Trainer Mike Paciro outlines Afrec Foundation’s stent-access workshops and patient care in Africa

Trainer Mike Paciro described how the Afrec Foundation’s Stent Access Initiative runs in-country workshops that teach endoscopy and stent placement to local teams and provide short-term clinical care.

"We've now done 19 editions of this, and we've trained over 64 teams of nurses and endoscopists," Paciro said, adding that the program has assisted about 344 patients and "there's almost 1,500" individuals who have been touched by its activities. He credited an ongoing partnership with Boston Scientific for long-term support: "This has been because of the partnership we've had with Boston Scientific."

Why it matters: the workshops aim both to transfer skills to local providers and to give symptomatic patients — many who cannot swallow because of advanced disease — a palliative intervention that can restore oral intake and nutrition. Paciro described the work as clinical training and short-term patient care rather than curative therapy.

Paciro outlined the program’s origins and partners. The first workshop, he said, took place at Tenet Hospital and was led by a small team including David Baisher and Mark Topazian; initial participants from Tanzania returned home and trained others. Recent partners named during the session included AIM (for logistics), the American College of Gastroenterology (support for visiting clinicians), UNC and national ministries of health in countries such as Malawi and Tanzania.

On operations, Paciro said each site recruits patients locally and programs generally seek a target number of patients (for example, about 20) rather than applying strict inclusion or exclusion criteria. Stents are shipped in advance, cleared through customs and stored on arrival for use in the workshop; Paciro said this replaced an earlier practice of carrying devices informally across borders.

He described the clinical workflow: teams take histories, explain the stent and procedure to patients and families, prepare patients for endoscopy, discuss findings and biopsies if needed, and provide guidance on home care for the stent. Paciro said refusals are rare because patients typically present with severe swallowing problems and want relief: "It's been rare. I don't think I have anybody who's actually said no to having a stent placed."

Paciro emphasized the palliative nature of the intervention: "We are not fixing the problem, we are not removing the cancer. We are helping them to swallow," he said, noting that stents often allow months of improved quality of life (he cited ranges such as six months to a year depending on disease biology). He also discussed staff support, saying teams debrief regularly to address the emotional impact of providing palliative care.

Family involvement is built into the process: clinicians include family members in counseling about disease progression, pain management and post-procedure care, and some units involve chaplains or social workers. Paciro recommended providing take-home information packets so families have written guidance after discharge.

The session closed with a reminder that prevention, earlier detection and advocacy remain important complements to palliative services. For more information, the moderator pointed listeners to africaecc.org.

Next steps: Paciro said another edition of the Stent Access Initiative is scheduled in Malawi next week; organizers described ongoing logistics and partner coordination but did not state further formal commitments or funding details during the session.