Year : 2009 | Volume : 6 | Issue : 2 | Page : 82-84

Transfer of surgical competences in the treatment of intersex disorders in Togo

K Gnassingbe1, S da Silva-Anoma2, GK Akakpo-Numado1, AH Tekou1, B Kouame2, C
Aguehounde3, L Coupris4, RB Galifer5, D Aubert6, Y Revillon7
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),

Click here for correspondence address and email Date of Web Publication
29-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 GK, Tekou AH, Kouame B, Aguehounde
C, Coupris L, Galifer RB, 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 GK, Tekou AH, Kouame B, Aguehounde
C, Coupris L, Galifer RB, Aubert D, Revillon Y. Transfer of surgical competences
in the treatment of intersex disorders in Togo. Afr J Paediatr Surg [serial
online] 2009 [cited 2009 Aug 11];6:82-4.
Available from:
http://www.afrjpaedsurg.org/text.asp?2009/6/2/82/54768

Introduction
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
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
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
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
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la chirurgie pιdiatrique en Afrique. Mιd Afr Noire 1999;46:243.
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.
4. Lazarovici. Consιquences psychologiques de l'ectopie testiculaire. Chir
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5. Driller C, Holschneider AM. Training in Paediatric Surgery. A Comparison of
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6. Gbenou AS, Biotchane I, Fiogbι M, Lokossou T, Biaou O, Adibabi W. Bilan
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Correspondence Address:
K Gnassingbe
Department of Pediatric Surgery, Lome Teaching Hospital (Prof. Hubert Tekou), PO
Box 57, Lomé Togo



Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0189-6725.54768

Tables
[Table 1]