Goitre Programme
For ten years, 2nd CHANCE trained Congolese and Burundian surgical teams to treat giant goitres safely. The goal was to restore a surgical practice that had almost disappeared from the region. That goal has been achieved: local teams now operate independently, and the programme has been successfully completed.
The condition
Goitre is endemic in the African Great Lakes region. It is caused by severe iodine deficiency, worsened by a diet rich in cassava. Most patients are women of childbearing age living in rural areas.
As it grows, a giant goitre compresses the windpipe and the oesophagus. Patients struggle to breathe, especially at night. Swallowing becomes difficult, the voice can change, and pain sets in. Working in the fields or at home becomes exhausting. The visible deformity also brings stigma, which can go as far as exclusion from the community.
Some people think it is a punishment for something I did. They no longer speak to me and point at me.
Why 2nd CHANCE stepped in
After decades of armed violence in eastern DRC, thyroid surgery had almost stopped. Expertise had been lost, supplies were scarce and costly, and operative risks were high. Complications were so frequent that patients feared surgery and surgeons stopped performing it.
Faced with this situation, the medical authorities of eastern Congo asked 2nd CHANCE to organise dedicated training in giant goitre surgery.
Our approach
Safe thyroid surgery depends on everyone in the operating theatre. The programme combined theory with surgical and anaesthetic mentoring, in three complementary tracks.
Theory, basic surgical skills, then thyroid surgery step by step, from assisting to supervised autonomy and finally full independence.
Airway management, detection and management of hypoxia and bleeding, and the WHO Surgical Safety Checklist, mostly delivered to nurse anaesthetists.
Hand preparation, sterile field and instrument care, and appropriate use of antibiotics, to reduce the risk of infection.
Checklist use, morbidity and mortality reviews and team training became part of daily practice. Cervical ultrasound was later added to improve diagnosis and follow-up.
Operated patients were followed up, including in remote villages, to assess their medical recovery and their return to community life.
Mastering a demanding procedure improved the surgeons' overall dexterity and judgement, raising the standard of all the operations they perform.
Three phases, one goal
Training began at Katana, in South Kivu, then continued in Goma. The first Congolese surgeons, based in Goma and Kisangani, became autonomous and were then mobilised as mentors.
Supported by the surgeons trained in phase one, the programme extended across North and South Kivu, Ituri, Tshopo and Haut-UΓ©lΓ©. A first mission run entirely by Congolese surgeons and anaesthetists took place, and local teams organised their own surgical campaigns between missions.
The model was transferred to Burundi, in Bujumbura and then Ngozi, while Congolese teams continued their training. The final Burundian surgeons became autonomous in 2023, completing the programme.
Results
Training sites Β· Katana Β· Bukavu Β· Goma & Masisi Β· Kisangani Β· Bunia Β· Nebobongo & Isiro (DRC) Β· Bujumbura & Ngozi (Burundi)
Voices from the field
Here are our latest actions in the field: through specialized interventions, patients suffering from burns, congenital malformations, obstetric fistulas, or goiters have regained their health, dignity, and independence. These essential treatments transform not only the lives of the patients but also those of their families and communities.
For detailed results and figures, see our annual reports.
