African surgeons gain month-long training in Kingston thanks to international partnership

03 Jun, 2025

Dr. Nanji standing with Two Surgeons from Africa

Dr. Eugene Niyirera has travelled halfway around the world to observe surgeries at Kingston General Hospital (KGH) and gain new knowledge to carry back to his home in Africa.

There, his hospital is also called KGH — the Koidu Government Hospital in Sierra Leone, a country in West Africa that has struggled with some of the world’s worst health outcomes, according to the organization Partners In Health, which has facilitated Niyirera’s travel to Kingston and learning from Kingston Health Sciences Centre (KHSC) doctors.

Niyirera’s hospital is in Kono District and helps provide surgical care in a region of 500,000 people. Located 360 kilometres from Sierra Leone’s capital, Freetown, the hospital offers some of the only health-care access in the region.

“I’m the only surgeon who is practicing in the district hospital, which is so far way from the capital,” Niyirera told the Whig-Standard during an interview at Kingston General Hospital on Tuesday.

As the hospital’s solo general surgeon, Niyirera performs an average of 26 major surgeries each week and more minor procedures. He can see up to 50 patients in a day, but “medical officers” — or doctors in training — also help with patients each day.

“I receive all of the patients with surgical problems,” he said. “The most common procedures we do are emergencies. Around 60 per cent are emergencies.”

Other common surgeries include hernia or bowel perforation repairs, goiters and even breast cancer surgery. Commonly, he treats infection from traumatic wounds.

“Soft-tissue infections are very common because of patients, whenever they get any injury or wound, first of all, they go to traditional healers, and instead of improving the wound to heal, it gets worse,” he said. “Whenever it gets worse, that’s the time for them to go to come to the hospital as the last option.”

He said that people travel for days to get to his hospital, which offers free health care thanks to its partnership with the nongovernmental organization, Partners in Health.

“We are even receiving patients from other countries,” he said.

Surgical Clinical Officer Dr. Eugene Niyirera, right, conducts a surgery at Koidu Government Hospital (KGH) in Sierra Leone. Photo by Chiara Herold / PIH /Chiara Herold / PIH

Niyirera didn’t travel to Canada from Africa alone. Dr. Gerald Ekwen, a surgeon at J.J. Dossen Memorial Hospital in Harper, Liberia, is also in Kingston for the month of May learning surgical procedure and techniques at KHSC.

Ekwen works in similar conditions to his colleague, but in a community in Liberia that is more than 750 kilometres from the country’s capital city of Monrovia. His hospital also offers free health care thanks to Partners In Health.

“The road is not a paved road,” Ekwen described.

His hospital is the only facility with a general surgeon for a catchment area of 500,000 patients — all other hospitals in the region refer surgeries to him.

As the only general surgeon, he can do more than 800 procedures a year.

“If we cannot save them when they come in for an emergency, they’re likely not going to reach the nearest teaching hospital, which is in Monrovia,” Ekwen told the Whig-Standard. “For some procedures we could move them, but that would take a week, to get that patient up to the hospital in the capital. We are the last stop for the patient in that environment.”

Dr. Sulaiman Nanji is an associate professor in the Department of Surgery at Queen’s University, and attending staff at Kingston Health Sciences Centre.

Nanji explained that Partners In Health, which he described as a “longstanding and well-established, well-reputed NGO (nongovernmental organization)” had approached Queen’s “some time ago” about forming a collaboration to help with training its doctors, particularly in surgical training.

“One of the challenges, of course, is the lack of manpower there in human resources, because there’s one surgeon for massive catchment areas that are responsible for tons of work daily,” Nanji told the Whig-Standard.

While initial discussions included exploring sending Canadian surgeons to cover for the African doctors while they travelled, Nanji admitted that it takes “a special kind of surgeon” who can work in those types of environments, and doctors working in academic centres might not be equipped to hit the ground running.

After visa difficulties arose, surgeons were sourced locally to cover the time off.

“Preceding their arrival, we’ve been working together to try to figure out what would be most useful for them, in terms of experience and exposure and learning,” Nanji said.

It’s the first time that Ekwen and Niyirera have left the continent of Africa.

“Clearly, doing robotic surgery is not necessarily all that applicable to the West African context, but they they’ve had a wonderful time kind of exploring all the new technologies that they’ve never seen before,” Nanji said.

While Ekwen and Niyirera are gathering all the experiences that they can to take home with them, Nanji said it can be frustrating to find common ground, with such vastly different work environments.

He pointed out that surgeons in Africa have access to the “same information, videos and journals that we do.”

“Their knowledge and our knowledge is very similar, but what we’re able to actually do in our professions is vastly different, related to resources,” he said. “We can speak as colleagues, even though they can’t perform (the same operations). And so there’s a lot of limitations to professional development in these countries for eager, ambitious medical professionals.

“The opportunity to come abroad and see and learn gives them that opportunity, because it’s not available locally, despite interest and ambition and curiosity.”

Dr. Gerald Ekwen, left, and a team of medical professionals perform a surgery in the operation theater at J.J. Dossen Memorial Hospital. Photo by Luther N. Mafalleh/Partners In H /Luther N. Mafalleh / PIH

Nanji expressed great respect for the two men sitting across from him on Tuesday — not only for their commitment to the work they do as surgeons, but also for the resilience that they exhibit on a daily basis in the working environment that they face.

“There’s a lot of humility in having this exchange, for us,” Nanji said. “We have conversations about the kinds of environments that they have to work in, and (how) we’ve become so reliant on our technologies and how we do things.

“In their local context, there’s no CT scanner. They have an X-ray machine. Blood work is available, but not regularly. In fact, electricity and clean water is not a guarantee in the hospital. Sterility is not guaranteed, oxygen is not guaranteed.

“To see their resourcefulness around these types of work environments, to still be able to find ways of stabilizing patients and saving lives, with the limited resources they have…is inspiring.”

Nanji said that Ekwen and Niyirera were able to give a lecture to KHSC and Queen’s University faculty and residents during a teaching session, an eye-opening glimpse into a different world of health care.

“I think it’s really important for all of us, whether we’re in our training or finished, to be more globally aware of the disparities in health care around the world,” Nanji said.

While he recognizes not all doctors can make a difference in global health care, he believes the knowledge shared by the African surgeons could help increase awareness for those who may have the chance to help “bridge the gap” in health-care disparities, either through training, or even financially supporting organizations like Partners in Health.

“(Health care) is a basic human right, and in countries like where they work, and many places in in sub-Saharan Africa, life expectancy hasn’t even exceeded 50 years,” he said. “There’s a big gap between what’s happening on this side of the world and that side of the world.”

Nanji is hopeful that the partnership with Partners In Health will not only continue, but expand in the future.

“If this goes well, and there’s some good lessons to be learned here, then we can continue this and expand to not just involve surgeons, but surgical teams, because surgery doesn’t happen on its own. You need anesthesia, nurses and more.”

Nanji would love to see Kingston health-care workers travel to Africa as well.

“We could consider doing a larger exchange in the future, a true exchange, and also bring on other other caregivers from West Africa to come here and learn in other fields of medicine as well,” he said.

For Ekwen and Niyirera, the journey to Canada is a brief foray into an unknown world that could help inform their life’s work.

Niyirera describes his commitment to surgical practice as “a calling.”

“My grandfather was a traditional healer, and in my childhood I was working with him, and he was teaching me. I was seeing that in a time when people saw medicine was not advanced like now. He was treating poor people for free. And I decided to imitate him in the future.”

He credits his home country of Rwanda and its government’s investment in young people for the educational opportunities that made him the surgeon that he is today.

He is proud of the improvements his hospital has seen under his direction.

“I’m trying my best, and what I am seeing is, I’m almost three years there, and we are improving.”

Ekwen’s commitment to his overwhelming responsibility as a solo surgeon for hundreds of thousands of people comes from his own background and experience with health care.

“When you have been a patient yourself, and you’ve gone through a broken health system and see how you almost lost your life, just because you had to pay a certain amount of money,” he said. “I remember when I was a medical student and I had gastroenteritis, and I couldn’t receive care because I had no money.”

A friend called his uncle, who paid for the life-saving treatment he needed.

“I grew up in that kind of environment where you suffered, and you could easily die, because you have to pay for health care,” he said. “That pushed me to get into medicine, and then to get into surgery and to develop interest in working where people need our services most.”

He described the distress of formerly working in a hospital where health care was not free.

“You can’t do surgery for them because they have not paid,” he said. “I got troubled about that. When I was in my struggle with that, I came across Partners In Health, and saw the work they were doing in Rwanda.”

He joined forces with the organization and has been able to provide health care to as many people as he can, without fear of being required to reject them.

“And that’s been my motivation, because I think they need the health care just as any other person in the world,” he said. “It is a human right.”

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African surgeons gain month-long training in Kingston thanks to international partnership

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