Broadening ENT skills through practical training

Posted on 1 Feb 2021

The University of Pretoria Department of ENT (Ear, Nose and Throat) and Mediclinic Southern Africa recently identified the need to upskill ENT specialists within Africa, but based within the surgeon’s own theatre environment. A collaboration was planned between Dr Christian Quitter, ENT surgeon at Mediclinic Sandton as well as Deputy HOD Department ENT-HNS (Head and Neck surgery) and Specialist for Rhinology and Anterior Skull Base Surgery, at the University of Pretoria and Medtronic SA. This training session was initially delayed by the COVID-19 outbreak.

However, in November 2020, the team was able to visit Eswatini to provide some valuable insight and training at the Mbabane Government Hospital. Dr Eunice Haumba is the senior ENT surgeon at the facility and has previously attended training sessions with Dr Quitter. These sessions had however been conducted on cadavers as part of the training process.

Dr Quitter understands the reality and challenges facing doctors in the African setting, when attempting to expand their knowledge. He sees it as an opportunity for private and public healthcare sectors to work together to assist. “I think finance is a big hurdle. Also to be allowed to attend courses such as this takes possibly the only specialist in a department out of service for a few days. So to see, discuss and then treat patients in the relevant local centre helps from a financial perspective but also from a practical aspect.”

According to Dr Quitter, he believes that there is great value in taking the teaching to the place where the doctor is working. “We can better understand what the individual doctor’s circumstances are. This then allows us to teach according to what equipment a colleague has available and what pathology they are seeing.” He explains this approach has specific advantages in comparison to teaching bigger groups. In a fixed programme, educators have to engage and teach doctors that are at different levels of their development. This suits most but not all and even though instructors try their best, they are not always able to tailor make the teaching experience to cater to every delegate.

During this training visit, four patients were identified, and following some intense and long hours in theatre the procedures were completed. These included surgeries that could take up to six hours each, but Dr Quitter acknowledges that the doctor’s confidence and skills improved with each patient.

In this particular training scenario, all the surgeries were sinus surgeries for either inflammatory disease or benign tumors. We are finding that there is a large demand for this as especially inflammatory disease is very common – affecting approximately 15% of the world’s adult population. Such training will prove invaluable to the community within which such doctors are operating.

Claire Fox (Medtronic), Dr. Quitter, Dr. Haumba

The team in Eswatini


Dr. Haumba operating


Preop ward round, counseling and taking consent (for operation and photo to be published)

In looking to the future, and how such training on a practical level can expand and proceed, Dr Quitter believes that more companies should be funding outreach programmes under the leadership of university departments and in co-operation with the private hospital industry. This concept is practical and applicable for most medical specialties.

But the focus is not only on the training. It is a great reward to know that patients’ lives are being impacted by these sessions. “The four patients we worked with have a good chance of either cure or very good control of disease. The doctor receiving training now has an improved skill set and will apply what she learnt until we return and teach more advanced procedures, with the potential of impacting more and more patients within her care.”

“I am very excited that I was able to test the concept, which worked extremely well. I believe my colleague from Eswatini benefited a lot and we are considering undertaking another outreach in March or April of this year,” Dr Quitter concludes.

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