The Charter of PAACS

I. DEFINITION

The Pan-African Academy of Christian Surgeons (PAACS) is an international, non-profit organization of Christian surgeons dedicated to providing education in Africa and the developing world. It is a commission of the Christian Medical and Dental Associations (CMDA) of the United States (a non-profit ministry organized under Section 501(c)3 of the Internal Revenue Code). Its official address is:

II. MISSION

The PAACS exists to provide surgical and discipleship training for African doctors in Africa and doctors in developing countries will enable them to serve in Christian hospitals or wherever they will have the greatest influence for Christ.

III. VISION

PAACS’s vision is:

IV. ACTIVITIES

To accomplish this, PAACS will:

• accredit sites for training surgical residents,
• set standards for surgical training and practice
• certify successful graduates of the surgical training programs in cooperation with Loma University,
• provide educational materials for the training programs in keeping with the educational standards expected;
• connect Christian surgeons through conferences, training programs, and communication materials;
• mobilize prayer for PAACS, its training centers, its teaching staff, and its residents;
• recruit short-term, visiting surgeons and career missionary surgeons in a variety of specialties to assist in training at PAACS training centers;
• strive to develop a centralized database of surgical opportunities and personnel needs, develop a database of resident operative cases, centralize a database for equipment offers, and the equipment and supply needs of PAACS training centers;
• foster collaborative research activities among its members;
• represent missionary surgery at professional meetings and conferences; and
• raise funds for resident educational stipends and for PAACS operating expenses.

 V. STATEMENT OF FAITH

• We believe that the Bible, in its entirety, is the only inspired, inerrant Word of God.
• We believe that there is one God eternally existent in three persons: the Father, the Son and the Holy Spirit.
• We believe that Jesus Christ is God the Son, born of a virgin, who willingly died on the cross for the sins of Man and rose from the dead to sit at the right hand of the Father.
• We believe that the forgiveness of sin and the gift of eternal life come only through repentance and faith in Jesus Christ.
• We believe in the ministry of the Holy Spirit who indwells those who are born again by the Spirit of God, and enables believers to live a godly life.
• We believe in the personal return of Jesus Christ to reign in power and glory on the earth. He will judge the saved and the lost – the saved will receive eternal life and the lost will receive everlasting punishment.
• We believe in the unity of all believers who love, worship and obey Jesus Christ as the Son of God.
• We believe that it is the duty of all who love and obey Jesus Christ to proclaim his gospel to their neighbors and to the world and to respond with compassion to the suffering around them in the ways that Jesus did, regardless of race, religion, nationality, or social status.

VI. ADMINISTRATIVE STRUCTURE

The PAACS Council and Officers:

Nature of the PAACS Commission

The PAACS is organized under the CMDA’s Board of Trustees as a commission and is subject to all bylaws, policies and procedures pertaining to Commissions in the CMDA bylaws and Handbook for Commissions, Sections, Committees and Councils – CMDA.  PAACS is under the oversight of the Chief Executive Officer of the CMDA. The officers of the PAACS Commission are as follows:

• Chairman
• Secretary
• Treasurer
• Chief Executive Officer (non-voting)
• Director for Africa (non-voting)

The Commission will consist of seven to sixteen members who will be nominated by the PAACS Executive Committee, selected by the President of CMDA and approved by the CMDA Board of Trustees by a simple majority vote, serve a two year term. Those members may succeed themselves at the discretion of the PAACS Commission and the President of CMDA, renewable every two years without limit.

The Chairman of the PAACS Commission is selected by simple majority vote of the Commission and the name of the person elected is forwarded to the President of the CMDA and the Board for ratification. The Chairman of the PAACS commission is appointed for six years and may serve a consecutive term.  The President of CMDA and the Chief Executive Officer of CMDA are ex-officio voting members of all meetings.

The Commission will include at least one member of MEI (Medical Education International) and a representative of Loma Linda University nominated by their respective executive bodies to the President of the CMDA for ratification by the CMDA Board of Trustees.

An Executive Committee consisting of the Chairman, Secretary, Treasurer, Chief Executive Officer of PAACS and the Director for Africa of PAACS will address PAACS issues that need to be decided at times other than the annual council meeting. Executive Committee actions must be approved at the next Commission meeting. The Commission will meet at least once a year and additional meetings may be held from time to time.

At least a 14-day advance notice shall be given prior to any meeting. A quorum of the Commission will be fifty percent of its members. If fewer than fifty percent of its voting members are present at a meeting, a majority of those present may adjourn the meeting and set a date for the next meeting.

The Commission shall have the authority to meet via conference call, by video or Internet teleconference. Action without meeting is also permissible if consent in writing by mail, fax, or e-mail is obtained from a majority of the Commission members.  Such approval of action without meeting must clearly state the actions taken or the nature of the motion.

The Commission provides oversight for all of the organization’s activities that have already been mentioned. It can amend the Charter of the PAACS with the approval of the CMDA Chief Executive Officer. The Commission will be responsible for all fiduciary matters.  The Commission shall establish appropriate accreditation and educational standards and will coordinate the awarding of diplomas with Loma Linda University.

The following permanent committees will be appointed by the Commission Chairman to provide structure to the Commission’s activities:

• Finance
• Education (curriculum, examinations, accreditation)
• Publications
• Resident selection and evaluation

The Administration of PAACS (Chief Executive Officer, Director for Africa, Regional Directors, Program Directors and their assistants) are not eligible to become members of the Commission. The Chief Executive Officer, Director for Africa and Regional Directors may attend all meetings as non-voting attendees.

The Chief Executive Officer of PAACS is selected by the PAACS Commission and is responsible to carry out PAACS decisions and policy at the various training centers in any of the programs. The Executive Director is an ex-officio non-voting member of the Commission and serves at the pleasure of the Commission.

The PAACS Director of Africa is appointed by the PAACS Commission and is responsible to carry out PAACS decisions and policy at the various training centers in the African program. 

The Program Directors of the PAACS Training Programs and the Regional Directors for PAACS in East Africa, South Africa, West and Central Africa will assist both the Chief Executive Officer and the Director of Africa in the administration of the residency programs.

The PAACS Commission shall keep minutes and copy them to the Chief Executive Officer of the CMDA and the President of the CMDA.

Membership in the Commission

These are the criteria for Commission membership:

Advisory Council:

In order to carry out the programs of PAACS, an advisory Council has been established. The appointees may be included where their expertise, knowledge or help may further the goals of the Commission. They may function as members of committees or perform activities as appointed by the Chairman of PAACS. The Chairman of PAACS commission may appoint advisors for a two year period, renewable indefinitely.

These are the criteria for appointment to the PAACS advisory council:

Program Directors and Assistants

Each Training Program must be directed by a Program Director (PD) who is certified or eligible for certification by an internationally-recognized surgical certification board, such as the American College of Surgeons, the Royal Canadian College of Surgeons, or the Royal College of Surgeons. The candidate for Program Director must demonstrate pedagogical skills and have proven ability to teach residents in the classroom, on the wards, and in the operating room. They shall be required to attend the ACS school or something equivalent. Surgeons who are trained in Africa under PAACS and who have achieved certification by an internationally-recognized surgical certification board will also be eligible for these positions but should have some specific training in surgical education or have demonstrated such expertise. The surgeons appointed as Program Directors should have a minimum of three years of practical post-residency experience.

Each Training Center may also have an Assistant Program Director to help and to direct the residency program for up to one year during required absences of the PD. The Assistant PD may be board-certified in either general surgery or a surgical subspecialty. Post-residency practical experience is not required for this position.

With permission of the Chief Executive Officer, a board-certified non-surgeon physician may be appointed to the position of Administrative Assistant Program Director. Such Administrative Assistant Program Director reports to and may assist the Program Director in all educational and administrative roles as deemed appropriate by the Program Director, Regional Director, Director of Africa and Chief Executive Officer of PAACS.

The Chief Executive Officer has the right to appoint interim directors and faculty to serve for a time up to one year as deemed necessary to maintain a specific training site. He has latitude to relax the criteria if necessary for the continuation of a program. Such appointments shall be approved by the Executive Committee or Commission as soon as is convenient and in no case less than three months before the appointment begins.

Requirements for Program Directors and Assistant Directors

Either the Program Director or the Assistant Program Director must be a general surgeon serving in a full-time capacity. Assistant PD’s may be surgical sub-specialists and should meet the same requirements as PD’s.  The Program Director and Assistant Director (both referred to hereafter as “PD”)

• should be a fully trained, experienced surgeon with credentials from a recognized, international surgical society or board
• should be licensed to practice medicine in the country where he serves
• should be passionately committed to training young, national doctors to become qualified general surgeons and to disciple them as followers of Christ
• should have, prior to his appointment, demonstrated that he or she is able to model to residents what it means to love and obey Jesus Christ, both in and out of the operating room
• should be able to demonstrate experience in personal evangelism, ability to lead Bible studies and mentor and have had an active and meaningful role in his home church in these and similar activities.
• should be someone willing to stay at his post for four years or longer to assure adequate continuity of the education for the residents in his program
• must be able to arrange for other qualified surgeons to come short-term to share in teaching the residents, both in the operating room and in the classroom
• be willing to prepare, or oversee the preparation of a minimum of two (2) one-hour lectures or surgical conferences every week for the residents, review the residents’ written case reports, establish a weekly Bible study with the residents and their spouses to assure their spiritual development, and insure that all PAACS training requirements are met.

Finances

All its financial matters will be conducted in accordance with the financial standards established by CMDA.

The Commission will establish and approve a yearly budget. PAACS funds will be kept in CMDA accounts and will be spent in accordance with the budget and Commission directives. The Financial Committee shall have oversight.  The Treasurer shall be a member of the Financial Committee. The Treasurer will prepare or oversee the preparation of  a financial report annually. PAACS financial accounts will be subject to the annual CMDA audit.

Academic Stipends for Residents

The supporting church, mission or organization is strongly encouraged to provide sufficient financial support for the resident for the duration of his training.  Such fully-supported residents will be required to commit to serving that supporting agency for a previously agreed-upon amount of time.  Residents requiring financial assistance may qualify for support stipends from the PAACS and will be subject to similar contracts regarding repayment through subsequent service at various hospitals.

VII. SURGICAL TRAINING

University Affiliation

A partnership between PAACS, CMDA and Loma Linda University will provide academic review of the training programs. After successful completion of the full surgical training program, a diploma will be issued to each resident jointly by PAACS and CMDA under the academic approval of Loma Linda University. Loma Linda University will review each new training program before the program accepts trainees and each program will be reviewed every three years. The report of each review will be sent to the PAACS Commission and recommendations for the program will be made. This agreement is for five years and is renewable upon mutual agreement of PAACS, CMDA and Loma Linda University.

Length of Training program

The length of surgical training in PAACS programs is a minimum of four years. Five years is the minimum for a COSECSA-accredited residency.

The Requirements for Training Centers are as follows:

The Training Center will sign a Memorandum of Understanding with PAACS.  It will contain, but not be limited to, the following items:

• The hospital must be on the African continent or on one of the islands considered part of Africa (i.e. Madagascar, the Comoros, Sao Tome, etc.) or in a country considered part of the developing world.
• The hospital must appoint a full-time, general surgeon to serve as the Program Director (PD) of the surgical residency program and must insure that a qualified PD is on site for each year of the residents’ training. If the hospital appoints a surgeon who is certified in a surgical subspecialty, that surgeon may replace a general surgeon as PD for up to one year. Otherwise, a board-certified general surgeon must serve with the PD as a full-time faculty Assistant Director. All appointments as Program Director or Assistant Program Director must be acceptable to the PAACS Commission and the choice ratified by the PAACS Commission by 2/3 majority vote.  New training centers must have a minimum of two full-time surgeons involved in the PAACS program.  One of the two must be a board-certified general surgeon and that surgeon must serve as either the Program Director or the Assistant Program Director.
• The hospital must be able to perform a minimum of 500 major operations¹ a year and 200 major operations annually for each general surgery resident in the program.²
• The hospital must have the ability to competently and regularly perform general inhalational anesthesia, in addition to other forms of anesthesia.
• The hospital must have a ministry to the sick that does not exclude the poor and that clearly proclaims that Jesus Christ is God’s only son, that He is God’s only provision for the forgiveness of sins; and that the Bible is the only inspired, written Word of God.
• The hospital is responsible to provide appropriate, furnished housing, with utilities, and to provide free health care for the residents it accepts to train, along with their spouses and unmarried children under 18 years of age.
• It is the responsibility of the sponsoring mission, church group, or organization to pay the resident’s living expenses, cost of transporting the resident and his family from his home to the Training Center and back, and to pay all necessary visa expenses for the resident’s dependent children.
• The PAACS will pay to transport residents to pre-approved rotations between hospitals, as funds are available.
• The hospital must provide an adequate surgical library and study area for the residents, preferably with a computer and a printer for the residents’ required monthly case reports.
• The hospital must have the freedom to allow PAACS to invite short-term, well-qualified, board-certified surgeons to come from North America, Europe or other countries with advanced medical systems to serve as Visiting Faculty. These surgeons must be able to come for 2 weeks to 2 months or longer to operate with the residents, do teaching rounds, and give lectures. Visiting Faculty members are expected to pay their own expenses and volunteer their services for free.

Admission Requirements for Residency Candidates:

The surgical resident must be a born-again Christian. Each year the resident must participate fully in the requirements of the academic and spiritual curriculum.  The resident’s performance will be regularly evaluated on criteria including amongst other things, his or her medical knowledge, technical skill, attitude, aptitude and Christian walk. At the end of each year of training, he will take an in-service examination. If he does not pass the examination, he will not advance to the next level of training. If his Director does not believe that his effort or skill justifies repeating the year, or if he finds the resident to be insubordinate or irresponsible, neither the Program Director nor the PAACS will be under any obligation to keep the trainee as a resident physician.

Applicants must fulfill the following requirements:

• Make application to PAACS indicating the Training Center of their choice and provide all necessary documentation as required for their application
• Be graduates of a recognized medical school
• Have completed a post-graduate internship
• Have experienced a life-changing conversion to Jesus Christ
• Give consistent evidence of obedience to the Word of God, the Bible in both word and deed
• Be recommended by their local pastor, a church elder, and by a Christian doctor who has worked with them
• Sign a contract with either the church, mission organization, or other credible agency that will support them financially during their training, and employ them afterwards
• Sign the agreement at the end of the application form to meet the conditions for training under the PAACS

Visiting Faculty

Board-certified visiting surgeons who come short-term to teach residents in the operating rooms and through formal lectures will be born-again Christians and considered as faculty for those residents.They will be required to be approved by the PAACS administration and meet the requirements for visiting faculty. Their names should be included in the resident’s training records.

Curriculum

The surgical and spiritual curriculum, standards, policies and the methods of evaluation shall be established by the Curriculum committee and approved by the Commission. The Chief Executive Director and his designates shall oversee the compliance to the curriculum and the methods of evaluation.

The Training Environment

The Commission shall establish minimum standards for all training sites. Rotations to hospitals outside of integrated PAACS Training Centers must be pre-approved by the Director for Africa or his designate. Only those hospitals approved by the PAACS Commission to serve as Affiliated Training Centers will be eligible to receive PAACS residents on rotation.

¹ A major operation is defined as an operation that involves at least one of the following:
• More than 45 minutes to complete
• Entering the abdomen, chest, retro peritoneal spaces, cranium, or neck
• Inguinal, femoral or axillary dissection
• Open fracture reduction or fixation
• General, inhalation anesthesia
• Intestinal resection
• Other clear and general-accepted criteria for major procedures

² The number of residents at each Training Program is established by the PAACS Commission.