I decided to become a doctor at the age of 12, while my family was spending the summer in the Philippines. My young mind could not grasp how and why so many children died of communicable diseases that were easily treated back home. I couldn’t comprehend growing up in a place where there just weren’t enough physicians to provide basic medical care. This motivation to make a difference in global health carried me through medical school and an MPH degree. Several of my mentors during my MPH studies questioned my desire to enter a career in surgery, encouraging me instead to pursue a career in pediatrics or Infectious Diseases- a specialty that, in their mind, was more useful for someone wanting to pursue a career in global health. What they perhaps did not appreciate, and what I can now better articulate, is that a career in global surgery IS a career in global public health. Most of us have heard the numbers published by the Lancet Commission on Global Surgery in 2015…..5 billion people in the world without access to basic emergency surgical care when needed…. 143 million additional operations needed every year to meet this need…. vast disparities in the surgical workforce between high and low/middle income countries (LMICs)…..surgery is an “indispensable, indivisible part of basic health care provision”. These are big numbers, overwhelming numbers. Where do we start, and how can we make a difference?
I used to think that the only way to be involved, to participate in improving global health care, is to move to a foreign nation, and set up practice. This is one way, but not the only way. There is growing momentum behind the concept of “twinning”, or the development of partnerships between academic institutions in high income countries, and hospitals/academic institutions in LMICs for purposes of developing collaboration around patient care, clinical research, workforce education, and surgical capacity building. There are advantages to this model- resource sharing (money, minds, expertise) between institutions, mutual education of residents from both programs, utilization of the expertise of practitioners in the LMICs regarding culturally-relevant, feasible, sustainable workforce solutions, among others. As these partnerships have been established, we have seen a dramatic increase in the number of general surgery residency programs offering global surgery electives, and increased attention to global surgery as a viable academic pursuit.
I recently had the privilege of being the Lloyd Nyhus Traveling Fellow of the US chapter of the International Society of Surgery, and traveled to Basel, Switzerland for the World Congress of Surgery. The ISS represents 6 member societies (International Society of Endocrine Surgeons, International Association for the Surgery of Trauma and Surgical Intensive Care, International Association for Surgical Metabolism and Nutrition, International Society for Digestive Surgery, and the Alliance for Surgery and Anesthesia Presence) and surgeons from more than 100 countries. There were 48 fellows from around the world, and one of the greatest benefits of attending the meeting as a Traveling Fellow was the opportunity to interact with them. Although coming from very diverse backgrounds, languages, and countries, I was struck, by our common goal to provide the best possible care to our surgical patients, with whatever resources were available to us. We exchanged ideas on ways to improve patient care and surgical education. One program in Rwanda recently hosted a research training program for their residents, to provide formal education around devising and conducting a research study. Another program in Kenya is beginning a competency-based skills training curriculum to provide a means by which to evaluate their residents’ technical skills prior to moving on to the next year of training. Many of these individuals are conducting truly excellent, insightful research (largely on their own time and without training or research support) in resource-constrained settings, and are directly improving access to care, surgical education, and surgical capacity. I met a pediatric surgery from Nigeria who spends her evenings maintaining her own personal database of patients with gastrochisis that she cares for. She has noted that, despite managing gastroschisis differently in Nigeria that in the US, her patients do very well, and she would like to study this formally. I could not help but think about how we, as the Association for Academic Surgery, might partner with these educators and researchers as a means to increase international involvement and attract bright, energetic new members. The expertise amongst our members is vast, and I would love to see how the AAS might foster and support international research and surgical education collaborations through similar traveling fellowships to attend our annual meeting, research training courses, or even offering a session by which an international researcher who cannot travel to the meeting can present his or her work remotely. Some of these efforts are already underway through the AAS Global Affairs Committee, and I look forward to continued opportunities to meet with other engaged individuals of various backgrounds and perspectives, foster relationships and collaborative efforts, and synergize novel strategies to address the vast burden of surgical diseases across the globe.