Colorectal cancer rates are surging in Nigeria, especially among those under 50, driven by rising life expectancy and increasing rates of non-communicable diseases.

This trend prompted Prof. Olusegun Isaac Alatise from Obafemi Awolowo University (OAU) in Nigeria and Dr. Peter Kingham of Memorial Sloan Kettering Cancer Center (MSKCC) in New York to launch the African Research Group for Oncology (ARGO).

In 2018, Dr. Gregory Knapp, a general surgeon and surgical oncologist at Dalhousie University, completed a Global Cancer Disparities Fellowship at MSKCC, sparking a partnership between Dalhousie University’s Global Surgery Office (GSO) and ARGO.

Dr. Knapp spent six months in Nigeria with Prof. Alatise; that led to a phase II study of the fecal immunochemical test (FIT) as a possible tool for colon cancer screening in Nigeria. FIT is currently used as part of the provincial screening program in Nova Scotia. This test checks for hidden blood in the stool, which can be an early sign of colon cancer. The results were recently published in Lancet Global Health and represent the first time this commonly used screening tool has been evaluated in West Africa.

With Nigeria seeing gaps in screening and a severe shortage of trained endoscopists, Prof. Alatise approached Dr. Knapp to collaborate on a colonoscopy training course – the first of its kind in the country.

In April 2024, Prof. Alatise worked with Dr. Knapp and Dr. Richard Spence (also a general surgeon and surgical oncologist at Dalhousie), Dr. Shilpa Murthy from Yale School of Medicine, and Dr. Sahle Griffith from Queen Elizabeth Hospital, Barbados, to deliver a colonoscopy training course for 18 junior consultants from across Nigeria.

The course included nine weeks of online lectures followed by an in-person colonoscopy exam using simulation models, allowing trainees to practice basic scope manipulation. The training included proctored colonoscopies on patients and culminated in a comprehensive skill assessment.

“[The course] was successful and impacted the trainees positively,” said Prof. Alatise. Thanks to sponsorship from Dalhousie GSO, the course was free for all attendees. Prof. Alatise and Dr. Knapp hope to make the course an annual event with Dalhousie’s continued support.

Technological advancements were key to the course’s success. Dr. Knapp noted that “tele-mentoring allows for first-hand training without needing to be physically present.” Combining real-time mentoring with practical sessions on patients and simulators provided the students a thorough learning experience.

Although all trainees had basic endoscopy experience, none were performing colonoscopies routinely. “One month later, eight trainees were performing colonoscopies regularly,” Prof. Alatise said.

International collaborations like this are crucial for advancing surgical education. “These partnerships create a foundation for education and practice, growing into something sustainable and self-fulfilling,” said Dr. Knapp.

“Mentoring and teaching are challenging but rewarding. It’s refreshing to see the excitement and anxiety of learning new skills through the eyes of eager learners,” he said. This sentiment underscores the reciprocal value of education, where both mentors and students grow together.

Global surgery education is not just about skill enhancement; it is also about addressing health-care gaps and fostering a global perspective on health-care delivery. “It is about answering key questions and increasing capacity for equitable care while learning from different health systems. This provides insight into challenges at home,” said Dr. Knapp.

Through initiatives like this colonoscopy training course, Dalhousie GSO is not only enhancing surgical skills globally, but also fostering a global culture of lifelong learning and mutual respect in education. This initiative, and the work of Prof. Alatise, Dr. Knapp, Dr. Spence and the rest of their team, is a reminder that the pursuit of knowledge is a lifelong endeavour, one that holds the promise of a healthier, more connected world.

Top photo: Dr. Richard Spence (third from left) instructed and supervised junior surgeons in endoscopic maneuvering techniques on live patients.

*This blog post is an excerpt of a longer article that appeared in the September 2024 issue of doctorsNS magazine. 

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