scheduled in the Foundation. The surgeon who was granted the first surgical mission of the OESO Foundation in 2010 then succeeded in organizing a special training program in in his Hospital in Yaoundé, the only one in Cameroon.
To date, two hundred procedures have already been performed in this hospital, with obvious improvement of the post-operative course and quality of life. In addition, due to the restricted availability of having CT scans in his country, laparoscopic surgery can be considered as a help for diagnosis in diverse circumstances, and thus now has a role in the field of Health Economics.
The team in Yaoundé now wishes to expand laparoscopic surgery in other countries of Africa with connections to other centers.
Several members of the Executive Committee of the Foundation would be happy to be involved in such a cooperation, as would a lot of US surgeons, who would be eager to be part of such missions in these countries.
Training in endoscopy and use of new endoscopes with disposable channels
Since 2010, the program has been consolidated for the organization of a one week training period of two endoscopists, one from Casablanca, Morocco, and one from Yaoundé, Cameroon.
The beneficial role of Gastro-Intestinal (GI) endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer is well established. Like many sophisticated medical devices, the endoscope is a complex, reusable instrument that requires reprocessing before being used on subsequent patients. The most commonly used methods for reprocessing endoscopes result in high-level disinfection.
To date, all published occurrences of pathogen transmission (bacteria and viruses) related to GI endoscopy have been associated with failure to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment. In consideration of this worrisome situation, Dr Ingo Herrmann (Munich) created the "Ingoscope", that could be of particular interest in developing countries: indeed, in these countries, the use of disposable channels (cost of only a few US $ each) now existing in the Ingoscope will be of great help in regular endoscopy practice, as well as for the exploration and dilation of caustic stenoses. These stenoses are particularly frequent in Africa in young children following ingestion of caustic liquids (caustic soda), in countries where no surgeon can perform esophageal surgery.
The content of the OESO Post-Graduate Courses from the preceding World Congresses of OESO, presented in a “How-to…” format will be offered in several categories of esophageal practice, using the DVDs from these congresses to upload the material of the courses.
The intended audience will be the same as that for the already existing online CME project, which comprises practicing physicians and trainees (residents and fellows) with an interest in the physiology and diseases of the digestive tract.
In particular, this body of knowledge is expected to be of use to those physicians who do not have easy access to attend the OESO World Congresses or other specialty meetings, such as those who practice in remote areas or regions with more limited resources, but need to keep abreast of the latest practical knowledge in the field, and who would get practical updates on what can be done and how to do it.
Each online topic consists of an approximately 10-minute slide presentation with audio narration that can be easily uploaded online and streamed using the current OESO CME Platform.
The distant impact of such post-graduate courses can be expected as considerable.
A significant addition to this proposal can be considered from now: in the aim to assist African surgeons in digestive celioscopy, a noteworthy project for surgical eLearning is ready to be proposed to all African countries interested in the development of this technique. Surgeons will be offered the opportunity of a connection to a surgical center via Internet, and will access an innovative eLearning module:
● morning: watching surgical procedures live, with possibility to ask questions, translated into French or English
● afternoon: interactive exchanges and didactic presentations.
This new system technically allows for simultaneous, worldwide connections in as many countries as wish to.
The entire content of the week will afterwards permanently remain on the web as an educational tool accessible from any country.
The Geneva-based RAFT coordination will provide support:
● To train the coordination team to the appropriate use of the RAFT software, on-line, and then on-site during the national workshop.
● To review the deployment plan and advise on technical and logistical decisions.
● By participating to the national workshop and help communicate about the RAFT experiences in other countries.
● To ensure institutional anchoring by signing a memorandum of understanding with official authorities.
● To connect the national coordination team with other RAFT teams in African countries.
● By monitoring activities, providing feedback and technical support.
● By mediating, when needed, access to specific expertise to address tele-expertise requests.
The Geneva-based OESO Foundation and the Vienna based Unified Patient Project will provide support:
● To organize the CME program
● To organize the meetings of the editorial board of the project with web conferences
● To follow up on educational requests made by authors and other partners within the project
● To link the OESO Foundation with other scientific structures
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