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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 6  |  Issue : 2  |  Page : 82-84
Transfer of surgical competences in the treatment of intersex disorders in Togo


1 Department of Pediatric Surgery, Lome Teaching Hospital (Lomé- Togo)
2 Department of Pediatric Surgery, Yopougon Teaching Hospital (Abidjan - Ivory Coast)
3 Department of Pediatric Surgery, Cocody Teaching Hospital (Abidjan - Ivory Coast)
4 Department of Pediatric Surgery, Angers Teaching Hospital (Angers-France)
5 Department of Pediatric Surgery, LAPEYRONIE Hospital (Montpelliers - France)
6 Department of Pediatric Surgery, St Jacques Hospital (Besançon- France)
7 Department of Pediatric Surgery, Necker Enfants Malades Hospital (Paris-France)

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Date of Web Publication29-Jul-2009
 

   Abstract 

Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. Results: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French- speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities.

Keywords: Paediatric surgeons, sexual ambiguities, transfer of competence

How to cite this article:
Gnassingbe K, da Silva-Anoma S, Akakpo-Numado G K, Tekou A H, Kouame B, Aguehounde C, Coupris L, Galifer R B, Aubert D, Revillon Y. Transfer of surgical competences in the treatment of intersex disorders in Togo. Afr J Paediatr Surg 2009;6:82-4

How to cite this URL:
Gnassingbe K, da Silva-Anoma S, Akakpo-Numado G K, Tekou A H, Kouame B, Aguehounde C, Coupris L, Galifer R B, Aubert D, Revillon Y. Transfer of surgical competences in the treatment of intersex disorders in Togo. Afr J Paediatr Surg [serial online] 2009 [cited 2020 Mar 30];6:82-4. Available from: http://www.afrjpaedsurg.org/text.asp?2009/6/2/82/54768

   Introduction Top


The complexity of intersex, similar to many other congenital anomalies, poses treatment challenges to the African pediatric surgeons. Technological improvements during previous years have permitted a great amelioration in the detection and treatment of some pediatric surgical pathologies in the developed countries; whereas, most of these advances are lacking in many developing (African) countries. [1],[2] As a result, the transfer of competence in various forms between the developed countries and the developing countries is the most desired.

One forum to transfer such surgical competence is through seminars. In November 2006, a precongress workshop on paediatric urology and intersex was held in Mombasa, Kenya; as a part of the sixth biennial congress of the Pan-African Paediatric Surgical Association (PAPSA). In December 2006, the French-speaking African Pediatric Surgery Society, Togo, organised a teaching seminar to improve and reinforce the paediatric surgeons from French-speaking Africa countries, on intersex management. This seminar was focused at initiating them to the new surgical techniques in treatment of intersex. The aim of this study was to evaluate the impact of such scientific exchange of competences on patients and paediatric surgeons from the African countries.


   Materials and Methods Top


This was a study of the patients treated for intersex during a workshop, held in the paediatric surgery department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo, from December 4 th to 8 th , 2006. This workshop took the form of theoretical and practical surgical sessions.

Among 11 patients, five had karyotype and genitography, and the rest were excluded for the following reasons: (1) isolated hypertrophied clitoris, (2) micropenis with testicular agenesis toward an infantilism, (3) vaginal agenesis, (4) failure of a masculinising gιnitoplasty in a male pseudo hermaphroditism, (5) a 23-year old patient, having a congenital adrenal hyperplasia, refused to be feminised, and (6) micropιnis associated to hypospadias in whom the hormonal stimulation has not be conducted.


   Results Top


There were 107 participants [5 French professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French-speaking countries), and 40 general surgeons].

The different intersex disorders treated during the practical session included one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism. The epidemiological, diagnostic, and therapeutical characteristics of the patients treated during the workshop are represented in [Table 1].

Participant's satisfaction and confidence assessed at the end of the seminar with regard to the management of intersex showed high level of confidence in all the participants.


   Discussion Top


The frequency of genital malformations seems on the increase; environmental pollution by pesticides, used to destroy mosquito larvae, has been implicated. [3]

Genital malformations, in particular intersex, are important topics in our countries because of the strong psychological pressure they impose [4] such as stigmatisation and social exclusion leading to suicide in some cases. It is therefore important to recognise them and treat them well.

Although paediatric surgery practice is well established [5] the number of paediatric surgeons varies from one country to another. In Europe, the ratio of paediatric surgeon to the patients varies from 1:424 to 1:35714, per year. [5] In Africa, where 50% of the population is less than the age of 15 years, the ratio is weak with an average of four paediatric surgeons per country. Due to this, the children in Africa with intersex are treated most of the time by urologists, who are not competent in this regard. This situation is compounded by the lack of modern facilities (laboratories, magnifying glasses, and microscopes).

These difficulties often push African paediatric surgeons to refer the patients to developed countries for management, with attendant exorbitant cost. Non Governmental Organisations (NGOs) such as, "Terre des Hommes", "La chaξne de l'Espoir", sometimes play some role in assisting these high costs. At times NGOs also collaborate with their western partners to carry out benevolent health expeditions for local treatment of patients suffering from congenital abnormalities, including intersex in Africa. [6] It was in the light of these challenges that the French-speaking African Paediatric Surgery Society recently chose to improve the level of competence of paediatric surgeons concerning the management of intersex by organising a workshop during which some patients with intersex were operated free [Table 1].

The high number of participants in the workshop underscored the perceived interest, in this arrangement. Every practitioner, whether a paediatric surgeon, a general practitioner, a general surgeon, or a urologist, has to be confronted with the difficulties of treating these affections in one's professional life. This probably explained why the general surgeons participated in these teaching seminars and workshops.

The experience from this workshop highlights few facts: (1) the value of cooperation between paediatric surgeons in Africa and the global pediatric surgical community, (2) the late presentation of patients with intersex in some African countries, (3) the potential role of media in health education in Africa, and (4) the need for conducting similar workshops in the future.

We like to conclude that collaborative scientific/surgical workshops appear to facilitate transfer of surgical competence, although evaluation of the aftermaths of this training in a short or midterm is necessary before a definite recommendation.

 
   References Top

1.Harouchi A. Les progrθs de la chirurgie pιdiatrique moderne ont-ils atteint les enfants africains ? Chir Pιdiatr 1990;31:284-6.  Back to cited text no. 1    
2.Balde I, Doumbouya N, Agbo-Panzo D, Diallo AF, da Silva-Anoma S. Panorama de la chirurgie pιdiatrique en Afrique. Mιd Afr Noire 1999;46:243.  Back to cited text no. 2    
3.Hosie S, Loff S, Witt K, Niessen K, Waag KL. Is there a correlation between organochlorine compounds and undescended testes? Eur J Paediatr Surg 2000;10:304-9.  Back to cited text no. 3    
4.Lazarovici. Consιquences psychologiques de l'ectopie testiculaire. Chir Pιdiatr 1989;30:150-2.  Back to cited text no. 4    
5.Driller C, Holschneider AM. Training in Paediatric Surgery. A Comparison of 24 countries in Europe and other countries around the World. Eur J Paediatr Surg 2003;13:73-80.  Back to cited text no. 5    
6.Gbenou AS, Biotchane I, Fiogbι M, Lokossou T, Biaou O, Adibabi W. Bilan de 4 missions chirurgicales caritatives ιtrangθres au Bιnin. Bιnin Mιd 2002;22:65-70.  Back to cited text no. 6    

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Correspondence Address:
K Gnassingbe
Department of Pediatric Surgery, Lome Teaching Hospital (Prof. Hubert Tekou), PO Box 57, Lomé Togo

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.54768

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    Tables

  [Table 1]

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