In late 2020, trainees gathered at three treatment centers across Nigeria. Despite their varied professions and backgrounds — including operating room nurses, technicians, biomedical engineers, and one operating room manager — they came together with a shared goal: By the end of the seven-week course, they would not only bring safer surgical care to patients in Nigeria, but spark change for generations to come.
The tools these trainees used to achieve their lofty goals? They were, well, tools.
Through the Surgical Instrument Refurbishment Technician (SIRT) training program, which began as a pilot in the Philippines and Ethiopia, Smile Train and the Safe Surgery Initiative (SSI) are working together to teach Smile Train partner surgical teams to identify surgical instruments in need of repair, and then to repair them.
While the quality of the instruments that make surgery possible is often overlooked, top-quality tools can save lives and improve surgical outcomes for patients. Having effective instruments frees surgeons to focus on providing the best results possible, which is especially important for facial surgeries (like cleft surgery) that can strongly affect patients’ physical and psychosocial health.
“They say that the outcome of a good surgery can only be as good as the skills of the surgeon and the surgical tools — we have the good surgeons, and they need the best tools possible,” says NK Obi, Smile Train Program Director for West and Central Africa. “This is why Smile Train has partnered with Safe Surgery Initiative to design the Surgical Instrument Repair Technician Training workshop. It provides a long-term, sustainable solution to maintain a safe surgical instrument inventory and stimulate strong mentorship of early-career bio-medical technicians.”
In keeping with Smile Train’s “teach a man to fish” model, the course also focused on long-term capacity building, which means that each trainee was taught, in turn, to train others.
"The goal of the SIRT program is to address a systemic problem in global surgery,” says Keith Miles, the co-founder of SSI. “Too often, surgeons and nurses are operating with broken, unsafe surgical tools. We set up training workshops at three Smile Train partner hospitals across Nigeria. The trainees received extensive hands-on skill development over that timeframe.
“Once the trainees began refurbishing instruments and receiving positive feedback from OR staff, they went from giving 100% effort to 150%. To me, that really underscores the benefits on how this program can improve surgical care. Seeing the change in confidences of the participants over time was one of my personal highlights.”
The trainees underwent pre- and post-training testing to ensure that they had developed the level of skill and confidence necessary to perform repairs and impart their knowledge to others.
Many of the trainees came in unsure of whether they were the right members of the surgical team to learn these skills.
Chioma Oguzie, a perioperative nurse and OR Manager at Smile Train partner National Orthopaedic Hospital Enugu, found that these skills were another way to advocate for the safety of her patients.
“When I was nominated to the program, I wanted to decline,” she said. “I felt the program was meant for biotechnicians, and that it would be a waste of time for me to learn to repair instruments. By the last day of the session, I felt it should not end. These skills have given me a step ahead and helped me to understand that I really am an advocate for my patients. Patients in the operating room are safer if I can identify when an instrument requires replacement, repair, or sharpening.”
Many of these trainees will go on to play an even larger role in continuing the training beyond their own hospitals and treatment centers — and Smile Train and the Safe Surgery Initiative will continue to expand this incredible training program to surgical teams around the globe.
“If surgeons, nurses, and anesthetists are the heart, mind, and hands of surgical care, then surgical instrument specialists, CSSD techs and biomedical engineers are the spine and backbone,” says Miles. “Without them, we cannot move forward to improve surgical care where it’s needed the most."