Welcome to GPED's 18th Newsletter!
Although we are still in the midst of our global struggle against the pandemic, the roll out of the COVID-19 vaccine brings hope and the prospect of a changing landscape. In resource limited countries however, there is still a long way to go until a vaccine is widely available. Healthcare providers continue to struggle with increased burden posed by the COVID pandemic. Outpatient care is being widely affected and may be pushed to the side to make way for more urgent priorities.
As healthcare providers we continue to advocate for children and adolescents with endocrine disorders and diabetes. We must continue to find ways to connect, to learn and to provide essential care despite ongoing challenges. We hope the online educational initiatives in this months newsletter will provide you with some much needed inspiration. They prove that there is always more we can do.
The Resource Limited Countries (RLC) module of ESPE e-learning: Training in pediatric endocrinology and diabetes now accessible worldwide
The Resource Limited Countries (RLC) module is a free and easily accessible curriculum in Pediatric Endocrinology and Diabetes targeted towards front-line health care providers in RLC. The project is under the patronage of International Consortium of Pediatric Endocrinology (ICPE) with representation in the editorial board of all participating Pediatric Endocrine Societies, including ISPAD and GPED. The curriculum offers a broad spectrum of pediatric endocrinology and diabetes content in RLC and is hosted as a section of ESPE e-learning (www.espe-elearning.org). Authors from all over the world
have produced content resulting in 16 chapters and 24 vignettes, and have contributed its translation so that the content is available in 5 languages (English, French, Spanish, Chinese and Swahili). The RLC module was visited over 500 times between May 2018 and June 2020. The majority of users were from Asia/Australia and Africa. The RLC module is used as teaching material in ESPE schools and other training such as medical student, resident and fellowship education in several parts of the world (Indonesia, India, Sudan, Kenya, Guyana). Chapters as well as cases are suitable for self-study but also provide useful background information in conjunction to econsultation. Additionally, several cases of the RLC module were used as material for a competition by the Chinese Society for Pediatric Endocrinology and Metabolism.
For more details about the development of the RLC module visit our recent publication: “Multilingual Global E-Learning Pediatric Endocrinology and Diabetes Curriculum for Front Line Health Care Providers in Resource-Limited Countries: Development Study”, JMIR Form Res 2020;4(11):e18555, doi:10.2196/18555
Contact: Evangelia Kalaitzoglou
Programme d’enseignement en Endocrinologie et Diabète pédiatriques en Afrique Francophone (PEDAF)
Overall, more than 280 million live in French speaking countries in Sub Saharan Africa and an estimated 100 million speak French. Twenty-one countries are traditionally considered as French Speaking in Africa. In addition, a minority of the population also speaks French in Mauritius, Guinea-Bissau and Mauritania (Figure). Unfortunately, to date, there is no international training program for pediatric endocrinology and diabetes in Francophone sub-Saharan Africa. The Programme d’Enseignement Francophone en Afrique Francophone (PEDAF) is being design to address this need.
Two training programs in pediatric endocrinology and diabetes are presently active in Africa. The first one started in 2008. The International Society for Paediatric and Adolescent Diabetes (ISPAD) and the European Society of Paediatric Endocrinology (ESPE), together with Gertrude’s Children’s Hospital, the Aga Khan University Hospital and the Kenyatta National Hospital/ University of Nairobi Department of Child Health started the Paediatric Endocrinology Training Center for Africa (PETCA) in Nairobi, Kenya. A second center, coordinated by Dr Abiola Oduwole, was later opened in Lagos (University of Lagos, Lagos University Teaching Hospital. This initiative, originally funded by the World Diabetes Foundation, led to the training of more than 100 pediatric endocrinologists and diabetologists mostly in Sub Saharan English speaking countries.
At initiation, this 18-month program consisted of 6 months in Nairobi with lectures, case discussions and clinical experience in each of the 3 participating hospitals, 9 months in the home country for the development of a new pediatric endocrinology center and to perform a research project and 3 months back in Nairobi for further training and a formal examination. International tutors came to the PETCA centers for 2-4 weeks at a time, with a progressive transfer of responsibilities from international tutors to African tutors. The second program is an ongoing
Frenchspeaking initiative in Northern Africa which aims at promoting the training and education of paediatric endocrinologists mainly in Algeria, Tunisia and Morocco. The format of this Maghreb school (Maghreb is a name that is more commonly used in French than in English and refers to the north western part of Africa) is very different from PETCA: an international faculty of French-speaking teachers from Northern Africa and from Europe meet with 25 students for 5 days. A cycle lasts for 3 consecutive years and covers most topics in paediatric endocrinology and diabetes.
In June 2020, at the initiative of Julia von Oettingen, Carine de Beaufort and Jean-Pierre Chanoine, a first virtual meeting was organised with pediatric endocrinologists from 13 francophone African countries. We meet once a month to design a program that will lead to a formal recognition of pediatric endocrinology and diabetes as a subspecialty. Several subgroups (location, content, structure, recognition) are also meeting in parallel. While we are in the first stages of developing this project, several directions are already emerging:
• The certificate should obtain recognition from the Conseil Africain et Malgache pour l’Enseignement Supérieur (CAMES)
• The program should take place both virtually and in person. This reflects not only the existing COVID-19 epidemic but also takes into account the cost of staying in a different country and the separation of families
• The format will take place in 2 African countries. At the time of writing, Drs Djibril Boiro (Dakar, Senegal) and Suzanne Sap (Yaoundé, Cameroun) have agreed to be considered (Figure)
• The overall program will include a virtual “preprogram” of 3-6 months that can be attended by any pediatrician interested in pediatric endocrinology and diabetes and that will provide basic knowledge useful for clinical care. Thereafter, candidates will be selected to attend a full program of 1-2 years duration (to be determined).
The program is expected to be finalized in 2021 and start after funding is obtained.
Jean-Pierre Chanoine, Clinical Professor and Secretary General, GPED
Development of distance learning by the Maghreb School faculty -complementing the e-learning project of the European Society for Paediatric Endocrinology (ESPE)
The e-learning website of the European Society for Paediatric Endocrinology (ESPE) is a free and globally accessible paediatric endocrine resource which was developed in the Netherlands by Professor Stenvert Drop in 2010. The site is intended for those wishing to improve their skills in paediatric endocrinology and diabetes, particularly young paediatricians in training hoping to specialise in this field. The modules are mainly composed of chapters and interactive clinical cases or vignettes. The ESPE e-learning project is committed to supporting doctors in resource-limited countries, and a recent publication describes the development of a multilingual e-learning module specifically for health care workers in such settings: (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677026/pdf/formative_v4i11e18555.pdf). In addition to a section for resource-limited countries, there is one in Russian, and more recently, a section in French prepared by teachers and students attending the ESPE Maghreb school.
ESPE Maghreb school was created in 2011 by Professor Juliane Léger who was its coordinator from 2011 to 2016. The aim of Maghreb school is to promote the training and education of paediatric endocrinologists in the French-speaking countries of North Africa. Each November, an international faculty of 12 teachers and 25 students meet for 5 days and cover selected topics in paediatric endocrinology and diabetes. In contrast to other ESPE schools, Maghreb school is delivered as a 3-year cycle – one year in Algeria, the next in Morocco and the final year in Tunisia – with students being encouraged to attend for the full three years. The seminar, conducted entirely in French, consists of interactive lectures by the teachers, student case presentations, and small-group meetings to discuss teachers’ cases (pictured), student research projects and rehearsal of student case presentations.
Since 2016, some of the best student cases presented at Maghreb school have been selected for conversion into interactive vignettes by Dr Malcolm Donaldson (coordinator from 2017-2019) with the help from faculty members and made available on the e-learning portal by the ESPE e-learning committee members and team members –Sten Drop, Annemieke Boot, Conny van Wijngaard - de Vugt and Sander Spaans (pictured). During the past year Dr Donaldson and Dr Asmahane Ladjouze (coordinator from 2020, pictured with Dr Donaldson) have revised the four existing cases, added a fifth, and translated all cases into English.
These five cases are now available in the ESPE e-learning portal of the ESPE Maghreb School folder in the ‘Courses’ section. Of note, they can be shown in parallel for classroom discussion in French and English simultaneously. Consanguinity has a high prevalence (up to 30%) in the Maghreb countries, autosomal recessive disease is common and so there is a rich variety of cases which are very rare in other parts of the world. The vignettes selected, which include rare calcium and adrenal disorders, make the Maghreb School e-learning folder of interest to all.
Future plans for the Maghreb School e-learning project, apart from the addition of further interesting cases, include theoretical chapters on diabetes mellitus and congenital adrenal hyperplasia. These will be written in French in the first instance, but with a commitment to English translation so that they can be shared with the global paediatric endocrine and diabetes community.
Login procedure information, available in English, French, Spanish, Swahili and Chinese, can be found at https://www.espe-elearning.org/ homepage.
Handover of coordinator role from Malcolm Donaldson to Asmahane Ladjouze at Maghreb School in Sousse, Tunisia, November 2019.
Members of e-learning team pictured outside Leiden University in 2018. On the left Conny van Wijngaard - de Vugt and Annemieke Boot, second on the right Sten Drop.
Dr Asmahane Ladjouze, Bab El Oued Hospital, Algiers, Algeria
Dr Malcolm Donaldson, Glasgow University School of Medicine, UK
Ms Conny van Wijngaard – de Vugt, Mr Sander Spaans, Dr Annemieke Boot, Professor Stenvert Drop, ESPE elearning team, Rotterdam, The Netherlands
The first multidisciplinary Gender Diversity Clinic is established in Colombia
The care of transgender children has long been an under recognized gap in many parts of the world. In Colombia, the care of children and adolescents with gender dysphoria has mainly relied on the skills of individual health care providers. There was no specialized clinic in the entire country to provide a
systematic and multidisciplinary approach to care. However, a new clinic has been established at Fundación Valle del Lili in Cali, Colombia to address this gap.
Fundación Valle del Lili is a private non-profit institution which was established in 1982. The hospital provides services with a focus on high and medium complexity of healthcare delivery and is at the forefront of research and education. The objective of the new Gender Clinic is to meet the needs of the gender non-conforming population in Colombia. Youth attending the clinic have access to a group of trained health professionals applying a gender affirming model of care. Counselling is provided regarding gender, gender expression and the process of transition including medical and/or surgical options. There are many benefits of a systematic approach to transgender care, including for health insurance companies which are able to understand its relevance and allocate much needed resources.
Dedicated outreach has taken place with local physicians and health care providers to increase referrals to the clinic as well as sharing its aims and the services provided. The clinic has been positively received within the local community. Recently, the emerging experience of this program was also shared at two national (Pediatric and Adult) Endocrinology Congresses, which both had dedicated blocks for transgender care. Our number of referrals are still modest, but it is an important step forward in providing much needed care to this population in southwest Colombia.
Dr. Mario Angulo, Pediatric Endocrinologist (lead physician)
Dr. Rodrigo Lemus, Pediatric Endocrinologist
More information: https://valledellili.org/en/departamentos-y-servicios/gender-clinic/
Bridging gaps in subspecialty care with distance-based learning: A collaboration with the Pediatric Residency program in Guyana
Guyana is an 83,000 sq. mile English speaking country found on the northern mainland of South America with a population of just over 750,000. Georgetown Public Hospital Corporation (GPHC) is the main referral and teaching hospital in the country with a capacity of 600 beds. The Pediatric department comprises a 30 bed Pediatric Ward, 4 bed PHDU, walk- in Pediatric Out-patient Department (POPD) and chronic disease clinics which include a once monthly endocrinology clinic.
Our endocrine clinic currently has forty (40) registered patients. The majority are patients with Type 1 Diabetes. There is one adult endocrinologist at GPHC and in Guyana so pediatric patients with endocrine pathology are mostly managed by General Pediatricians.
Most of the pediatricians in Guyana are graduates of the Pediatric Medicine Post Graduate Program at GPHC. This program was started in 2011 when there were only three qualified pediatricians in Guyana. The program was delivered through the Institute of Health Sciences Education (IHS), University of Guyana and in partnership with Giving Help to Kids (GHTK) and McMaster University. Initially most of the teaching faculty were external, however 9 years and 21 pediatricians later, local faculty have championed curriculum delivery. There are however modules such as endocrinology, where due to the lack of subspecialists, we continue to benefit from distance learning.
Our teaching collaboration with the Pediatric Endocrinology division at McMaster University takes the form of virtual sessions via zoom once or twice weekly over the four (4) weeks of the resident’s endocrinology unit annually. There are didactic sessions, case presentations, journal clubs, summative and formative assessments. These sessions are all based on the resident’s objectives of training and tailored to our resources and limitations.
There are currently eight (8) pediatric residents in the pediatric residency training program. All our residents have had to make adjustments of some sort during the COVID19 pandemic but due to their familiarity with distant education, learning via a virtual platform was one less needed adjustment. For that, we are thankful.
Dr. Arnelle Sparman
Program Director, Pediatrics Program
Georgetown Public Hospital Corporation, Georgetown, Guyana
ESPE Yearbook 2020
Each year, the European Society for Paediatric Endocrinology (ESPE) publishes a Yearbook with expert commentaries on the most important articles published over the last 12 months. Since 2016, the Yearbook of Pediatric Endocrinology includes a chapter on Global Health for the Pediatric Endocrinologist. The 2020 edition is no different!
For more information, please visit https://www.espeyearbook.org/ The full version of the yearbook can be accessed freely by ESPE members or can be found on Amazon (USD $11).
The Global Health for the Pediatric Endocrinologist can also be accessed on line through the GPED website (www.globalpedendo.org) or by following the link below. This year’s chapter includes 16 articles that cover not only the most significant articles on endocrinology and diabetes but also societal issues. I particularly recommend the first paper, written by Dr Garcia (Peru) and is entitled: Corruption in global health: the open secret. Enjoy the read!