Problems of education and training in gastroenterology in the Middle East and Africa

Gastrointestinal diseases are prevalent throughout the Middle East and Africa, causing high morbidity and mortality. The available data point to a morbidity of 20% in Zimbabwe and 18% in Egypt, and to a mortality of 26.6%, 17.9%, and 7.9% in Egypt, Mauretania, and Syria, respectively. However, most if not all the countries in our area of interest lack valid medical statistics. Gastroenterology is a neglected speciality in our region. Community-based curricula have only been tried in Egypt and Sudan universities. In Egypt, which tops the list, the number of gastroenterologists serving the community is 1/500,000, compared with 1/400,000 in Turkey and 1/100,000 in Denmark. Lack of funding is of considerable importance, as are low salaries, shortage of and insufficient service of equipment, and inability to attend international meetings. Gastroenterology is not represented at departmental levels in hospitals. There is a lack of team spirit among the medical profession, at the expense of much duplication of equipment. In most African countries training programs and gastrointestinal societies are lacking. The needs for the future: establishment of national programs for education and training in gastroenterology; creation of departments of gastroenterology and of membership/fellowship/university degrees; establishment of community-based curricula and promotionally based training; creation and reviving of societies of gastroenterology; and organization of activities, team work, and economic support of training programs.