WEO: Dr DiSario, could you tell us about the origins of the Outreach Committee and its present day activities?

Dr DiSario: Yes of course, the mission of the Outreach Committee is to promote digestive endoscopy worldwide, and particularly for underserved populations. I proposed the creation of this Committee to the WEO Governing Council in 2004 and it was initiated as a function of the Education Committee which I chaired at the time. Initially, the goal of Outreach was to introduce or supplement endoscopic equipment in underserved areas, but it has evolved to do much more than that. We now also provide educational programs in both in developing and developed countries, and we have an Africa Working Group to represent the particular needs of African endoscopy. So our goal can be simplified to state that we promote digestive endoscopy worldwide – which is very much the overall mission of WEO.

There are currently 10 Outreach Centers throughout Latin America and in Africa. These are medical institutions where WEO has facilitated donations or other means of providing endoscopic equipment and supplies primarily for use in economically disadvantaged and underserved populations. These Outreach Centers may be located in some of the finest hospitals in a country, or in more modest units, but they all commit to substantial use of the equipment for underserved people.

WEO Outreach Committee – Worldmap of donations received

WEO Outreach Committee – Worldmap of donations received

The endoscopic equipment and supplies are provided by industry sponsors including Pentax Medical most recently, and Olympus in years past, all in strict compliance with laws and regulations. To be eligible to for a WEO Outreach Center, the institution must have a unit with appropriate medical, nursing, technical and administrative support for proper use and upkeep of the equipment. There must be a budget for maintenance and supplies. The unit must also commit to working with WEO and to submit annual reports on use of the equipment, particularly for populations in need. They must also report on educational and training activities at their site. Educational programs at the Centers are not necessarily traditional postgraduate medical education.  A center may provide community education related to digestive health, training for nurses and technical staff, or other innovative programs. In recent years, we have had great success with combined Pentax Training and WEO Outreach Centers in Latin America.

The Outreach Committee is also responsible for the Program for Endoscopic Teachers (PET), which was initially directed by Professor Douglas Faigel and currently by Professor Jonathan Cohen. This is a two-day program, which focusses on improving endoscopic teaching skills. The format is small group discussions, workshops, and hands-on sessions using state of the art endoscopic simulators, endoscopes and accessories. PET is appropriate for both developed and developing countries. Beginning in 2014, successful PET courses have been held in Hyderabad (India), Moscow (Russia), Rio de Janeiro (Brazil) and Bogotá (Colombia). There was also a PET course in Cairo (Egypt), directed by Professor Ibrahim Mostafa, and a PET course in the United States in collaboration with the American Society for Gastrointestinal Endoscopy (ASGE) at ASGE Institute for Training and Technology (IT&T Center) near Chicago. A white paper describing PET is now being developed in collaboration with the ASGE. Future PET courses are planned in Bangkok (Thailand), Singapore, Rome (Italy) and as part of the World Congress of Digestive Endoscopy in Hyderabad (India) in February 2017.

PET Chicago 2016 – Hands-on training at the ASGE Institute for Training and Technology

PET Chicago 2016 – Hands-on training at the ASGE Institute for Training and Technology

The Outreach Committee also runs symposia on “How to Get Published in International Literature”. This approximately 3-hour program was initially established in collaboration with David Woods, Global Chief Marketing Officer for Pentax Medical, for Spanish-speaking gastroenterology and endoscopy fellows, and junior faculty.  However, it has also been well received by English-speakers and attendees at all levels.  “Getting Published” symposia have been held with a world-class faculty at the time of DDW in San Diego, California in 2012 and on the program at Pan-American Congress of Gastroenterology (SIED) in Panama in 2013.

We hope to expand and run these workshops in other regions in the future.

WEO: What has been the impact of the Outreach Centers in these underserved areas?

Dr DiSario: The Outreach Centers often have substantially improved the ability to provide and teach endoscopy in a region. A good example is the very first Outreach Center, which opened at the Eva Perón Teaching Hospital near Rosario, Argentina in 2004. In preceding years, this was a center of surgical excellence in digestive disease, but had fallen into disrepair with old and nonfunctional equipment.  Additionally, there was a catastrophic flood which heavily damaged the hospital, the endoscopy unit, and medical school. There was essentially no endoscopy available for this populous region. Dr Diego Murature, a rising young surgeon at the time, responded to the WEO request for proposals for the Outreach Donation despite skepticism from his professors who felt that they would never receive such a grant. However, the professors were wrong and the unit received a new Olympus endoscopic processing tower, endoscopes, accessories and disinfection equipment and supplies.

The Argentinian government became aware of the Outreach Donation and provided building materials which community volunteers used to reconstruct the endoscopy unit. The government also expedited rebuilding medical school lecture hall from which the opening ceremony of the Outreach Center was televised nationally. An educational program was held which included Dr Roque Sáenz from Santiago (Chile), myself representing WEO, and local faculty. There was a large turnout of regional attendees.

Eva Peron Perón Hospital, Santa Fe, Argentina, 2004. Left to right Drs Diego Murature, James DiSario, Roque Saenz, and Pablo Huanambal with the newly donated Olympus endosocpic tower and equipent.

Eva Peron Perón Hospital, Santa Fe, Argentina, 2004. Left to right Drs Diego Murature, James DiSario, Roque Saenz, and Pablo Huanambal with the newly donated Olympus endosocpic tower and equipent.

Performance of diagnostic and therapeutic procedures resumed and substantially increased. They began to put on educational programs with live endoscopy which have continued. A medical gastroenterology faculty was hired and there are now active and sustained academic medical gastroenterology and surgical endoscopy training programs. The unit has submitted annual reports to WEO for over a decade and is functioning well.

Another great example of the impact of Outreach Centers is the Ecuadorian Institute for Digestive Diseases (Instituto Ecuatoriano de Enfermedades Digestivas) in Guayaquil (Ecuador). Prior to 2011, there were few endoscopy services and essentially no advanced therapeutic endoscopy available in this region for people with limited financial means. In collaboration with David Woods and Igor Nemalceff, Martketing Manager for Pentax Latin America, the concept of combined Pentax Training and WEO Outreach Centers was developed.  Dr Carlos Robles-Medranda was selected to be the director and the Center was implemented at the newly constructed Omni Hospital.  Endoscopes and equipment were provided by Pentax Medical, and the Ecuadorian Ministry of Health helped support the clinical enterprise. With access to state the art equipment, Dr Robles established world-class clinical endoscopy and educational programs in conjunction with Pentax and WEO, and this continues to the present. Since that time, Dr Robles has performed thousands of basic and advanced procedures. He puts on live endoscopy courses with international video streaming, and hosts visiting local and international endoscopists and trainees from basic to advanced levels. Dr. Robles is now president of the Society of Ecuadorian Gastroenterology and hosted the 2016 national meeting in Guayaquil with an international faculty and delegates, record attendance, and live endoscopy demonstrations from the Pentax Training and WEO Outreach Center. There are also Pentax Training and WEO Outreach Centers at the Hospital Italiano in Buenos Aires (Argentina) and at the Hospital Clínica Bíblica in San Jose (Costa Rica).

Bear in mind that each of the Outreach Centers is remarkable and unique. The Metrofraternidad Foundation provides medical care to patients with limited means in Quito and elsewhere in Ecuador. They were granted an Outreach Donation from Olympus in collaboration with WEO in 2010. The donated endoscopes and processing unit are housed in the Metropolitan Hospital in Quito for use in patients. However, the equipment is also taken to remote areas of the country to provide endoscopy for standard clinical indications, and for gastric cancer screening in high-risk populations. There have also been Olympus donations for WEO Outreach Centers at the J. M. de los Rios Childrens Hospital in Caracas (Venezuela) and to the Hospital San Juan de Dios in Quetzaltenango (Guatemala).

Metrofraternidad Foundation, Quito, Ecuador, 2010: Ceremony for donation of Olympus tower and endoscopes. Dr Luis Rodrigo Vineza Rojas, Medical Director (left), Dr James DiSario from WEO (3rd from left), Olympus Latin America representative far right, and Metrofraternidad Foundation Executive (2nd from left) at the at the Opening Ceremony of the Fundación Metrofraternidad Outreach Center in Quito, Ecuador, 2004.

Metrofraternidad Foundation, Quito, Ecuador, 2010: Ceremony for donation of Olympus tower and endoscopes. Dr Luis Rodrigo Vineza Rojas, Medical Director (left), Dr James DiSario from WEO (3rd from left), Olympus Latin America representative far right, and Metrofraternidad Foundation Executive (2nd from left) at the at the Opening Ceremony of the Fundación Metrofraternidad Outreach Center in Quito, Ecuador, 2004.

There are three Outreach Centers in Africa. The Yalgado Ouédraogo University Medical Center in Burkina Faso (West Africa) is the only public tertiary hospital in this country of over 15 million people.  According to Professor Alain Bougouma, the donation from Olympus and WEO of several digestive endoscopes, a bronchoscope and a processing tower resulted in reconstruction and expansion of the endoscopy unit, hiring new digestive and pulmonary endoscopists, nurses, and staff, and major increases in endoscopy utilization. There have been substantial reductions in morbidity and mortality from digestive disorders, the need for surgeries, and for distant and expensive international referrals. The academic gastroenterology program has expanded and visiting professors have come from elsewhere in Africa and Europe.

Prof. Alain Bougouma (standing at center) at the Yalgado Ouédraogo University Medical Center in Burkina Faso in West Africa

Prof. Alain Bougouma (standing at center) at the Yalgado Ouédraogo University Medical Center in Burkina Faso in West Africa

WEO treasurer Dr Robert Bailey and colleagues from the Royal Alexandra Hospital in Edmonton (Canada) in collaboration with Olympus Canada organized an Outreach Donation of 4 gastroscopes, 4 colonoscopes, and a processing tower to the St. Pauls Hospital and Millennium Medical School in Addis Ababa (Ethiopia). This has resulted in major increases in endoscopy use, improvements in medical care, and substantially decreased need for major surgery.

Professor Chris J.J. Mulder from the VU Medical Center in Amsterdam, Netherlands, donated gastroscopes and colonoscopes to the Mulago Teaching Hospital, at the College of Health Science of Makerere University (Uganda). This is also region of endemic schistosomiasis with associated portal hypertension and esophageal varices for which endoscopic therapy saves lives and precious medical resources.

WEO: That all sounds great. What are your plans for the future?

Dr DiSario: We are currently launching a strategic initiative to expand Outreach activities in Asia.  We are working with our industry partners to identify potential new sites for Outreach Centers, and we have plans for PET programs in Thailand, Singapore and India, as mentioned. We aim to expand our activities at the existing Outreach Centers in Latin America and Africa and to further develop video networking for educational and clinical activities at the Outreach Centers.  PET is certainly a popular program that is in demand and we look forward to continuing globally. We also anticipate holding more “Getting Published in the International Literature” symposia worldwide.

We wish to thank our generous and insightful sponsors from Pentax Medical, Olympus Latin America, Boston Scientific, Cook, ERBE, US Endoscopy, and others for contributing to the WEO Outreach Program and promoting the healthcare of underserved peoples worldwide.