Professional Assocs The contribution of professional associations Francis Omaswa and Rosemary Mugwe trace the journey of the Association of Surgeons of East Africa (ASEA) to the College of Surgeons of East, Central and Southern Africa (COSECSA) The Association of Surgeons of East Africa (ASEA) was should be put in practice in a selected remote setting in launched in 1950 at a meeting in Nairobi, Kenya by East Africa. This later became the Ngora Hospital Project expatriate surgeons from Kenya, Tanganyika (now Tanza- on Cost Effective Rural Surgery of which Francis Omaswa nia) and Uganda. The story of ASEA and its founders is an became the Project Director and Medical Superintendent example of socially accountable professionals in the colo- of that hospital. nial health service who decided that they needed to meet ASEA also set up specialist training positions in Urol- regularly to discuss how they could serve the population ogy in Moshi, Tanzania and Orthopedic Surgery in Bula- better and also enjoy fellowship and the company of each wayo, Zimbabwe, and Lusaka, Zambia. other. At that time there were no indigenous Africans who In 1985 another Symposium was held in Nyeri, Kenya were specialised as surgeons. The frst President of ASEA on the theme Surgery in Africa in the year 2000. It was was C.V. Braimbridge from Nairobi, who was succeeded at this meeting that a paper on postgraduate training a few years later by A.J. Boase, also from Nairobi, and was discussed. Concerns regarding the quality of the M. John Croot and Ian McAdam, both from Kampala. Other Med programs in the whole region were raised; kick- notable leaders in this pioneer group are Michael Wood, ing off protracted and sometimes diffcult consultations one of the founders of Amref Health Africa, Gerald Nev- that led to the decision of 25th ECSA Health Community ille, Kirkaldy Willis, Roy Miller and Dennis Burkitt (who Regional Health Ministers Conference held in Mauri- described Burkitt’s lymphoma), among others. tius in November 1997 to authorise the Secretariat to These expatriates held surgical meetings annually establish a Postgraduate Medical College of which the in the capitals and quarterly council meetings in the College of Surgeons of East Central and Southern Africa provinces, districts and far-fung up-country locations (COSECSA) would be the frst. This was followed a week providing support and encouragement to the surgeons and later when the ASEA Annual General Meeting (AGM) in non-surgeons who practised their surgery in those locali- Harare, Zimbabwe resolved to launch the COSECSA. ties. These surgeons were also the leading thinkers in the Prof Omaswa, who became Chief Surgeon and Director medical profession in the region and were credited with General in the Uganda government, attended the Regional promoting education and training of surgical specialists Health Ministers’ Conferences and facilitated the deci- from local people. The frst African to pass the Fellowship sions of the health ministers as well as the Harare ASEA of the Royal College of Surgeons was Sebastian Kyalwazi resolution on launching COSECSA. He also corresponded from Uganda who was supported by McAdam in his ef- with the Royal College of Surgeons of Edinburgh of which forts to become a fully trained surgeon. The second was he is a Fellow. Ignatius Kakande from Uganda used his Alex Odonga, also from Uganda, who wrote about some annual vaca- of the challenges of working with expatriate staff, doc- tion to draft the tors and nurses. The frst Kenyan specialist surgeon was General Surgery M. W. Warambo and all the three, not long after, became Curriculum that presidents of ASEA. was presented for It was this group led by McAdam that introduced train- approval to the ing for UK surgical qualifcations at Makerere Medical Health Ministers School in Kampala with examiners coming to Kampala Conference. CO- from the UK. The pass rate in Kampala was higher than SECSA was for- in the UK and, after proving that local standards were mally launched high, they established the Master of Medicine in General at the ASEA AGM Surgery and other medical specialties, frst at Makerere in Nairobi in University and later in all other universities in the region. December 1999 One example of the social accountability of the ASEA with Omaswa community is that in 1980 they convened a Symposium in as founding Mombasa on how to increase access of the rural popula- President. A seed tions in the region to quality surgical services. At that sym- grant from the posium, McAdam, who had by then relocated out of the German Chris- region, made a bold proposal that all the ideas discussed tophel Blinden Mission was ne- Professor Ian McAdam, longest-serving Francis Omaswa, Surgeon and Rosemary Mugwe, Executive Secre- gotiated by ASEA Head of Department of Surgery, Maker- tary, COSECSA member from ere University 28 Africa Health July 2019 Professional Assocs Zambia Chris whom 84% are in home countries and 93% are practising Lavy, which in Africa. There are over 1000 currently registered college funded the sec- trainees. The curricula are benchmarked internationally retariat and the and there are affliations with several international surgical employment of colleges who send representatives examiners to the annual Jimmy James, an examinations that are held around the region, tagged to ASEA member Annual General Meetings and Scientifc Conferences of from Scotland the College. The college is an active member of the Inter- as the frst full national Global Alliance for Surgical, Obstetric, Trauma, time Execu- and Anaesthesia Care (The G4 Alliance) that advances tive Offcer of access to quality surgical care as part and parcel of the COSECSA. SDGs and also publishes the East Central Africa Journal of The mandate Surgery (ECAJ). of COSECSA which remains Fraternity and fellowship valid today What makes this surgical fraternity so successful? The was assigned characteristics of ASEA and COSECSA that have contrib- as follows: (i) uted to this phenomenal success are the following: (i) a Sebastian Kyalwazi: frst Ugandan Organise train- strong fellowship spirit where members feel loyal and Head of Department of Surgery, ing programmes true to each other and do not tolerate anti-social conduct Makerere University in recognised among members, such as dishonesty or a failure to per- institutions; (ii) form allocated tasks. They host each other at their homes Organise examinations in various disciplines of surgery; and share transport whenever possible. (ii) Strong com- (iii) Promote and encourage postgraduate education, mitment to professionalism and the highest standards of relevant to the Region; (iv) Organise workshops, seminars, practice. This is demonstrated by presentation of members lectures and conferences to bring surgeons together in work to the group and subjecting them to constructive Fellowship and promote the art and science of surgery in criticism and peer review. (iii) Commitment to social the region; and (v) Above all – set up the highest ethical accountability by working tirelessly to ensure that those standards and promote the honour and dignity of surgical who need services are reached by the association. This and allied professions. is exemplifed by localisation and expansion of training COSECSA now operates in 14 African countries as the of surgeons from UK to Africa and within African coun- largest surgeons’ college in Africa and trains surgeons tries. (iv) Members are willing to make personal sacrifces at accredited institutions away from capital cities near to pay for travel to meetings and host colleagues and to rural populations, and as well as in the capital cities with support projects that are undertaken. (v) Lastly, they apply rapidly growing urban poor. It is a ‘college without walls’ tactics that inform and inspire the governments and each that fosters postgraduate Education & Training in Surgery. other instead of naming and shaming and they persist and Up to 2018, COSECSA has graduated 346 surgeons, out of persevere to achieve goals. Regional Training on laboratory equipment maintenance and management July 2019 Africa Health 29.