The four important lessons I have learned from InciSioN and IGSS2018

<Emina Letić, student of Faculty of Medicine Sarajevo, Bosnia and Herzegovina >

It was four months ago when I first opened InciSioN-International Student Surgical Network web page and at the background read the sentence: “Nobody should be pushed into poverty for needing surgical care”

This statement made me stay on the web page and keep reading. It attracted me to the noble idea of Global Surgery and InciSioN showed me how medical students can contribute to this field.
It was destiny that pushed me further into InciSioN Network- I applied for the scholarship that InciSioN Global Surgery Symposium 2018 ( IGSS2018 – 5th and 6th May, Leuven, Belgium) offered and become one of the eleven travel scholars.
So, my InciSioN adventure started and here are the four important lessons I have learned in the last four months.

No.4 Enthusiasm is the main fuel of Global Surgery
Global Surgery is a big dream and it is not easy to achieve safe surgery for everyone everywhere but there are many examples of successful programs that implement Global Surgery in different parts of the world that encourage us all.
At IGSS2018 Dr. Lubna Samad presented the fascinating work of Indus hospital in Karachi, Pakistan, that provides free healthcare for all the people in need without administrational procedures why it is also called “paperless hospital”. The initial idea in 2007 was to establish a tertiary care hospital in Karachi but now it evolved into the Indus Health Network with many other healthcare facilities in other cities in Pakistan. This hospital developed also the Pehla Qadam program for clubfoot treatment. The good idea of Pakistani doctors just grows and spreads!

An other inspiring example from Nicaragua was presented by Dr. Yener Valle- the Surgey for the People (Cirugia para el pueblo) program in cooperation with the NGO Operation Smile (Operacion Sonrisa) provides free treatment of the cleft lip and palate. It is great example how the cooperation between international organizations and local healthcare workers can give good results.
And Dr. Yener is only 28 years old! All participants of IGSS2018 that I have met are passionate young doctors and students that want to make this world a better place. The power of a young force should never be underestimated and we have to be aware of it. As Dr Basem Higazy said “Stay eager, stay foolish, stay hungry, stay connected…”and with absorbing knowledge and experience from proficient colleagues and mentors it is with no doubts an excellent formula for achieving our dreams.

No.3 Only SAFE surgery

Performing surgery in any kind of working settings should be in the way that patients get the best possible treatment and that deaths from preventable factors are avoided. The safe surgery was one of the highlights of IGSS2018. This is more than challenging to achieve in low resource settings and a systematical approach with the governments, NGOs and surgical teams is needed.
But also some simple improvements, like the WHO Safety Surgical Checklist, that impacts communication and interconnection within the surgical team can prevent some serious conditions like surgical side infections or forgetting the instruments or sponges inside of the body. And it doesn’t require too much to implement. The simple things can achieve a lot- The Checklist Effect directed by Lauren Anders Brown is an inspiring documentary about the influence of the Safety Surgical Checklist in different countries and their hospitals.
There is no safe surgery without safe anaesthesia and the role of anaesthesia in Global Surgery is important. Dr. Rediet Shimles Workneh from Ethiopia presented at IGSS2018 a motivating story about hardworking anaesthesiologists in her country, really small number of them compared to what the population needs. She also emphasized the role of anaesthesia technicians in filling the lack of anaesthesia doctors which is an illustration of how healthcare workers can rely on each other and strengthen each other to achieve safe surgery.

No.2 Work locally and achieve globally

Many of the examples I have mentioned above started as initiatives at the local level and developed and grew up in something bigger with the support of international organizations and/or local people who fundraised the initiatives.
Local+ local + … + local equals global. This model enables countries to build up healthcare systems adjusted to the specific needs of the people living in it but also to contribute to the quality and equity in healthcare worldwide.
And the changes have to start from the local level!
InciSioN is a network connecting thousands of students worldwide and it has 27 National working groups from 27 different countries. My favourite story from InciSioN blog is “The Cargo of hope”. It describes the great success of students from Grenada who “managed to ship a boat containing nearly $400,000 worth of medical and surgical supplies to the Grenada General Hospital”. This story inspired my colleagues and I to send the request to InciSioN to establish a national working group in our country. It is a small step for us to get more involved into Global surgery and one of the small steps in making surgery in our country safer, more accessible to all and preventing the impoverishment of the people needing surgical care. We also want to bring important messages from the Global Surgery community and spark enthusiasm of the students and young doctos to be active and change things.
The InciSioN’s 23rd National Working Group is a newly formed working group from my country, Bosnia and Herzegovina.

No.1 Nobody should be pushed into poverty for needing surgical care

Nobody should be pushed into poverty for needing surgical care -this is my lesson number one. When I read it, I imagine one little family- The Mum, The Dad, The Daughter and The Son and one member of the family needs to undergo a surgical treatment. They don’t have a health insurance and they are faced with the financial issues of paying the treatment. Are they going to delay the operation? Are they going to lose one member because they can’t afford treatment? Are they going to lend the money and protect the family from losing one member but get worried after the treatment about the debts? And I truly empathise with this surrogate family because I know that in the reality many families are faced with similar situations and have to take difficult decisions.
Nobody should be pushed into poverty for needing surgical care is my lesson number one, one simple statement so right and so logical that I keep repeating it often to myself because I want to give my best to see happy and healthy families in the future, in my country and everywhere.


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