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South to South Training Project

 “Hub and spoke model of training in children’s surgical conditions for district hospitals”


A new initiative by the Government of India envisages screening of all children and adolescents for key medical and surgical conditions and their referral to and treatment by the existing healthcare providers.  However, in the existing system there is a shortage of trained non-paediatric specialists in the field of orthopaedics, trauma, surgery, urology, neurosurgery, thoracic surgery, ENT and ophthalmology.  In addition, the support services such as anaesthesiologists and intensive care units for children under six years of age are, in many settings, inadequate or non-existent. This leads to many crisis situations wherein identified children are unable to access or obtain quality care.

During the first Global Initiative of Childrens Surgery (GICS  meeting, Professor Kokila Lakhoo from University of Oxford and Professor Vrisha Madhuri from Christian Medical College in Vellore, India met for the first time, planned, and took forward this development project “Hub and spoke model of training in children’s surgical conditions for district hospitals”

Surgeons from the Royal College of Surgeons of England  (Prof Kokila Lakhoo and Mr Richard Stewart), have partnered with their Indian colleagues to  develop a curriculum for training in identifying and grading of critical surgical conditions, devising a decision making algorithm, imparting skills to prevent and treat the early stage disease at the district level secondary centres (Spokes) and have the necessary referral network/Telemedicine portals to refer advanced cases to the training centres (Hubs). The program envisages connectivity between the ‘Hub and Spokes’ to provide a continuous seamless care.

Phase one of the project is completed with a 3-day course training surgical teams (general surgeon, orthopaedic surgeon, anaesthetist surgical nurse) from District general hospitals in India (spokes) by children’s specialist from Vellore (hub).

The project is in its second phase in developing a module and curriculum by June 2018.  The anticipation is that the course will form the backbone of a cascade of training in a state or region which will greatly improve the effective diagnosis, triage and referral of paediatric conditions on a global level.