Gut Check | Tuesday, January 9, 2018

Structured GI Endoscopy Education in the Developing World

Debbie den Boer, BSN RN CGRN CPAN

It was very worthwhile to haul two heavy suitcases and carry-on luggage filled to the brim with books, educational material and donated items, on a 30 plus-hour travel from San Diego to Cairo, Egypt, just to see the eagerness and thankfulness in the faces of our nursing colleagues in Egypt. Finally, a GI endoscopy nurses workshop/conference in Egypt — something my colleague Agnes Gaber and I have wished for so long! We had been invited to give presentations and be involved at GI conferences in countries in the developing world like Jordan, Sudan, Saudi Arabia, Thailand and Nigeria, but being involved with organizing a GI endoscopy nurses conference in Egypt had eluded us for many years.

Reflecting back on my many years as a GI endoscopy and motility nurse, I am so grateful for all the amazing, wonderful opportunities and experiences I had, not only in my daily work but also in the fact that I could meet so many nursing colleagues around the world. Having visited hospitals and GI units in many parts of the world, I observed the desperate need for structured, GI-specific nursing education. This became my mission (our mission) and my passion, to share knowledge and experience with nurses in the developing world, to care, to educate, to demonstrate, to teach in a way that will be easy to understand and apply.

I remember when I came to the United States from South Africa how I appreciated the SGNA courses, the regional and local GI endoscopy nursing conferences, and of course Theresa Vos’s ERCP courses! All of them so structured, so focused, so targeted to the daily nursing problems and challenges and that helped me personally so much in my long career as a GI endoscopy nurse.

Our last two trips were to Egypt, Cairo and Alexandria, where we were able to be part of organizing their first GI/endoscopy nursing workshops and present on many important topics. With the CRE outbreak and the ERCP endoscope’s minute mechanical details still fresh in our minds, it was an appropriate focal point for our talks on infection control and step by step endoscope reprocessing. Our mission was to start with the basics of gastroenterology and endoscopy nursing and we put together power point presentations elaborating on the role of the endoscopy nurse, from initial assessment to emergencies.

According to the National Institutes of Health, hepatitis C virus (HCV) infection is a major public health burden in Egypt, where it bears the highest prevalence rate in the world. “Estimates for prevalence are based upon data reported from the 2008 and 2015 Egypt Demographic Health Surveys”. In Egypt, the prevalence rate of HCV infected individuals was 872,000 (15 percent of the population) in 2013, with an estimated incidence of newly infected 125,000 viraemic individuals each year, the rate which is considered as one of the highest prevalence rates of HCV worldwide.

Just about every family in Egypt is touched by hepatitis C,” says Dr. Henk Bekedam, WHO Representative in the country. The blood-borne virus, which is highly infectious, kills an estimated 40,000 Egyptians a year and at least one in 10 of the population aged 15 to 59 is infected. Egypt’s hepatitis C epidemic dates back decades when glass syringes, used during a mass vaccination campaign were not properly sterilized between used, explains Dr. Manal Hamdy El-Sayed from Egypt’s National Viral Hepatitis Committee.

“This reservoir of infection was sustained for years because there was no awareness and no efforts to control the spread,” she says. Part of the problem is that hepatitis symptoms can take a long time to show.

“Most people do not know they are infected, as they often do not have symptoms until they develop serious liver disease, which can be years later,” says Stefan Wiktor from WHO’s Global Hepatitis Program.

Hepatitis is today recognized by people at all levels in Egypt as a major challenge, Dr. Bekedam notes. There are 26 specialized centers and 350,000 people have been treated in the past six years. Yet despite these efforts, the virus is still spreading, with some 165,000 new infections each year.

During the conference, we were amazed that the audience/attendants at the first workshop in Cairo were mainly managers, head nurses, lecturers and professors from various university nursing faculties in Egypt. The benefit of that was that these lead nurses and faculty members could appreciate the importance of knowledge in all aspects of endoscopy, in theory as well as in practice. Even though there are cultural differences that we always have to be aware of and honor, we all strive for the same goal: patient safety and excellent patient care.

We felt that the workshops were successful simply because of the enthusiasm, gratitude and interest of the registrants, the sharing of email addresses and communication afterward. It is because of the urgent contact of nursing professor Naglaa Youssef, PhD, faculty of nursing at the University of Cairo, that the vision was born to offer a clinical education program for endoscopy nurses in the hope to develop an “Endoscopy Center of Excellence” that will serve as a model for other endoscopy units in the region and beyond. The World Gastroenterology Organization (WGO) developed a very successful global program for “Training Centers” in different developing countries where physicians can learn and practice endoscopy techniques and our dream is to mimic some of this idea.

So, our mission is not complete. Noticeable among the Egyptian nurses, technicians and other patient care workers was the language barrier. This spurred the idea that in order to have an effective, efficient GI education program, the material and presentations should be translated into Arabic. This becomes a major task, as our goal is to present them with practical evidence-based gastroenterology/endoscopy nursing standards, based on the SGNA and ASGE standards and guidelines. Emphasis will be on practical skills, competencies, handling and care of equipment and especially the reprocessing of endoscopes and related accessories. 

This program is scheduled for the summer of 2018. Agnes and I already have multiple suitcases full of books, manuals, educational material and donated items like biopsy forceps, snares, brushes, mouthpieces, band ligatures, cleaning charts and so on.  And it will be a pleasure again to haul these suitcases to Egypt to our beloved nursing colleagues.