We have all experienced a challenging year thus far, and so in this edition of the PGSSC newsletter, we would like to showcase how our team continues to be committed to global surgery.

It is in the very midst of this global pandemic that we welcomed our new team of Paul Farmer Global Surgery Research Fellows and Research Associates. The PGSSC is working very differently this year than it has in the years past. For the first time in PGSSC history, we will not be meeting in person nor will we be traveling to our project sites. The year began with a virtual orientation in the summer and our enthusiastic and impassioned team members dove straight into creating and taking on projects, the details of which you will learn about in this edition.

As we continue to expand our global footprint, this year has also forced us to look inwards and face some difficult and raw conversations regarding racism and neocolonialism. Our team has been committed to this process, and we are actively focusing our efforts to ensure that we do justice to the "SOCIAL CHANGE" in our name.

PGSSC Team Spotlight

Deen Garba

My name is Deen Garba and I am a research associate at the PGSSC as well as a medical student at the University of North Carolina in Chapel Hill, NC.

As part of my work with the PGSSC I am working on Team Uganda with the formidable Dr. Adeline Boatin and the amazing Isioma Okolo. We are working primarily to understand challenges to equitable obstetric delivery in Uganda and Sub-Saharan Africa at large. I am also working with the Global Neurosurgery Initiative on several key projects aiming to increase sustainable access to neurosurgical infrastructure and care globally.

My time with the PGSSC so far has been an enlightening whirlwind of having my passions and beliefs challenged daily by outstanding fellow teammates. Despite the inherent challenges of virtual meetings, I feel immensely grateful that I am able to have meaningful conversations with likeminded and inspiring colleagues across time zones, which has only validated and further ignited my desire to visit these destinations in hopes of contributing to lasting social change.

Though it has only been a few months, I can easily see how this year will go much faster than I could have ever imagined. I look forward to the challenges and growth I will continue to experience alongside this PGSSC cohort, doubtlessly emerging a more improved version of myself as a result.

Isioma Okolo

My name is Isioma Okolo. I’m a junior fellow at the PGSSC and an obstetrics & gynaecology registrar in Edinburgh Scotland. As well as the Paul Farmer fellowship, I’m completing the MPH in Clinical Effectiveness part time at Harvard T.H Chan School of Public Health.

At PGSSC, I’m on team Uganda working with my inspiring mentor Dr Adeline Boatin, whose work focuses on maximising the quality of facility-based birth for mothers and newborn babies. My project specifically is investigating the overuse of caesarean deliveries in Uganda.  Alongside this, I’m part of the PGSSC financing team. Here we’re exploring ways to drive sustainable impact in Global Surgery, Obstetrics & Anaesthesia through research, policy and creative financial streams. I’m also involved in the early stages of projects on Female Genital Mutilation and cervical cancer in low and middle income countries.

Transitioning from full time clinical work to academia and studentship has been very interesting, with various challenges and opportunities. We’ve had to be creative about how we build connections and communities, whilst navigating various time zones and the awkwardness of the Zoom room. Though physically distanced, virtual connections have given me a different perspective on my colleagues. Unexpected cameos from pets, partners, children and glimpses of jazzy wall art and book collections have provided excellent ice breakers!

I have enjoyed being able to ‘attend’ multiple events in different continents on the same day. But have tempered all this with the need for self-care and intentional digital detoxing. Currently in my free time I am relearning how to run a marathon and perfecting my handstands. I’ve got my eyes on the Boston Marathon 2022!

Please visit our website to learn more about our other team members!

Academy Health: Annual Research Meeting

In July several of the PGSSC Fellows and RA's presented their work at the Academy Health 2020 Annual Research Meeting. Projects presented included gender equity among medical students in India, the Safe Surgery 2020 program in Tanzania, and surgical and anesthesia capacity assessments in Mexico and Guatemala.

Due to the COVID-19 pandemic, the meeting was held virtually this year, and our participation involved both synchronous presentations during live events and asynchronous presentations for the virtual poster hall. While this format was new to most of us, our team worked together to share tips and ideas on how to best communicate our findings through this virtual platform. And without the limitations of cost and travel associated with an in-person meeting, we also may have been able to reach a wider audience than was previously possible.

As more conferences are being converted to virtual formats, these lessons will likely be very useful for our team in the upcoming year!

Here are a few of the visual abstracts that the team created as a snapshot's of their presentations. If you are interested in learning more, click here to view the presentations.

COVID 19 and Surgical Care Webinar

As part of the COVID-19 Seminar Series hosted by the Harvard Medical School Department of Global Health and Social Medicine, PGSSC organized and hosted a webinar entitled “COVID-19 and Surgical Care” on May 21. PGSSC program director Dr. John Meara opened the session with an overview of the COVID-19 pandemic and a discussion of the need for international cooperation in combating it. Former fellows Drs. Alex Peters and Vatshalan Santhirapala then shared experiences from New York City and London, respectively, and current fellow Dr. Alaska Pendleton discussed the creation of the COBRA line team at Massachusetts General Hospital in Boston.

Former research associate Dr. Nabeel Ashraf, Lancet Commissioner Dr. Nivaldo Alonso, and Dr. Sadoscar Hakizimana, OB-Gyn at Partners In Health - Rwanda, then shared their experiences working in Pakistan, Brazil, and Rwanda, respectively, and how surgical care in their communities had been affected by the pandemic. Dr. Abebe Bekele, dean of the University of Global Health Equity in Rwanda, then gave an overview of the impact of COVID-19 on surgical care delivery in Africa. These effects ranged from increasing delays in access to care due to difficulty finding transport, interruption of medical and surgical education and training, diversion of resources away from surgical care, and the risks and stress faced by healthcare workers treating COVID patients in hospitals without sufficient testing or PPE available.

Finally, Dr. Kee Park highlighted investing in surgical systems strengthening as a “best buy" for pandemic preparedness. The session ended with a lively discussion between Dr. Paul Farmer and the rest of the panelists, covering topics such as how to safely reintroduce surgical services and the social inequities highlighted by the pandemic. The session made it very clear that the global community cannot ignore surgical care, even during a viral pandemic, and in fact, investing in surgical care delivery and infrastructure may be a cost-effective way to strengthen health systems and their abilities to respond to future pandemics.

recording of this session can be found on the PGSSC Youtube.

UNITED NATIONS GENERAL ASSEMBLY: Side Events

This year’s United Nations General Assembly and its associated side events went virtual, and while we are looking forward to meeting in person again, the virtual platform provided opportunities for a new level of international engagement. PGSSC partnered with the G4 Alliance, InciSioN Global, and the World Medical Association to host a program of webinars about global surgery and leaders in the field. With the G4 Alliance, PGSSC hosted four events in a series titled, “From Pandemic to Progress: Building Capacity Through Global Surgical, Obstetrics, Trauma, and Anaesthesia Systems.” Surgery, obstetrics & gynecology, trauma, and anesthesia were each featured in their own panel discussions. Each panel included leaders in the field discussing the importance of each subspecialty in the broader global surgery movement. Here are a few quotes from the surgery panel:

Dr. Neema Kaseje, Founding Director, Surgical Systems Research Group: 

"We need to be more inclusive. These developments have been determined in the North. Women are not always represented. Youth are not always represented. Vulnerable segments are not always included."

"We need to make sure we are not parachuting in and out. International experts fly in and out. We need to leverage systems that are already in place, which if strengthened locally would have more impact."

Dr. Jim Kim, 12th President, World Bank 

"Investing in health and education is correlated more strongly to economic growth than anything (that most countries borrow from the world bank for) else. To prevent future expenditures and to promote growth, investing in health and education, in this case health, is important."

Dr. Emmanuel Ameh, Chairman, Global Initiative for Children's Surgery (GICS)

"Children’s surgery has been left out of existing surgery programs and existing child health programs, which has created large gaps for the care of children and the infrastructure required to take care of children. We need to train the required workforce. Training people takes time, and while we wait for that, we need to invest in training existing non-children surgery providers for essential and emergency surgical provisions."

Additionally, PGSSC partnered with InciSioN Global and the World Medical Association to host “Future of the OR: Youth in Global Surgery,” which featured a panel of young medical students and residents working in the field and their extraordinary accomplishments. Over 250 people from around the world were able to join this conversation of the importance of global surgery, why it is essential to engage youth in this cause, and how medical students, residents of all specialties, and healthcare workers in general can get involved.

Annual Report: 2019 - 2020

Click here to download our report!

Select PGSSC Publications

Investing in surgery: a value proposition for African leaders.
Jumbam DT, Reddy CL, Makasa E, Boatin AA, Rogo K, Chu KM, Nangombe B, Oladapo OT, Meara JG, Maswime S.
Lancet. 2020 Jul 4;396(10243):7-9. doi: 10.1016/S0140-6736(20)30482-7.

Cohesion Between Research Literature and Health System Level Efforts to Address Global Neurosurgical Inequity: A Scoping Review.
Ham EI, Kim J, Kanmounye US, Lartigue JW, Gupta S, Esene IN, Park KB.
World Neurosurg. 2020 Jul 13:S1878-8750(20)31515-1. doi: 10.1016/j.wneu.2020.06.237. Online ahead of print.

Emerging Trends in the Neurosurgical Workforce of Low- and Middle-Income Countries: A Cross-Sectional Study.
Kanmounye US, Lartigue JW, Sadler S, Yuki Ip HK, Corley J, Arraez MA, Park K.
World Neurosurg. 2020 Jul 18:S1878-8750(20)31588-6. doi: 10.1016/j.wneu.2020.07.067. Online ahead of print.

Pediatric trauma primary survey performance among surgical and non-surgical pediatric providers in a Brazilian trauma center.
Botelho F, Truche P, Mooney DP, Caddell L, Zimmerman K, Roa L, Alonso N, Bowder A, Drumond D, Abib SCV.
Trauma Surg Acute Care Open. 2020 Jul 21;5(1):e000451. doi: 10.1136/tsaco-2020-000451. eCollection 2020.

Validating the Global Surgery Geographical Accessibility Indicator: Differences in Modeled Versus Patient-Reported Travel Times.
Rudolfson N, Gruendl M, Nkurunziza T, Kateera F, Sonderman K, Nihiwacu E, Ramadhan B, Riviello R, Hedt-Gauthier B.
World J Surg. 2020 Jul;44(7):2123-2130. doi: 10.1007/s00268-020-05480-8.
PMID: 32274536 Free PMC article.

Toward a complete estimate of physical and psychosocial morbidity from prolonged obstructed labour: a modelling study based on clinician survey.
Roa L, Caddell L, Ganyaglo G, Tripathi V, Huda N, Romanzi L, Alkire BC.
BMJ Glob Health. 2020 Jul;5(7):e002520. doi: 10.1136/bmjgh-2020-002520.
PMID: 32636314 Free PMC article.

Training Neurosurgeons in Myanmar and Surrounding Countries: The Resident Perspective.
Lepard JR, Corley J, Sankey EW, Prentiss T, Rocque B, Park KB, Rock J, Hlaing K, Myaing W.
World Neurosurg. 2020 Jul;139:75-82. doi: 10.1016/j.wneu.2020.03.114. Epub 2020 Apr 3.
PMID: 32251819

Emergency and essential surgical healthcare services during COVID-19 in low- and middle-income countries: A perspective.
Ma X, Vervoort D, Reddy CL, Park KB, Makasa E.
Int J Surg. 2020 Jul;79:43-46. doi: 10.1016/j.ijsu.2020.05.037. Epub 2020 May 16.
PMID: 32426019 Free PMC article.

Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns.
Jumbam DT, Menon G, Lama TN, Lodge Ii W, Maongezi S, Kapologwe NA, Citron I, Barash D, Varallo J, Barringer E, Cainer M, Ulisubisya M, Alidina S, Nguhuni B.
BMC Health Serv Res. 2020 Aug 8;20(1):725. doi: 10.1186/s12913-020-05559-x.
PMID: 32771008 Free PMC article.

Identifying essential components of surgical care delivery through quality improvement: An updated surgical assessment tool.
Lin Y, Raykar NP, Saluja S, Mukhopadhyay S, Sharma S, Frett B, Enumah S, Iverson KR, Johnson W, Meara JG, Shrime MG.
Int J Surg. 2020 Aug 15;82:103-107. doi: 10.1016/j.ijsu.2020.08.002. Online ahead of print.
PMID: 32810595

We Asked the Experts: Global Surgery-Seeing Beyond the Silo
.
Umutesi G, Davies J, Hedt-Gauthier BL.
World J Surg. 2020 Aug 18:1-2. doi: 10.1007/s00268-020-05747-0. Online ahead of print.
PMID: 32812135 Free PMC article. No abstract available.

Development of a surgical assessment tool for national policy monitoring & evaluation in Ethiopia: A quality improvement study.
Iverson KR, Ahearn O, Citron I, Garringer K, Mukhodpadhyay S, Teshome A, Bekele A, Workneh S, Workneh RS, Zemenfeskudus S, Gultie T, Varghese A, Shrime MG, Meara JG, Burssa D.
Int J Surg. 2020 Aug;80:231-240. doi: 10.1016/j.ijsu.2020.03.025. Epub 2020 Mar 19.
PMID: 32198096

Diagnosing Post-Cesarean Surgical Site Infections in Rural Rwanda: Development, Validation, and Field Testing of a Screening Algorithm for Use by Community Health Workers.
Cherian T, Hedt-Gauthier B, Nkurunziza T, Sonderman K, Gruendl MA, Nihiwacu E, Ramadhan B, Gaju E, Nahimana E, Habiyakare C, Ntakiyiruta G, Matousek A, Riviello R, Kateera F.
Surg Infect (Larchmt). 2020 Sep;21(7):613-620. doi: 10.1089/sur.2020.062. Epub 2020 May 18.
PMID: 32423365 Free PMC article.

Travel Time to Access Obstetric and Neonatal Care in the United States.
Roa L, Uribe-Leitz T, Fallah PN, Williams W, Jarman MP, Bergmark RW, Boatin AA, Molina RL.
Obstet Gynecol. 2020 Sep;136(3):610-612. doi: 10.1097/AOG.0000000000004053.
PMID: 32769634 No abstract available.

Bellwether Procedures for Monitoring Subnational Variation of All-cause Perioperative Mortality in Brazil.
Truche P, Roa L, Citron I, Caddell L, Neto J, Reis M, Moore E, Botelho F, Alonso N, Watters D.
World J Surg. 2020 Oct;44(10):3299-3309. doi: 10.1007/s00268-020-05607-x.
PMID: 32488666