Mr Nathan Coombs is a Senior Consultant General Breast and Endocrine Surgeon and a Royal College of Surgeons Surgical Tutor for the Great Western Hospital in Swindon. He recently described his experience of using Biogel® gloves to teach closed glove technique in western Africa with the charity Mercy Ships.
Mercy Ships medical capacity building
Mercy Ships is a non-governmental charitable organisation that provides healthcare, healing, and hope to the world’s poor: about a billion people have no access to safe healthcare in sub-Saharan western Africa alone. The largest charity run hospital ship in the world, the Africa Mercy, has five operating theatres, four inpatient wards, full X-ray and CT facilities, and a crew of over 400, and remains in port for nine months. Most enrolment and training of local staff, patient selection, and triage occurs in the year before the ship arrives. Mercy Ships always operates at the request of the local government, and works in partnership with them.
What excites Mr Coombs about Mercy Ships is their holistic approach towards both treating the person and making a positive impact on the community and the country: in addition to carrying out surgery, they work with host countries to renovate medical facilities, train local staff, and teach them how to bring safe surgical, nursing, obstetric, and anaesthetic techniques to their country. Building medical capacity in this way leaves a legacy of enthusiastic and qualified staff who can pass their skills on to others after the ship leaves.
‘Patients receive first-world treatment from Mercy Ships that they could otherwise not afford to pay for or, indeed, that their country could provide.’
Most Mercy Ships training takes place in the community; the local government provides a hospital room that can be equipped appropriately for each separate course, often several months before the ship docks. This room remains after the courses have finished.
Biogel® gloves facilitate surgical skills training
Mr Coombs provides training with Mercy Ships a couple of times a year, and helps to run their two-day essential surgical skills course. This always starts with the foundations of good surgical practice, including basic hygiene, handwashing, gloving, and applying the World Health Organisation (WHO) Safe Surgery Checklist, before moving on to knots, suturing, and operating techniques.
Having had an association with Mölnlycke for almost 30 years, using Biogel® gloves and knowing their reliability and consistency, Mr Coombs felt that the high quality of Mölnlycke gloves would be valuable when teaching the course.
‘Every pair of Biogel® gloves is the same high standard when I open the packaging; I can rely on their consistency.’
Mölnlycke donated differently sized gloves so that all trainees could choose the best-fitting size.
‘If gloves don’t fit correctly, surgery can be very tiring to the fingers, but with Biogel® it doesn’t feel as if you’re wearing gloves.’
Mr Coombs finds that Biogel® gloves rarely need changing, because the material holds its integrity. They’re quick, easy, and comfortable to put on for closed glove techniques, and rarely rip. Also, because Biogel® gloves are robust, he is less worried about needlestick injuries when operating on a highrisk patient. Biogel® gloves are sturdy enough to sustain most of the tearing forces that may occur with a closed glove technique.
‘I think, for the patient’s benefit, we’re using gloves that we feel are of superior quality because this provides a better patient outcome.’
For a short time, Mr Coombs tried a different make of glove for his everyday list because of hospital financial pressures. However, the gloves were less comfortable to wear, often had to be changed halfway through the operation, and made the tissues difficult to grip because of their texture. This negative impact on surgical technique and its potential effect on patient care convinced hospital procurement to reintroduce Biogel®.
‘It’s the comfort and robustness of Biogel® gloves, as well as the ability to feel the tissues even when wet, moist, or fatty. If I can’t trust my fingers, I can’t do the operation.’
‘Clinicians need to be involved in hospital procurement decisions because, in the end, patient care depends on them. It’s good when hospitals involve clinicians and are prepared to modify a decision based on their feedback. I’m in favour of looking for innovative ways of change that may be better, but only if patient care is improved, not compromised.’
Skills training can result in lasting change
Any procedure is a skill that must be learned and then practised to acquire the muscle memory. The repetitive nature of putting on gloves in a closed glove technique with sufficient gloves to practise again and again means that the technique is more likely to stick.
'The most frequent comment when the trainees see the technique for the first time is ‘Wow! this is magic. This is something that needs to be shown to my colleagues.’
Most incisions in the UK are clean ones in a sterile environment, which means that surgeons’ gloves must be sterile. In western Africa, doctors see many infected wounds, so they understand the dangers of sepsis, and the need for sterility and proper wound debridement. It is then logical to explain the basics of procedures such as gowning and gloving, which are taken for granted in the UK. This starts to build a legacy that will become daily routine. Although the standard of gloves used daily in western Africa may be lower than those used in training, after using quality gloves they know how to handle them in a robust but safe way.
‘Senior surgeons in Africa said “I need to show my colleagues and nursing staff how to do this tomorrow, not just sometime in the future.” When you hear comments like this you know you’ve really effected change.’
One example of the value of training was in Benin, where a follow-up of hospitals which had received training on the WHO Checklist showed that around 25 of the 30 hospitals were still implementing it regularly, albeit in a slightly modified form. The WHO Checklist was developed to minimise errors and adverse events throughout surgery and enhance communication among the surgical team.
Ethics play an essential role in choice
Mr Coombs believes that ethics in choice is becoming more important in daily life. If we value people as individuals, they should receive the correct wage for the work they do, wherever that may be; it’s vital to protect the vulnerable. It’s not always possible to do this directly; however, the choices we make may influence change in another country, even though we won’t necessarily see it. In the same way, if a company’s message is clearly aligned with the quality of their product, their message will be credible; quality should never be compromised if it affects outcome.
Mölnlycke’s commitment to high quality and ethical standards for themselves and their suppliers, their investment in local communities, and support for charities that share their ideals made them the natural partner to help Mr Coombs with Mercy Ships training.