With five out of seven people lacking access to safe surgery and 4.2 million dying within 30 days of operations each year, experts at the inaugural Advancing Medical Education in Africa Conference (MedEdAfrica 2025) this week highlighted how these interventions, paired with innovative training, are reducing risks and reshaping healthcare education.
'When the lights go off mid-operation, our headlamp comes on, and we continue,' said Professor Nobhojit Roy, a Lifebox governing board member and surgery professor at the University of Global Health Equity (UGHE).
Lifebox's headlamps, distributed across 116 countries, tackle a universal hurdle: power interruptions.
In Rwanda, like many other countries in the region, they have illuminated operating theaters, with Prof. Roy describing them as a 'practical fix' in cases of power hitches, ensuring surgeries can continue uninterrupted even with the slightest interruption.
Senait Bitew Alemu, Lifebox's Chief Programme Officer, highlighted the WHO Surgical Safety Checklist as a cornerstone of their Clean Cut project, which includes components such as proper hand hygiene, skin antisepsis, sterile equipment and environment, and timely antibiotic prophylaxis.
In Rwanda, the non-profit organization focused on improving the safety of surgery in low-income countries has been implementing the Clean Cut program in four facilities, including CHUK, Kabgayi, Kigeme, and Kirehe. According to the organization, globally, Clean Cut has demonstrated a 35% reduction in infections among all patients.
'A patient shouldn't return with an infection,' Alemu said, emphasizing the importance of safer recoveries for mothers post-cesarean.
Pulse oximeters, which monitor oxygen levels, have also played an important role in safer surgeries.
'It's a device you saw during COVID,' Prof. Roy noted.
A pulse oximeter is the only piece of equipment included on the WHO Surgical Safety Checklist and is a minimum standard for safe anesthesia. Yet, operating rooms across the world still lack this essential device, putting millions of lives at risk, according to Lifebox experts.
Since 2011, Lifebox has distributed more than 35,000 pulse oximeters in 116 countries. Coupled with the training of more than 14,000 healthcare providers on safe surgeries, these efforts are making surgery safer for more than 200 million patients.
Additionally, as part of efforts for safer surgeries, Lifebox, in partnership with Smile Train, is equipping 650 operating rooms with Smile Train-Lifebox Capnographs. These essential monitors ensure patients receive adequate oxygen during anesthesia. While they have been used universally in high-income countries for decades, they remain absent in many low-resource operating rooms.
The MedEdAfrica conference, launched Monday at the Kigali Convention Centre, drew over 600 medical educators, students, healthcare leaders, and policymakers from Africa and beyond.
Hosted by UGHE, the Ministry of Health, and partners, it birthed the Consortium of Medical Schools in Africa (COMSA) to foster collaboration.
Speaking during the opening of the conference, Health Minister Dr. Sabin Nsanzimana stressed the importance of evolving education to meet a shifting health landscape.
'Diseases have moved from malaria to cancer as life expectancy rises,' he said. 'We need specialists, and fast.'
Lifebox supports the ministry through a nine-month nursing fellowship at Butaro Teaching Hospital, which began two months ago and is ongoing.
'Nurses are the backbone,' Alemu affirmed. 'We're training them in safety, leadership, and sterilization," she added.
The Lifebox training program, targeting general nurses in perioperative roles, aims to cascade training across Rwanda, with five initial trainees set to mentor others.
Reforms on medical training
Professor Abebe Bekele, UGHE's Dean and COMSA co-chair, emphasized the need for education reform across Africa to address existing gaps.
'Africa can't afford 15-20-year training timelines,' he said, advocating for shorter, intensive programs and multi-level training to meet rural healthcare demands.
He termed the reforms as crucial to supporting initiatives such as the 4x4 program launched in July 2023, which aims to quadruple the number of healthcare workers in the country within four years, with a target to achieve this by 2027.
Thomas Weiser, a Stanford surgeon and Lifebox collaborator, echoed this call for change: 'We've trained doctors the same way for 120 yearsâ€"it's too slow.' He proposed simulation and task-sharing with non-medical doctors, noting, 'Nurse anesthetists handle 80% of rural US anesthetics.'
Minister Nsanzimana pushed for a tech-driven overhaul, stating, 'The demand is growing, and we must respond by aligning medical education with healthcare needs. There is no debateâ€"medical education is crucial. The burden of disease is increasing and evolving. We have moved from primarily dealing with malaria, HIV, and tuberculosis to addressing chronic illnesses like cancer and organ failure. These shifts are recentâ€"perhaps in the past decadeâ€"but they are significant.'
He added, 'AI is already transforming fields like radiology and pathology. Should we continue training the same number of specialists in these fields, or should we adapt to the changing landscape? Technology is not replacing healthcare professionals, but it is shifting how we work. We must integrate these advancements into medical education.'
Prof. Roy reinforced this urgency: 'With population growth, we need faster trainingâ€"15 years won't cut it.'
Wycliffe Nyamasege
