10 years of CapaCare – The international trainers

It is now ten years since the first students started their journey in the Surgical Training Programme (STP) in Sierra Leone. This was the start of CapaCare providing training in [...]

It is now ten years since the first students started their journey in the Surgical Training Programme (STP) in Sierra Leone. This was the start of CapaCare providing training in life-saving surgical and obstetric skills. During 2021, we are reflecting on the last ten years by interviewing two people every month that have played an important role in the development of the organisation and programme. A core element of the STP is to develop the surgical skills through module-based training. These training modules are conducted in Masanga and tutored by specialist medical doctors, nurses and midwifes. This month we have interviewed Lesley Hunt and Frank van Raaij, two of the international specialist trainers that, have been deeply engaged in the training programme.

Can you describe briefly what your role is or has been in CapaCare?

Lesley: My role is as a general surgery trainer. When I first went to Masanga the role was teaching based on day-to-dayclinical work and operations. I was also asked to deliver training based on the WHO’s ‘Surgical Care at the District Hospital’ manual. Although helpful as a starting point, there was a need to go on from this and address the specific surgical challenges seen in Sierra Leone. I went on to make 3-4 trips a year and was able to set up and deliver the Basic Surgical Skills (BSS) and Abdominal Surgery courses for STP* students. These courses continue to form a large part of my work. I also provide Continuing Medical Education courses for our graduates and BSS and General Surgery courses for newly qualified Sierra Leonean doctors. For the past three years I have been coaching selected graduates as trainers. I directly teach operative surgery on cases as they present and elective referrals are often timed to coincide with the visits. I sometimes travel to other hospitals to assist our graduates with complex cases and take part in the consultation service for abdominal cases, used by them.

As with any training programme there is work behind the scenes, designing new courses, producing the picture guides, updating materials, procuring equipment, and making presentations for use by new trainers. This year we began work to transfer some of the older booklets and video to an eBook format. Working with Martelien and Daniel**, we designed and introduced structured objective assessments for key operative and clinical situations. A big project has been to establish and document the BSS, abdominal and wet-lab course curricula. This work, which is almost complete, aims to standardise the educational experience when it is delivered by different trainers. The latest development has been to create the Abdominal Surgery Distance Learning Programme, a series of recorded lectures, available electronically.

*STP Surgical Training Programme; STPs Surgical Training Programme students
 ** Martelien Grootjans and Daniel van Leerdam, former CapaCare International Coordinators 

Frank: I was working in Masanga as a medical officer in charge when Håkon and Brynjulf first visited Masanga Hospital and I had the pleasure of doing some surgical procedures with them. I of course hope that my role at that time in running and improving the still basic hospital played a part in their initiative to start the Surgical Training Programme. The actual project started shortly after my departure from Masanga. Luckily, I was quickly invited to come back as a trainer for the obstetrics and gynaecology part of the training. I did not have to think about this for very long. It proved to be a golden opportunity for me as well. During the years I visited Masanga numerous times as a trainer and helped set up the obstetric part of the training, on site and from home by helping with the development of the exams.

Lesley teaching the basic surgical skills course back in 2015

Frank Van Raaij supervising the late Samuel Batty preforming a hernia repair


How has CapaCare impacted your life?

Lesley: In 2013, I took a sabbatical from my UK job to go to Masanga. A few years earlier, I had attended a lecture by Nigerian surgeon Jimi Coker. His talk was inspirational and when my son and daughter left home, I felt I could give myself to a new challenge. I had been actively involved in surgical training in the UK and thought this was something I could contribute to. I expected the trip to be a one off. I would go to Africa for a few months and then settle back to my life in the UK. I did not expect it would change my life. However, Sierra Leone had an effect on me. I felt a connection to the surgeons and would-be surgeons as they struggle in difficult circumstances and wanted to continue to work with them.

So, I chose to adjust my life to accommodate this. I re-negotiated my UK contract to allow 11-12 weeks a year in Sierra Leone, and since 2013 I have made 24 more trips, all but two of which have been for CapaCare. Over time, I have built some enduring relationships and the STPs and graduated surgeons have become part of my life; now when I am in the UK it is unusual for a day to go by without either some work for CapaCare or contact from a graduate. Since I started, interest in Global Surgery has increased and I have found the way this is perceived at home has shifted. It is now quite a fashionable thing to do and I have been asked to talk about the work at national surgical meetings.

Frank: I already mentioned the golden opportunity it was for me. I started as a trainer when I was still in my obstetrics/gynaecology specialisation in the Netherlands. I got the opportunity from my professor to provide three weeks of training every year in the hospital’s time. She also saw the value of this training for both the Sierra Leonean health care system and my personal professional development. And that was exactly what it was. Every time I came to Masanga I was able to transfer knowledge and skills and I also learned so much myself. I was able to grow as a medical professional and a teacher thanks to CapaCare and the wonderful students I met.

My experience as a teacher in CapaCare also gave me opportunities to teach in other countries and allowed me to become a MOET (Management of Obstetric Emergencies and Trauma) instructor in The Netherlands when I was still a registrar, which was highly exceptional and against the course’s own policy at that time.  Up to this time I am still a obstetric skills teacher in the Netherlands and the experiences and exposure I had in Sierra Leone empower me greatly in training colleagues in dealing with rare emergencies which I encountered on numerous occasions during my work in Masanga.

Besides all that, the CapaCare family is a wonderful group to belong to. I met so many wonderful people over the years and made friends for life.


Students Emmanuel Tamba, Peter Mboma, Hassan Sherif and tutor Lesley Hunt during the basic surgical course in 2015

 Frank van Raaij supervising Emmanuel Tommy preforming a caeseraen section

Can you tell one personal CapaCare story that you will never forget?

Lesley: In 2017, Hindowa Lavally, a graduate of the STP, accidentally turned up for a refresher course two days early. I was busy teaching junior trainees. I often had lots of trainees requiring attention at once, so rather than send him away I asked if he would stay and help me run the course. He was extremely helpful, assisting the trainees and sorting their problems without them needing to wait for me to be free. In the afternoon, one of the students asked a theoretical question. Instead of looking to me for the answer, Hindowa went to the white board and started drawing and explaining the problem. Although by 2017 most day-to-day training of STPs was already being done by our graduates, this moment was something of an epiphany for me. I suddenly saw that if we brought people back to the same courses as teaching faculty, then over time they would be able to run these courses themselves.  Since then, STP graduates have been teaching with me on nearly every course. Amongst them we have people capable of running Sierra Leone’s future surgical training programmes. Training 30 surgeons is an achievement, but if we build and support a local teaching faculty, we do something truly sustainable.

Frank: One of the stories I always love to tell is the story of one of our first students Amara Conteh. During my time as Medical Officer Amara came to Masanga as an intern during his CHO (Community Health Officer) training. We saw that he was a hard-working intelligent student, but still inexperienced and quite shy. At times maybe somewhat intimidated by the European doctors. After finishing his studies, he started to work in Masanga and was in the first group to start in the CapaCare training. I was lucky to have him as a student a couple of times during my visits over the years and saw him grow as a medical professional and as a person. Over time the inexperienced and shy boy disappeared, making way for a skilled and confident surgeon who happily remained a warm and kind person to everyone. When I meet him now, he is explaining things to me and joking around with me as if I were the student! To witness such professional and personal growth makes it all worthwhile.

Hindowa Lavally pauses to ensure the student has fully understood

Mohammed Kamara receiving skills training from Helen Winter and Fran van Raaij

What is your hope for the future of CapaCare?

Lesley: I hope we can continue to maintain the quality of graduates whilst increasing trainee numbers. As technology develops, I hope we can move the theoretical and simulation parts of the curriculum online, thereby reducing the environmental footprint of the programme. I hope we can direct more research towards addressing the clinical questions facing West African surgeons.

However, these hopes are dwarfed by the one overriding issue which is obtaining a scheme of service and regulation for our graduates. They have the knowledge, they have the skills, and they are doing the work. Regulation and recognition will empower them to pass their knowledge and skills to the next generation.

Frank: I hope that CapaCare will continue to support the health system in Sierra Leone over the years to come and maybe expand or set an example for other countries and projects. The fact that they are not just doing it, but also researching the impact of their intervention makes this a unique and exemplary project. Keep up the good work and keep me in the loop!