Understanding the needs of low‐income countries: how urologists can help

Abstract

Delivering urological humanitarian aid to countries with greater need has been provided by urologists associated with British Association of Urological Surgeons (BAUS) Urolink over the last 30 years. Urolink has realised the need to understand where that need is geographically, what tangible help is required, and how assistance can be delivered in the most ethically appropriate way. The World Bank stratification of countries by per capita gross national income has helped in the identification of low‐come countries or lower‐middle‐income countries (LMICs), the vast majority of which are in sub‐Saharan Africa. The medical and socioeconomic needs of those country’s populations, which constitute 17% of the global community, are substantially different from that required in higher income countries. More than 40% of sub‐Saharan Africa’s population is aged <14 years, it has a substantially reduced life expectancy, which influences the type of pathologies seen, and perinatal complications are a major cause of morbidity for both mother and child. There is a significant problem with the availability of medical care in these countries and almost a third of global deaths have been attributed to the lack of access to emergency and elective surgery. Urologically, the main conditions demanding the attention of the very few available urologists are congenital anomalies, benign prostatic hypertrophy, urolithiasis, urethral stricture, and pelvic cancer. The management of these conditions is often substantially different from that in the UK, being limited by a lack of personnel, equipment, and access to geographically relevant guidelines appropriate to the healthcare environment. Assisting LMICs to develop sustainable urological services can be helped by understanding the local needs of linked institutions, establishing trusting and durable relationships with partner centres and by providing appropriate education that can be perpetuated, and disseminated, across a region of need.

The utility of urological clinical and simulation training for Sub‐Saharan Africa

“…Sub‐Saharan Africa (SSA) represents ~15% of the world’s population (1.136 billion people) and is comprised of predominately low‐ and middle‐income countries (LMICs) [1]. It has one of the world’s largest inequalities in health and social care delivery.…”

Disseminating surgical experience for sustainable benefits: the Urolink experience

“…Specialist surgical education, and training, in a global setting is, therefore, a relatively new concept in LMICs [8]. The bibliometric review by O′Flynn et al.…”

“…Consequently, junior surgeons have limited exposure to specialist urological knowledge or operative techniques, particularly endoscopy. Specialist surgical education, and training, in a global setting is, therefore, a relatively new concept in LMICs [8]. The bibliometric review by O 0 Flynn et al classified instruction in global surgery and differentiated academic education about global surgery from the training required to contribute sustainable skills appropriate to the care of the patient requiring surgical intervention [9].…”

Understanding cultural and logistical contexts for urologists in low‐income countries

“…Delivering urological care in LICs is challenging. As discussed already, patients present with advanced disease and referral pathways are often not well established, leading to delays in treatment and to complex cases [21,25].…”