A place at Rugby World Cup 2023 was not the only qualification on offer in the south of France this month, as a group of medics received training to become Match Day Doctors (MDD) during the Rugby Africa Cup 2022.

Six African doctors, hailing from Ivory Coast, Madagascar, Senegal, Tunisia, Uganda and Zimbabwe, were invited to the tournament to learn more about the role of an MDD.

The training sessions, which are part of World Rugby’s long-term plan to raise player welfare standards across the continent, were a mix of classroom and practical learning.

This year’s Rugby Africa Cup, which was staged in Aix-en-Provence and Marseille and doubled as RWC 2023 qualifying, was the first in which organisers had access to MDDs and head injury assessment (HIA) video technology.

Each of the six doctors who travelled to France were existing medical trainers who had previously completed level 2 Immediate Care in Rugby (ICIR) training.

The course began with a discussion on concussion, including the participants’ own experience of the Recognise and Remove protocol that is used when HIA is not available, before they progressed to video analysis and using the CSx concussion management app.

Subsequently, across two Rugby Africa Cup match days, the participants gained practical experience working alongside the MDDs and HIA doctors that had been provided for the tournament by the Fédération Française de Rugby (FFR). Doing so gave them the opportunity to perform HIA 1 and 2 in real time.

“It's always good to do things in the classroom, but applied work is what it's all about,” World Rugby Medical Education Manager, Isabel Grondin said.

“This course was a great success and appreciated by both sides. [It was] appreciated by the learners but also the trainers that were also the MDDs... We're very fortunate that the FFR was very cooperative in helping us make this process happen.

“It was a great success and great outcome for the learners because now they had an opportunity to see, to do, whether it was in the stadium with the iPad to be able to scroll back and move forward on the video immediately or it was with the video technology in the HIA room.”

Raising standards

Elvis Tano, a doctor from Ivory Coast who also sits on the Rugby Africa executive committee, said that he took part in the course “to put my experience at the service of everyone and to learn more as a trainer”.

“The rigour involved in this role is important and I support this approach,” he added. “I like to contribute in my own way to lower the risk of complications related to concussion.”

“Players in Africa and all over the world deserve to have expert doctors who know the latest advances in science, research and the most efficient working methods to make rugby, especially amateur, safe and accessible to all,” fellow participant, Dr Imed Mrabet said.

“As a doctor passionate about rugby, I want to perform well in the role of the MDD to ensure excellent secondary concussion prevention on the field.”

It is hoped the participants will take their learnings home with them, enabling the next edition of the Rugby Africa Cup to be played with enhanced player welfare protocols.

“If African rugby wants to grow and assert itself on the international scene, it must reach European or southern hemisphere standards with regard to the health of the player,” Didier Sirieix, who helped deliver the MDD course, said.

“Overall, the week was great, and I am ready to continue to help the development of African rugby MDDs in their next competitions.”

Supervising match day safety

Most fans would not know what an MDD does, but as Grondin states, they are one of most vital people at the stadium on match day.

An MDD will be at a match venue long before anyone else and will be in contact with a range of people, including all medical staff of the teams that are playing and the match commissioner.

“People don't realise that they arrive at the stadium two hours ahead of time,” she said.

“They make sure that the stadium, the grounds are safe, that everything is ready to care for the athletes, that we have the appropriate emergency care platforms in place, that there is an immediate care lead pitchside, supported by an extrication team ready to assist when needed.

“The MDD also works directly in a briefing with the team physicians, physios, those that are ICIR [trained] that will be crossing the white line during the time of the match.”

Following the success of the three-day course in the south of France, Grondin is hopeful that similar events will be rolled out around the world when and where the need arises.

“There is going to continue to be a growth of these courses worldwide,” she said. “The format that we used [in France] of having the applied component immediately, doing the classroom on day one and then day two and day three having some international matches our learners can work, was very well received from trainers and from participants.

“This format is going to occur again. We want to do more MDD courses worldwide to continue putting player welfare first.”