Karolinska Institute Global Surgery Course

Kampala, 12th January. After 11 intensive days in Uganda, the 3rd edition of the Global Surgery course of Karolinska Institute has come to an end. I will always be grateful for how the doctors, nurses, students and other staff at Mubende Regional Referral Hospital and Mulago National Referral Hospital, who welcomed us with open arms, who were always willing to share their impressive knowledge with us, and who always took their time to help and guide us in spite of busy schedules and difficult work.

<Jessica Zhang>

15 Swedish medical students had this honour of learning more about healthcare in low resource settings, supported by a competent team of supervisors. We had prepared for this through a number of lectures and seminars during the autumn, but of course few things can substitute observing and experiencing events first hand. During these few days, we have seen a glimpse of some health system and health financing challenges, we have seen how unequal global distribution of resources can affect the individual patients, as well as some consequences of decisions and priorities made on an international level. It’s great to hear that antimalarials, TB drugs and antiretrovirals are readily available because they have been prioritized, subsidized, sponsored or similar, at the same time it’s heartbreaking to hear how many other things are lacking.

Open heart surgery (Fallots tetrad) at Mulago National Referral Hospital (Kampala)

We have seen patients lying in hospital beds without receiving lifesaving interventions although healthcare is free because they cannot afford to buy necessary supplies such as gloves, without receiving adequate pain medication because they are out of stock, without undergoing radiological examinations that we take for granted in Sweden because the devices are not available. And the doctor says that there is no evidence supporting their choice of treatment, because research has not been done on this population. I know this is everyday life for many health workers, but for us it was a new reality.

Pediatric surgery (pyloromyotomy) at Naguru General Hospital (Kampala)

We have seen doctors, who seem to know all about everything from general surgery and orthopaedics to infectious diseases and dermatology to obstetrics and paediatrics by heart, and who are doing an absolutely amazing job with the means that they have. We have met young women with life threatening complications after unsafe abortion procedures, children with severe malnutrition, and patients with enormous T4 tumours that could’ve been cured if only they had seen a doctor earlier.

Mubende District Local Government Office 

We are constantly, and painfully, reminded of the global injustice and of our own privileges, both inside and outside of the hospital. And I keep thinking that as long as the system is unfair, whatever we do will not feel completely right. We could donate items, but will that create dependency and negatively impact the local market? We could contribute with our time or our hands, but honestly is that what is lacking and what is needed? We could provide financial support, but how will that influence other actors and stakeholders, and is that really a long term solution? Maybe we just need to change the system – if fairness even exists. And suddenly, the importance of international collaboration and policy once again becomes clearer.

Mubende Regional Referral Hospital

Talking about being fair nevertheless, it’s maybe also fair that we’ve also met a bunch of patients with similar complaints as we would find in Sweden, and participated in procedures more or less identical to what we do at home – everything from anaesthesia to cystoscopy to heart surgery. We have many things in common, in spite of the differences between our countries. Furthermore, there is so much potential to increase the availability, accessibility and quality of the healthcare with the right interventions – and with increased research as to ensure evidence based action. Most of us students would have loved to spend more time here, because we have so much left to learn. But then I’m thinking maybe it’s also good to leave with a feeling that you have not yet seen, done or learned enough; before you feel saturated, and with the hope of someday returning. I’m going home with new inspiration to become a better doctor, a better health advocate, and a better fellow human being.

UHC for a Healthier Generation

The Sustainable Development Goal (SDG) 3 aims to ensure healthy lives and promote well being for humans of all ages. Putting this in proper context means well-being before an individual is conceived – promotion of safe sexual practices, availability of contraception and the right to make informed decisions about our reproductive health; appropriate antenatal care services that go a long way to improve our present unsatisfactory global neonatal mortality rate of 19 deaths per 1000 live births in 2015. This also extends to baby care practices like vaccinations, breastfeeding and baby growth monitoring among others. Adolescent reproductive health comes next, and in the same spectrum lies mental health issues like substance abuse and adolescent response to various forms of bullying; especially in an internet age when the bullies now sleep and wake with the victim- in form of social media. The list then extends to communicable and non communicable diseases that can be found in adults, and not the least the health demands of seniors. In countries with strong militaries that make up an entire demographic, veterans health is a big concern. Achieving the aims of SDG 3 is daunting, but big progress has been made by countries and international bodies in the push towards a healthier human race.
<Alade Temidayo Qasim>
 
After the second World War, most European countries saw the mass reorganization of their societies as an opportunity to ensure health coverage for all their citizens. These were the first steps to ensure universal health coverage since Bismarck created his welfare state in the defunct German Empire in the 19th century. Many countries sought a health system that ensured all their citizens had access to health care relative to their health needs without necessarily compromising quality and exposing them to financial difficulties. Utilization relative to need, financial protection and equity in finance; and healthcare that has enough quality to be effective are the central ideas in how universal health coverage was described by the World Health Report of 2010.
 
Utilization relative to need refers to people getting the healthcare and services they require at a certain point in time. This spans through all stages of care- prevention, promotion, evaluation, treatment (either definitive or palliative), rehabilitation, and even surveillance services. This is actually quite difficult to ensure without compromising the two other core issues in UHC- financial stability and quality. Providing the best services is expensive; providing just about any service because it’s needed at that particular time may water down the quality of the care significantly. Therefore, the challenge lies not in whether governments can provide services, but whether those services will still be of the highest standards without exposing the people to undue financial risks. This unwillingness to trade off one core objective for another lies at the center of why UHC is difficult to implement. That quality healthcare cannot be cheap is a truth known to all. With that knowledge as the foundation of a push towards UHC, governments in each country can then draft specific health financing policies that are peculiar to that particular country; in a way that can guarantee quality healthcare for all.
 
Seeing UHC and health for all as a pipe dream is not pessimism, just realism that refuses to get examined. With the right steps taken to raise the funds needed to provide these services; with appropriate pooling and allocation of this scarce resources, the purchasing of the most essential services will not pose much of a problem as long as the benefit packages are designed in a very pragmatic way to favour the majority of people in the pool. UHC is possible, and will be our answer to a healthier and happier generation.

UHC Forum 2017 – Tokyo, Japan

In 1961, Japan became one of the first countries to achieve Universal Health Coverage (UHC), the key factor behind the country’s incredible improvements in health status and life expectancy of its population. 56 years later, the global health community united in Tokyo to learn from Japan’s experiences and achievements, and achieve similar goals in all countries worldwide, on a true quest for #HealthForAll. 
<Dominique Vervoort>
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“Our goal must be to protect and promote physical and mental well-being for all. Health is both an outcome and a driver of progress. It is at the centre of our vision of a more sustainable, inclusive and prosperous future […] When we invest in health – particularly of women and adolescents – we build more inclusive and resilient societies.” The United Nations’ (UN) Secretary-General António Guterres addressed the Forum with the UN’s willingness to support countries on their path towards UHC. Similar to Dr. Tedros, Director-General of the World Health Organization (WHO), he stressed the importance of political will to commit to UHC, which could yield a twentyfold return in terms of full-income growth within a generation. At the same time, Japan reaffirmed its reputation as the leading voice in UHC, pledging $2.9 billion to developing countries pursuing UHC, each in their own unique way.
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The WHO published its “2017 Global Monitoring Report”, which noted that half of the world’s population -more than 3.5 billion people- do not receive the healthcare services they need. From those that do receive healthcare, 800 million face catastrophic expenditure (more than 10% of household expenditure) and 100 million are pushed into poverty due to out-of-pocket payments for medical care.
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Just as peace is not simply the absence of conflict, so is health not just the lack of illness. Our goal is not only a band-aid or a single dose of medicine, important as those are. Our goal must be overall well-being, physically and mentally for everyone in all countries.
– UN Secretary-General António Guterres
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UHC Day
On December, 12th, the world celebrated UHC Day, which is now officially recognised by the UN. United by the UHC Coalition, over 1,000 organisations in over 120 countries joined forces to spread the word and discuss about UHC, to #WalkTogether and to #RiseForOurRight towards health for all.
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On this day, the Global Surgery community did not stay quiet either, holding an official #SurgeryUHC side event at the UHC Forum 2017, titled “The Power of Surgical Care to Catalyze Universal Health Coverage” and organised by the WHO, the governments of Zambia and Zimbabwe, the Harvard Program in Global Surgery & Social Change, the G4 Alliance and Johnson & Johnson, emphasising the essential role of surgery and anaesthesia for UHC. Global health and global surgery leaders, ranging from Jim Yong Kim (President of the World Bank) and Sania Nishtar (WHO Commission on NCDs) to Emmanuel Makasa (Permanent Mission of the Republic of Zambia to the UN) and Agnes Soucat (Director Health Systems, Governance and Financing at WHO) discussed key topics ranging from task-shifting and health workforce to health systems strengthening and health financing.
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In the other parts of the world, InciSioN’s National Working Groups held small UHC events on a local level, further advocating for UHC among the future health workers of the world. InciSioN-Rwanda believes that “healthier communities are essential for sustainable growth and development”, whereas Tanzania agreed that everyone -rich or poor- should have the right to access quality health services whenever they need it, all united to make sure that safe surgery and anaesthesia are enshrined in UHC by 2030.
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Check #SurgeryUHC on Twitter to read up on all important statements regarding Global Surgery on the UHC Forum 2017 in Tokyo, Japan.
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Read “Surgery & Anaesthesia: the Overlooked Keys to Universal Health Coverage” for more information: https://medium.com/health-for-all/surgery-anesthesia-the-overlooked-keys-to-universal-health-coverage-524bb2eeecb1

Global Neurosurgery Conference 2017 – Rabat, Morocco

After attending the Global Surgery Summer School last July in London, I became aware of how disproportionately surgical diseases affect the poorest people around the world. Currently being a second-year medical student at EUC Rotterdam, The Netherlands, I am very motivated to engage and help. Therefore, I participated in the first student-led Global Neurosurgery conference in Rabat, Morocco, organized by InciSioN and IFMSA-Morocco.

<Sebastiaan van Meyel>

In the early morning of the 11th of November 2017, everybody at the Abulcasis International University of Health Sciences in Rabat was excited about the forthcoming event where around 150 medical students participated. The main purpose of the day was to expand our academic horizons and learn how to advocate for global surgery, and neurosurgery in particular, and at the same time broaden our career options in these fields.

The programme was delivered through a combination of morning lectures, panels and highly interactive afternoon workshops. First, we started in a lecture-based-setting with different sub-themes of global surgery. After a coffee break, we enjoyed listening to the new insights into the role of global neurosurgery. These talks, especially reflecting on the African situation, enabled us to understand the challenges and opportunities of African Neurosurgery, and it also made me aware of the differences in medical education in Africa compared to that in other parts of the world. Another inspirational talk highlighted the efforts in global neurotrauma research. The morning sessions were rounded off with an interesting presentation about global anaesthesia. It was great to see how many efforts and endeavours already have been made. Subsequently, an interactive panel discussion with both Moroccan and international speakers took place.

Although the audience interacted with the panellists and created some engagement, it was the afternoon workshops that truly involved everyone. The barriers were clearly broken down and the talks became more open, with a much higher level of informality. In the afternoon, I joined the screening of the Checklist Effect, an eye-opening documentary elucidating the urgent need and shortcomings of surgical equipment and care around the world. I valued my second workshop too, being “The World of Global Surgery and Anaesthesia”. This high-level panel discussion by internationally-renowned neurosurgeons offered the opportunity to engage in a passionate exchange of ideas on the past, present and future of global surgery and global anaesthesia. We all left the room satisfied of this energizing debate, which consolidated our knowledge and left us with better understanding of the critical issues. I believe the amount of ambassadors for global surgery that day surged, or at least we got hope for positive future developments. As the icing on the cake, the national Moroccan soccer team qualified for the 2018 World Cup that day.

Overall, the first student-led Global Neurosurgery conference was a unique experience and it was great to have been part of it.

The Case for Human Resources for Health in Realizing the Sustainable Development Goals

In the past years and decades, many efforts have been made to increase access to healthcare on a global scale, yet even today, one in seven people will never see a single health worker in their entire lives. In fact, the crisis in human resources for health (HRH) has recently surpassed health system financing as the most serious obstacle to realizing the right to health within countries, calling for urgent upscaling and a drastic change in global priorities.

<Dominique Vervoort>

The World Health Organization (WHO) estimates that, globally, over 4 million additional health workers are needed to overcome the health workforce shortages in the 57 countries with the most critical needs. [1] However, the actual number is expected to be much higher (when including global disparities and countries with less critical shortages), with the deficits expected to rise to 12.9 million health workers by 2035. [2] In addition to the absolute shortages of healthcare providers, there is a severe imbalance in the distribution thereof between and within countries. Most healthcare workers, especially specialists, concentrate in urban areas, creating increasing challenges for rural populations to access healthcare services. As a result, one billion people worldwide will never see a healthcare worker in their entire lives, with the far majority residing in lower- and middle-income countries (LMICs), which are faced by (1) lower rates of training health workers, (2) fewer overall resources for health, and (3) brain-drain of trained health workers to high-income countries (HICs).


Today, modern globalization and resulting liberalization of markets lead to a complex health workforce migration pattern from LMICs to HICs. Moreover, the demand for healthcare is rising as a result of the large ageing population in more developed countries and the increase in the world’s population. Simultaneously, low-income countries continue to struggle with an unfinished agenda of infectious and non-communicable diseases. As a result, the HRH crisis is sustained and expected to worsen in upcoming years unless urgent measures are taken. To work towards the attainment of the Sustainable Development Goals (SDGs), health workforce and systems strengthening is needed on a global level.

 

Scaling up human resources for health is key in addressing the third Sustainable Development Goal (SDG3: Ensure healthy lives and promote wellbeing for all at all ages by 2030), especially with a focus on reducing global maternal mortality rates, neonatal and child mortality rates, reducing the number of deaths and injuries from road traffic accidents. The WHO estimates that at least 23 health workers per 10,000 population are needed to achieve the SDGs, yet 83 countries still fall under this threshold. [2] Of these, the African region has the highest burden in terms of workforce density, whereas the absolute shortages are highest in Southeast Asia, as a result of the larger population. [3]

 

Despite reduced maternal mortality rates in the past few years (with a 44% drop from 1990 to 2015), 830 women worldwide continue to die from preventable causes during childbirth every day, of which 99% occurs in the developing world and rural areas. [4] In LMICs, mortality rates are as high as 239 per 100,000 live births, whereas HICs face only 12 deaths per 100,000. As such, the SDGs aim to further reduce mortality rates to less than 70 per 100,000 live births, through adequate antenatal care, availability of skilled health workers during childbirth (including obstetricians or trained healthcare workers if a caesarean section is needed), and proper follow-up after birth.

In the developing world, only little over half of all mothers and children have access to skilled healthcare professionals during and shortly after childbirth, not only putting a mother’s health at risk, but also that of the newborn. [5] Neonatal (less than 28 days old) deaths account for 45% (2.7 million) of under-5 mortality, with 75% taking place in the first week after birth, and almost half within 24 hours. Of these, up to two-thirds could be prevented if access to skilled health workers was available, in order to prevent and limit complications (e.g., infections, asphyxia) and perform adequate health measures in the beginning of the newborn’s life (e.g., promote breastfeeding, keeping the baby warm).

 
When looking at all children under 5, approximately 5.9 million children continue to die on an annual basis worldwide, of which roughly half could be prevented through preventive or curative measures. [6] These rates are much higher in LMICs compared to HICs, with, for example, sub-Saharan Africa suffering from 14x higher child mortality rates compared to industrialized countries. Access to health workers is crucial in reducing child mortality, through proper education, prevention (e.g., vaccines), timely treatment and surgical care.


Lastly, every year, 1.25 million people die on the roads and another 20 to 50 million people remain injured or disabled as a result. Shockingly, 90% of road traffic mortality occurs in LMICs, especially the African region, despite having “only” 54% of the world’s vehicles. Road traffic injuries pose a major economic burden, not only for individuals and their families, but also for entire nations, costing them up to 3% of their gross domestic product (GDP). Although prevention and increased road safety should be the main focus in addressing these mortality and injury rates, timely access to health and surgical care is needed to adequately treat victims of road traffic crashes and limit morbidity and mortality thereof.

 
If we are to achieve the health-focused Sustainable Development Goals by 2030, emphasis should be put on human resources for health, which are a key component in improving access to healthcare and the delivery of healthcare services. With a rapidly increasing world population -especially in those countries needing improved access to healthcare the most- urgent upscaling is needed on a global level in order to prevent the human resources for health crisis to turn into an expanding global nightmare.

NB: This article was originally published in the 36th edition of Medical Students International (MSI36), the biannual online magazine of the International Federation of Medical Students’ Associations (IFMSA).

References:
1. World Health Organization. The World Health Report 2006 – Working Together for Health. 2006. Geneva: World Health Organization.
Available at http://www.who.int/whr/2006/whr06_en.pdf

2. Global Health Workforce Alliance, World Health Organization. A Universal Truth: No Health Without a Workforce. November, 2013. Geneva: World Health Organization.
Available at http://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/

3. World Health Organization. Health Situation in South-East Asia Region 2001–2007. 2008. New
Delhi, India: World Health Organization.

4. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387 (10017): 462-74.

5. World Health Organization. Newborns: Reducing Mortality. 2016. Geneva: World Health Organization.
Available at http://www.who.int/mediacentre/factsheets/fs333/en/

6. World Health Organization. Children: Reducing Mortality. 2016. Geneva: World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs178/en/

7. World Health Organization. Global Status Report on Road Safety 2015. 2015. Geneva: World Health Organization. Available at http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/

The Checklist Effect – Boston Screening

About 200 students from medical schools around Boston joined in the HMS Amphitheater on August 28th for the screening of the Checklist Effect documentary. The screening was hosted by the Boston chapters of the Global Surgery Student Alliance (GSSA) and sponsored by the Kletjian Foundation. Students came from Harvard, Boston University, and Tufts medical schools as well as other undergraduate colleges around the Boston area. The focus of the screening was to impress upon the importance of quality, safety, and ethics in global surgery.

<Prachi Patel>

The screening began with opening remarks from Kris Torgeson, Global CEO of Lifebox, who described to the audience what brought upon the idea of the Checklist effect. The Lifebox partners for years have been helping to deliver safer surgery projects across the world. However, delivering stories of these projects and experiences has not always been an easy task. The Checklist effect, based off the development of the Surgical Safety Checklist by surgeon, author, and Lifebox founder Dr. Atul Gawande, allows for an impactful story to be told to audiences across the world. Thus, accomplishing a crucial step in creating safer access to surgery globally.

The documentary screening itself discussed the quality, safety, and ethics in global surgery, especially in low-resource countries. It focused on the implementation of the surgical safety checklist under different settings, and how this implementation changed the lives of not only the doctors and nurses running the OR, but also the patients and their family. The documentary not only lets the audience into OR’s across the world, but also gives insight into the struggles faced by doctors and patients alike when proper resources are not provided.

Following the hour long screening of the documentary, audience members were able to attend a panel discussion on global surgery. The panelists included Dr. Atul Gawande, Chairman of Lifebox and Executive Director at Ariadne Labs, Dr. Brian O’Gara, Global Anesthesiologist at Beth Israel, Dr. Sabrina Sanchez, Global Trauma Surgeon at Boston Medical Center, and Dr. Victoria Mui, Global OB/GYN at Tufts Medical Center. Discussion revolved around the future direction of the surgical safety checklist, the experiences as a global surgeon, and how medical students can become advocates for change. The final keynote was given by Parisa Fallah, a second year medical student at Harvard Medical School and National Chair of GSSA, who gave a wonderful closing to the event and provided information regarding similar future events.

Undoubtedly it is within your power to contribute significantly to shaping the societies of the coming century; youth can move the world.”- Paris Fallah

InciSioN Sierra Leone – Safe Surgery & Universal Health Coverage Conference

SLEMSA held its 3rd national general assembly on the 22nd -23rd August, 2017 at the Bank Complex in Freetown. The GA is a conference that brings together medical students in the country. It is aimed at building the capacity of medical students in various subject areas including soft skills that they will need in the future as healthcare providers. The theme for this year’s conference was “Safe Surgery and Universal Health Coverage”. Access to safe surgical care is crucial for the population of Sierra Leone, yet the vast majority of the population has no access to skilled surgical care, largely due to high cost and because of shortages of staff equipment, drugs and supplies.

<Mohamed Bella Jalloh>

Over 350 medical students were in attendance and had the honor of hearing Professor Temidayo O. Ogundiran as the keynote speaker. He gave an insightful presentation on global surgery and the challenges of safe surgery in low- and middle-income countries like Sierra Leone. We also had the privilege of listening to the Director General of the National Social Security and Insurance Trust, where he talked about the Sierra Leone Health Insurance Scheme. There is a need for a reliable and sustainable domestic financing model to increase universal health coverage in an efficient and equitable way.

With surgical ailments being significant contributors to the global burden of disease, efforts to increase the interest and understanding in global surgery amongst medical students must be expanded. One crucial avenue toward achieving surgical workforce needs to involve exposing, educating and motivating medical students to participate in global surgery initiatives.

The second day of the conference offered unique training opportunities for students. We organized six sessions including global surgery and primary trauma care. The sessions were very much educative, interactive and fun-filled.

Inaugural Workshop Singaporean Global Surgery Student Interest Group

 

On August 12th, the Global Surgery Student Interest Group (Singapore) organized the very first student-led Global Surgery Workshop in Singapore, held at Lee Kong Chian’s Clinical Sciences Building.

<Jason Huang Juncheng>

Approximately 80 students from the three medical schools of the country came together to explore their passion for Global Surgery.

They were lucky to have Professor Russell Gruen, a commissioner of the Lancet Commission on Global Surgery, as a speaker.

Professor Russell Gruen

Professor Gruen shared invaluable insights on how Global Surgery is an emerging concern and how Singaporeans medical students have a role to play in the Asian region.

 

InciSioN partners with CSurgeries

InciSioN is happy to announce their latest partnership with CSurgeries, providing educational and research possibilities for students and surgeons alike, everywhere, in every setting.

CSurgeries: The Only Peer-Reviewed Surgical Video Journal

CSurgeries is an online surgical video journal dedicated to creating a centralized source of brief, peer-reviewed medical videos that are accessible to a wide audience, including students and professionals in all surgical disciplines. Created by surgeons for surgeons, CSurgeries aims to be a useful resource for teaching basic and complex surgical techniques, and a venue where surgical innovations can be shared across specialties. Enhance your learning by getting video publications delivered directly to your inbox.  

Become a member, publish videos, and contribute today

Contact for questions: editor@csurgeries.com

Bethune Round Table 2017

Many global surgery leaders from around the world joined in Ottawa from June 1-3rd for the Annual Bethune Round Table global surgery conference. Researchers came from Rwanda, Uganda, India, Zambia, Nigeria, South Africa, Bangladesh, Zimbabwe, Ethiopia, Canada, and the U.S. This year’s theme was “Evidence-Based Global Surgery.” The focus was to raise the standard of research being done in global surgery and to improve the way results are implemented in LMICs. 

<Parisa Fallah>

The conference began with a presentation from Dr. Ed Fitzgerald, a general surgery registrar in England. Dr. Fitzgerald runs GlobalSurg, an exciting research collaborative comprised of thousands of students and clinicians from 60 countries around the world. Rather than doing multiple smaller studies, GlobalSurg involves simultaneously collecting professionally crowd-sourced data from various sites worldwide, leading to large-scale studies that capture important trends in surgical care. Their most recent work includes developing a surgical instrument set for the bellwether procedures in global surgery.

One of the highlights of the conference was the Ab Guha Lecture given by Dr. Nobhojit Roy, who gave a talk titled, “Global Surgery 2030: What is Missing in the Discourse?” Dr. Roy filled in many of the gaps that exist between global surgery research and the way global surgery efforts are being implemented. He talked about topics that some have been more hesitant to discuss and left the audience with a lot of salient points to consider.

Other keynote speakers included Dr. Stephen Ttendo, who is working to build anesthesia capacity in Uganda, and Dr. Rachel Spitzer, who talked about equipping OB/Gyn trainees with the skills to participate in global surgery. The final keynote was given by Dr. Nadine Caron, who gave an incredible talk on the challenges to evidence-based indigenous health care in Canada and the importance of remembering that global can mean local as well.

Beyond the research presentations and keynotes, there were several workshops including: Innovation Development, Developing a Curriculum, Research in LMICs, Working with the World Bank, Advocacy for Political Change, Preparation for Successful Partnerships, and Getting Published in Global Surgery. There was also a banquet, where screenings of “The Checklist Effect” were shared and where director Lauren Brown talked about the value of media in enacting change. The conference ended on the final evening with multiple locally-hosted dinners that facilitated more conversations on global surgery.

From left to right: Dr. Laurence Bernard (Ob/Gyn resident), Dr. Adriana Ramirez (general surgery resident), Stacey Giles (nurse), Parisa Fallah (medical student), Dr. Andrew Giles (general surgery resident)

Several members of the Global Surgery Student Alliance (GSSA) leadership team were present, including Parisa Fallah, Dr. Andrew Giles, and Dr. Adriana Ramirez. Dr. Giles, one of the VPs for Residents/Trainees, presented his research on “Predictors of Obstetric Fistula Repair Outcomes in Lubango, Angola.”

As the InciSioN’s National Working Group (NWG) for the U.S., GSSA was able to have many conversations with key global surgery players at the conference and is now working towards partnering with Canadian medical students to help them develop their NWG in the coming year.

Look ahead to May 2018, when the Bethune Round Table will be held in Toronto. The theme is “The Role of Trainees,” so many will be listening closely to learn how they can support students and trainees in their localities who want to join the field of global surgery.