Understanding leadership development within new medical schools in Africa

The transient and multifaceted nature of leadership in Health Professions Education has changed over time. Programme directors associated with medicine, pharmacy, nursing, allied health and those involved in a clinical setting typically serve as managers and leaders concurrently. Furthermore, managers in modern organisations are expected to fulfil leadership roles. Leader and leadership development are inter-reliant phenomena. Moreover, the growth of leaders, the mutual development within a group and the consequent development of an organisation in the context of health professions education HPE require framing. This is especially true when leaders are faced with an array of constraints in low- and middle-income countries. In order to appreciate leader development, we need to ask “what qualities do we need to develop in our leaders?” and for leadership development “what qualities do we need to develop in our organisation?”. Thus, within the context of the current study we essentially ask: “What qualities have developed in our leaders, organisation and the consortium?” The current study sought to understand leadership development of appointed and emergent leaders in new medical schools in Africa. A mixed-methods approach was employed and the data collection instruments included: a Likert scale survey, a multiple case study approach and a qualitative document analysis (QDA). A total of 29 surveys (64.5% response rate) were returned and 10 successful interviews were conducted after ethical approval and obtaining consent. Many of the participants fulfilled multiple roles as lecturer (linked to the basic medical sciences), departmental head and/or a clinical teaching position in the hospital. Their academic positions and seniority as leaders included deans, a deputy dean, a programme director, heads of departments (HODs), medical educationalists and lecturers. Any additional biographical information was excluded in the study in order to ensure anonymity of the participants. Finally, the QDA relied on a four-step Scott method and considered a total of 58 documents that ranged from meeting agendas and reports, scholarly works, book chapters, newsletters, external reports, conference proceedings, and the CONSAMS (Consortium of New Sub-Sahara African Medical Schools) constitution. Findings from the current study led to the development of a framework to navigate the complex nature of leadership development in new medical schools in Africa. The three-tier framework views leadership development of the individual, the institution and within the context of collaboration such as a consortium. Leadership development at an individual level is dependent on the interplay between an institutional climate, contextual forces and resultant responses of leaders. Five archetypes of leadership development were identified at an individual level: the leader in front, the strategist, the silenced leader, becoming a leader and the leader as manager. The archetypes are the result of biographical, programmatic, institutional and contextual forces. The leader subsequently interprets these forces in order to negotiate their roles, position and course of action. Leadership development at an institutional level occurs within a hierarchical system and can sometimes occur in isolation. Development is often hampered by day-to-day activities that are reactive in nature in a bid to negotiate the various forces. The formation of teams and coalitions are hampered by climate factors such as ineffective engagement of colleagues, poor bilateral communication, perceived misalignment of the values and unsuccessful collaboration. The formation of networks and alliances, as in the case of CONSAMS, drives the leadership development at a collaborative level. Within this context, leadership development is largely dependent on effective communication and feedback. Within a consortium, each participant contributes from the position of their dominant archetype, but are also temporarily freed from institutional constraints to think more strategically. The consortium generates a unique climate where the heterogeneity of leaders through their archetypes can be challenged, tested and strengthened. Interaction within the consortium permits freedom, more so than within the domain of an institution

Engineering of a Collagen-glycosaminoglycan copolymer dermal regeneration matrix

Background: Tissue engineering and its contribution to regenerative medicine has advanced through the years. It has proven its efficacy especially in the treatment of advanced full thickness burn wounds. Tissue engineering is the synergy between biology and engineering. This fairly young science has one common goal and that is to regenerate new tissue. Various commercially available products have appeared on the market and this due to the ground-breaking work of many. One such well known product is Integra® which is the brain child of Yannas and Burke. This is a collagen-glycosaminoglycan copolymer which serves as a bioactive regeneration template or extracellular matrix analogue. Advanced wound healing is promoted along with the prevention of scar tissue formation and consequent contractures. Aims:</p This study provides an extensive review on the development of this dermal regeneration matrix and also aims to develop an equivalent product. Attention will be paid to: the biological building blocks and the motivation for their use; the essential production steps; and the final processing required in order to deliver a sterile product. Materials and Methods: A collagen and chondroitin 6-sulphate coprecipitate was prepared and subjected to either controlled or uncontrolled freezing. The frozen slurry was dried under vacuum for 17 hours after which each sample was coated with a thin silicone film. Glutaraldehyde crosslinking followed after which the product was thoroughly rinsed. The packaged products were then subjected to terminal sterilisation via gamma irradiation under various conditions. Various tests were conducted to evaluate the newly formed regeneration matrices and included scanning electron microscopy, enzymatic degradation by collagenase, and a cytotoxicity assay. Scanning electron microscopic analysis was done in order to reveal the adequacy of the scaffold architecture. Collagenase degradation of the scaffolds was used to project the rate of degradation of each template. Integra® served as the gold standard for each test. Quantifiable data was statistically analysed and any comparison made included the calculation of means, standard deviations and p-values (confidence interval of 95%). Results: Results indicated that highly porous bioactive tissue engineering matrices were obtained by either controlled freezing or uncontrolled freezing. The average pore diameter of the most homogenous scaffolds ranged between 52.47 and 136.44 µm with a mean of 87.34 µm. These templates were formed by using a 0.5% collagen concentration and a controlled freeze rate of 0.92 °C/min. Uncontrolled freezing (1.3 °C/min) of a 0.5% collagen concentration resulted in the formation of an irregular scaffold with an average pore diameter of 174.08 µm. It was found that the architecture of the most equivalent scaffold compared well with that of Integra® with p = 0.424. Scaffolds prepared using higher collagen concentrations (1.0%) and controlled freezing resulted in dense sponges with average pore diameters of 56.51 µm. Statistical analysis upon comparison indicated a significant difference p = 0.000 in the micro architecture. The rate of degradation of the most equivalent scaffold was 1.9 times that of Integra®. This implicates that the crosslinking was insufficient and due to one of the following: poor collagen quality; method of crosslinking; and degradation due to terminal sterilization. The rate of scaffold degradation can be extended, either by additional crosslinking or the prevention of degradation induced by irradiation. Temperature vacuum dehydration crosslinking through esterification or amide formation can be used as an initial crosslinking method in further studies. This form of crosslinking will complete the conventional glutaraldehyde crosslinking that reacts with the free amine groups of lysine or hydroxylysine of the protein backbone of collagen. It should be stressed that the determination of an in vivo degradation rate, in the form of an animal study, will aid to confirm the efficacy of the biologically active regeneration matrix.Dissertation (MSc)--University of Pretoria, 2008.Anatomyunrestricte

Microbes, molecular mimicry and molecules of mood and motivation

The hypothesis proposed is that functional disorders, such as irritable bowel syndrome, chronic fatigue syndrome and anorexia nervosa are caused by auto-antibodies to neuronal proteins induced by molecular mimicry with microbial antigens. The age incidence of these conditions, the marked female excess, increase with economic and technological advance, precipitation by infection, and the paucity of histological changes are all consistent with the hypothesis. It can be tested directly using human sera to search for cross reaction with brain proteins in model systems such as Drosophila melanogaster. The conditions might be amenable to treatment using pooled immunoglobulin. Identification and elimination from the microbial flora of the bacteria that express the cross reacting antigens should be possible

Health Care, Hospitals and Racial Hygiene in German Colonial Windhoek (1890-1915)

The gradual progress of health care within Namibia (formerly known as German South-West Africa), coincided with the three major historic periods: colonial settlement, the Herero-Nama genocide (1904-1907), and the transition of administration of the colony after the First World War. Here the authors draw upon primary and secondary sources to provide insights on the development of hospitals, health care and racial hygiene in in the colony with specific reference to Windhoek. The aim here is to contribute towards the lacking historiography of the medical landscape of Windhoek. Health care during the period of German colonial rule was centralised and segregated, and this trend prevailed when South Africa undertook administration of the colony. The initial strategy under German rule was to increase the formal treatment facilities within Swakopmund and Windhoek during the 1890s. The early growth of health care and hospitals was chiefly aimed at the needs of the white Europeans and driven by principles of racial hygiene

Collagen-based scaffold as a delivery system for a niacinamide dominated formulation without loss of resistance against enzymatic degradation

Exogenous factors aimed at promoting fibroblast activity might hold the key to improving the clinical outcome of chronic wounds. The current study explores the feasibility to use a collagen-based scaffold as a delivery system for a niacinamide dominated formulation in vivo. The combined use of niacinamide, L-carnosine, hesperidin and a HSP70 homologue is known to promote fibroblast activity in vitro. Scaffold mediated wound healing was assessed in 16 female Sprague-Dawley rats that received both a control scaffold and an enhanced scaffold. The test scaffolds presented with a higher fibroblast count (60.49 ± 9.90% of the total cell infiltrate) on day 7 compared that of the control scaffolds (42.62 ± 13.60%) but was found to be statistically insignificant. However, the addition of these active components did not compromise the in vivo resistance against enzymatic degradation nor alter the scaffold microenvironment deleteriously

The early history of ether anaesthesia in the Cape Colony, South Africa

News of the potential of ether as an anaesthetic arrived in the Cape Colony, South Africa, six months after Morton’s convincing demonstration in Boston. Anaesthesia in the Cape Colony shares a dental heritage after Alfred Raymond, a dental surgeon, became the first person to successfully administer ether anaesthesia in April 1847 in South Africa. Raymond became the first individual to do so in the Southern Hemisphere. A young band of physicians and surgeons eagerly proceeded with a series of experiments, yielding mixed results in the Colony. Unaware of Liston’s success in London, William Guybon Atherstone became the first surgeon in the Southern Hemisphere to perform an amputation using ether as anaesthetic in June 1847. This manuscript aims to contribute towards the lacking history of the first pioneers whom experimented with ether as an anaesthetic at the southern tip of Africa