One World, One Standard of Care

On September 28th, Global Surgery Amsterdam, in partnership with Netherlands Society for International Surgery (NSIS)InciSioN NL, and Doctors of the World, hosted the One World, One Standard of Care symposium in Amsterdam. This symposium focused upon skills in global surgery and featured the launch of Global Surgery Amsterdam, a Dutch platform that aims to improve global surgical care by collaborating in research and educational projects. The following is a summary of topics and discussion that took place at this global conference.

By Dr. Matthijs Botman, NSIS

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Global Surgery Amsterdam (GSA)

GSA is a Dutch platform that aims to improve global surgical care by collaborating in research and educational projects. The platform is founded by specialists and residents in general and reconstructive surgery and was launched during the opening symposium on the 28th September 2018. At the symposium we discussed how individuals and organizations from high-income countries could improve surgical care in low resource settings.

GSA believes that partnerships between local stakeholders and international institutes/organizations are key to acquire the necessary access to essential surgical and anesthesia care. As we learned during the symposium, there is no ‘one size fits all’ approach and each situation requires a specific strategy with the local partner in the lead. GSA is here to help build these bridges.

What happened since the Amsterdam Declaration on Essential Surgical Care in 2014?

Prof Pankaj Jani, president of COSECSA and board member of the G4 Alliance, opened the symposium and provided an overview of the achievements of the sub-Saharan region. Despite the increase in local surgical residents and the set-up of training locations outside the capitals, the necessary number of surgeons is not yet reached. Ongoing funding and government support remain needed to improve the training programs. Prof Jani inspired the room by taking us on the journey of a lion cub growing into adolescence, and who is now looking for partners to expand its herd and become the king of the Savanna.

The ‘Amsterdam Skills Centre’ and the local NGO Friendship Bangladesh

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After a merger between the two academic hospitals in Amsterdam, the new institute is about to open The Amsterdam Skills Centre. Europe’s largest skills centre will build the next generation learning platform to generate, apply and spread the knowledge about new ways of surgical training. During the symposium we discussed and exchanged ideas with opportunities for future collaboration between local non-governmental organizations like Friendship Bangladesh and surgical societies like COSECSA.

On the Job training

For many decades, surgeons from Western countries have been sent on humanitarian missions to provide surgical care in low and middle-income countries. Surgical care was not a priority in international health strategies of leading organizations like the WHO. Within the global health community, the surgical missions were seen as 'parachute missions'. Teams flew in, performed operations and left after a couple of weeks. Patients were treated but there was no structured organization of surgical care in between the missions and knowledge transfer to support local health workers was rare. It was difficult to play a role in local training programs simply because these programs did not exist. Since the emerging global surgery movement started years ago, there has been more demand for structured training initiatives to train local people in providing surgical care. How do NGOs like CapaCare, Doctors of the World and Interplast experience these changes? An important conclusion after the session was that there might still be a role for foreign surgeons ‘on a mission’ for neglected surgical diseases but the quality requirements are high, especially regarding the quality of follow up. And training activities should be embedded in local programs in order to be effective.

Off the job training

The master-apprentice relationship as the cornerstone of the training medical specialists has had its day. The training for medical specialists takes a long time, is costly and little use is made of innovative learning methods. Video assisted learning has just started to make an entry into high income countries; but what about the LIMCs? In English it is called leapfrogging: to skip certain gradual changes in order to apply the latest innovations directly, for example to train medical specialists. How can we use medical technology in low-income countries and how can global health care benefit from this. Win-win situation or utopia that medical technology can replace that old master?

MLX, Incision and Touch Surgery showed new opportunities to learn quicker and better, thereby limiting the need to use patients as training tools. The gap between the high-tech western medical industry and the daily practice in low income countries is still enormous but the organizations shared a strong ambition to help to narrow this gap in the coming years.

Personal experiences

How are health workers trained to provide safe surgical care in low resource settings? The experiences of Avelina Temba, nun and surgeon from Tanzania, the experienced plastic surgeon Einar Eriksen from Ethiopia and global health doctor Tom Gresnigt, from Sierra Leone, revealed the need to tailor training initiatives to what the local doctors really need to learn for improving their work. Short-term missions that focus on specific surgical conditions often disturb local systems too much. Also, programs that aim to train for example skin grafting in a hospital without the necessary tools for the procedure are not very effective…

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Leadership, Management and Advocacy: Training Leaders in Surgical, Anaesthetic, Obstetric and Trauma Practitioners

By Patrick Mwai

In 2016, a COSECSA surgical NGO forum was held in collaboration with the G4 Alliance, the Alliance for Surgery and Anaesthesia Presence ( ASAP) and Surgical Society of Kenya.

The event, now termed the s-NGO Forum, was organized at the COSECSA Mombasa conference and attended by local, regional, and international representatives, local NGOs, professional societies, and international NGOs. The programme included a series of introductory exercises, NGO presentations, interactive and co-creation sessions, expert speakers and group discussions.

Key recommendations that emerged from the group discussions focused on four key themes for building local surgical capacity: 

1)    Leadership training with emphasis on advocacy training

2)    Establishing a Kenyan s-NGO network

3)    Information technology infrastructure and tools to support an s-NGO community/network

4)    Audits of facility for safe surgical anaesthesia care at level 4 facilities

This year, to fulfill the original recommendation of the 2016 surgical NGO forum, a Leadership, Management and Advocacy (LMA) MDI course was held in Kenya. The course consisted of 7 full days of hands-on training in LMA for surgical, anaesthetic, obstetric and trauma practitioners and other health managers. 43 participants, including surgeons, anaesthesiologists, clinical officer anaesthetists,  medical officers, theatre nurses, quality assurance officers, and administrators from public, private and faith-based institutions, attended the training at SOS Training centre, Karen, Nairobi from Sunday 21st-Saturday 27th October 2018.

  Group work session in progress!

Group work session in progress!

Process

The goal of the training program was to equip surgical, obstetric, trauma and anaesthesia care providers with leadership, management and advocacy capability to enhance efficiency and effectiveness in the surgical sub-sector in Kenya. Armed with this training, these leaders will in turn enhance the efficiency & effectiveness of public, private and NGO stakeholders and institutions in the surgical health sub-sector to improve the quality and increase access to surgical services in Kenya. The program was customised from the existing MDI program through consultative effort among health care partners in surgical health including the G4 Alliance, Amref Health Africa and Johnson & Johnson. 

To address gaps in leadership, management and advocacy skills within the surgical Health Sub-sector, the course was broken down into 8 different topics. These topics include; Leadership and Ethics, Planning and Operations Management, Health Information Systems and Data for Decision Making, Human Resource Management, Customer/Patient Care Management, Management of Resources, Management of Change and Advocacy for Surgical Health care Sub-sector.

  Prof. Charles Mayaka leads a session.

Prof. Charles Mayaka leads a session.

Significant outcomes

Two participants from each participating partner institution will be required to develop a Surgical Health Improvement Project (SHIP) based on a real issue/challenge within their institution. The project will be implemented in the partner institution following the training and continue for 6 months, during which time the participants will receive support and mentorship from the faculty.

This project highlights the critical need for leadership and advocacy in improving health systems. With effective leadership and management of health systems and service delivery, the barriers to scaling up services for marginalized populations can be broken.

 Prof. Pankaj Jani, COSECSA, gives closing remarks

Prof. Pankaj Jani, COSECSA, gives closing remarks






Global Surgery at UNGA73

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Clockwise from top left: HE Robinson Njeru Githae (Ambassador of Kenya to the USA); Dr. Jaymie Ang Henry (Founding ED and Senior Advisor, The G4 Alliance;  Henry Family Advised Fund);  Ms. Demi-Leigh Nel-Peters (Miss Universe 2017); Ms. Erin Anastasi (Coordinator, Campaign to End Fistula, UNFPA).


‘Making the United Nations Relevant to All People: Global Leadership and Shared Responsibilities for Peaceful, Equitable and Sustainable Societies’  - this theme, the thread woven throughout the 73rd UN General Assembly, speaks to the critical role of partnerships in achieving the Sustainable Development Goals. This theme, of course, is closely connected to global surgical equity, an essential aspect of achieving the SDGs, Universal Health Coverage, and to peaceful, equitable, and sustainable societies.

Despite the need for safe surgical and anaesthesia care in achieving the SDGs and UHC, there are currently 5 billion people living around the world without access to this essential part of primary care. For these patients, easily preventable and correctable surgical diseases can quickly become physically and financially devastating. To highlight this global inequity as well as the partnerships that are forming to address it, The G4 Alliance and partners hosted “Eradicating Neglected Surgical Diseases: Advancing Universal Health Coverage Through Surgical Systems Strengthening” for an event that brought together government representatives, global surgery stakeholders, and civil society leaders to discuss the eradication of neglected surgical diseases and surgical systems strengthening as an essential part of Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs).

The session featured remarks from His Excellency Robinson Njeru Githae, Ambassador of Kenya to the United States and a special message from the President of Kenya announcing a national commitment and pilot initiative to eradicate neglected surgical diseases.

Opening remarks were shared by Ambassador Dr. Neil Parsan, Chair of the G4 Alliance and retired Ambassador of Trinidad and Tobago to the United States and Mexico, Ms. Demi-Leigh Nel-Peters, Miss Universe 2017, Dr. Jaymie Henry, Henry Family Advised Fund, Founding Executive Director of the G4 Alliance and UN Representative for the International Federation of Surgical Colleges, and Ms. Erin Anastasi, Coordinator for the Campaign to End Fistula at the United Nations Population Fund. 

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Left to right: Ambassador Dr. Neil Parsan (Chair, the G4 Alliance & Special Advisor, World Bank Group Former Ambassador of Trinidad and Tobago to the USA and Mexico), Dr. Esther Njoroge (Regional Director for Africa, Smile Train), Dr. Augustino Hellar (Surgeon and Regional Technical Advisor, Jhpiego), Ms. Natalie Draisin (Director, North American Office & United Nations Representative, FIA Foundation). 

A highlight of this session was a roundtable discussion, featuring regional experts speaking on the topic of neglected surgical diseases and collaborative strategies to address these conditions through surgical systems strengthening. Speakers included Dr. Esther Njoroge, Regional Director for Africa with Smile TrainDr. Augustino Hellar, Surgeon and Regional Technical Advisor at Jhpiego, and Ms. Natalie Draisin, Director of the North American Office and UN Representative for FIA Foundation.

The event wrapped up with a call to action to Member States and civil society partners to work together to eradicate neglected surgical diseases and support the principles of Health for All, first outlined in the Alma Ata declaration 40 years ago!

On behalf of our partners, thank you for joining us to help build priority for life-saving surgical and anaesthesia care as part of the UHC and the SDGs.

The G4 Alliance
Henry Family Advised Fund
Smile Train
Jhpiego
Global First Ladies Alliance

WHO Launches First-Ever Global Burn Registry

  Image Credit: WHO/DTR

Image Credit: WHO/DTR

WHO has launched the Global Burn Registry - the first-ever global platform allowing for standardized data collection from burn victims. This new resource will provide health facilities with a clear picture of the factors most likely to contribute to burns and the populations at greatest risk in their settings, with a view to prioritizing prevention programs.

Burns account for an estimated 180,000 deaths per year, the vast majority of which occur in low- and middle-income countries, mainly in homes and workplaces. Non-fatal burn injuries are a leading cause of morbidity, leading to prolonged hospitalization, disfigurement and disability, often with resulting stigma and rejection.

High-income countries have made considerable progress in lowering rates of deaths from burns. This has been achieved through a combination of proven prevention strategies ─ among them promoting safer cook stoves; advocating for the use of smoke detectors, fire sprinklers, and fire-escape systems in homes; and lowering the temperature in hot water taps ─ as well as through improvements in the care and treatment of burn victims. Most of these advances have been unevenly applied in low- and middle-income countries.

 Image Source: The design and evaluation of a system for improved surveillance and prevention programmes in resource-limited settings using a hospital-based burn injury  Accessed: questionnairehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853523/

Image Source: The design and evaluation of a system for improved surveillance and prevention programmes in resource-limited settings using a hospital-based burn injury

Accessed: questionnairehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853523/

Further hindering progress is the fact that data collection for burn injuries is weak, making it difficult for countries to rationally prioritize prevention strategies. WHO and a global network of experts, therefore, undertook a collaborative effort to address this, with the aim of developing this simple data collection tool. The resulting Global Burn Registry has been finalized following extensive pilot testing which took place in 60 health facilities across 30 countries (See related article at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853523/).

The Global Burn Registry is based on an easy-to-use data collection form that is used for patients with burns who are admitted to a health facility, and it takes approximately 5 minutes to complete. Data can be accessed and exported through the online registry interface maintained by WHO. The data collection form, as well as the online interface, are available in English, French and Spanish.

The online interface allows users to view data from their health facility as well as all other participating health facilities. Data from the Global Burn Registry (which are stripped of reference to information which allows identification of individual patients) are publicly available, and can be accessed and exported for further analysis by researchers, policy-makers, and additional stakeholders. The online platform also provides extensive data visualization and filtering capabilities.

To learn more about the Global Burn Registry and to participate, please go to http://www.who.int/violence_injury_prevention/burns/gbr/en/.

G4 Alliance Permanent Council Meeting at #WHA71

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The 3rd G4 Alliance Permanent Council Meeting convened over 50 members, observers, and partners and brought in a number of speakers from the global health community. Thank you for joining us for discussion, networking, and advocacy. We are grateful for the support of our member organizations and the work they do to bring safe surgical, obstetric, trauma, and anaesthesia care to the world's 5 billion neglected surgical patients!

Together, we are working towards our collective target of:
Safe Surgical and Anaesthesia Care for 80% of the World by 2030!

 

Meeting Materials

PC Meeting Slide Deck
Photos

Don't Forget to Check Out Our New Advocacy Toolkit!


G4 Meeting Highlights

Meeting Overview
The 3rd Permanent Council (PC) Meeting featured updates from our PC Officers, Board of Directors, Secretariat and Working Groups.  We also engaged in interactive sessions to better refine our plan of work and chart out a course of action to support our collective target of 80% by 2030 and our goal of increasing access to safe, timely and affordable surgical, obstetric, trauma and anaesthesia care for all those in need. 

 

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Networking
Member networking represented a special focus of this PC Meeting. Participants had the opportunity to engage in a "speed-dating" exercise to get to know their fellow G4 members and foster further partnerships. Feedback was also collected from members to define thematic breakout groups, which met over lunch to share ideas and network. On day 2, members shared specific examples of how engagement with G4 has been valuable in fostering collaboration with fellow members, supporting new partnerships, and improving the effectiveness and impact of their organizations. 

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The G4 Alliance strives to leverage the strengths of our network to support member collaboration. The G4 team and our Working Groups will continue working to identify strategies to best support member engagement and networking. Some examples of ongoing work include our Member Mapping project and online advocacy resources.  We would welcome your comments and suggestions to support member networking and meaningful collaboration!

Guest Speakers

This year, we were pleased to welcome a diverse lineup of exceptional speakers. Special guest speakers shared their knowledge and expertise in areas including global surgery, health workforce, effective advocacy strategies, fundraising,  policymaker engagement, and gender equality.

 Ambassador Dr. Neil Parsan, Dr. Roopa Dhatt, Mr. Saul Billingsley and Ms. Carla Eckhardt

Ambassador Dr. Neil Parsan, Dr. Roopa Dhatt, Mr. Saul Billingsley and Ms. Carla Eckhardt

Day 1 Speakers

Effective Global Health Advocacy

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This panel featured experts who discussed their experiences leading successful advocacy movements to promote gender parity at all levels of global health leadership, and to incorporate road safety as part of the post-2015 sustainable development agenda.

Dr. Roopa Dhatt
Executive Director & Co-Founder,
Women in Global Health


Mr. Saul Billingsley
Executive Director, FIA Foundation

Moderator: Ms. Carla Eckhardt (ACOG) 

 

Day 2 Speakers
The second day of our PC Meeting featured a number of speakers who shared their perspectives and advice with G4 members. Sessions were structured as interactive discussions to maximize dynamic engagement. 

 Mr. Jim Campbell shares perspectives from the WHO Health Workforce Department

Mr. Jim Campbell shares perspectives from the WHO Health Workforce Department

 Ms. Ellen Agler addresses the G4 Permanent Council. 

Ms. Ellen Agler addresses the G4 Permanent Council. 


Perspectives from the Global Health Workforce Community

Mr. Jim Campbell
Executive Director, Global Health Workforce Alliance & Director, Health Workforce Department, WHO

Mr. Vince Blaser
Director, Frontline Health Workers Coalition

Policy Engagement & Resource Mobilization
Ms. Ellen Agler
CEO, The End Fund

 Dr. Walter Johnson provides an update from the WHO Emergency and Essential Surgical Care Programme

Dr. Walter Johnson provides an update from the WHO Emergency and Essential Surgical Care Programme

WHO Updates and Recommendations
Dr. Walter Johnson
Emergency & Essential Surgical Care Programme Lead, Department of Service Delivery and Safety Department, WHO

Our thanks to Dr. David Ljungman who joined us to share an update regarding next steps to advance our joint Statement on the Collection of Surgical and Anesthesia Statistics. This publication was authored by the German Global Surgery Association & Harvard PGGSC, and published by the G4 Alliance. Over 120 global organizations endorsed this statement, which was launched during the 49th UN Statistical Commission in March 2018. 

 

We would like to thank all members who took the floor to facilitate sessions, share feedback and provide updates. 

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Interactive Planning Sessions & Expert Working Groups

Interactive planning sessions were facilitated by Sara Anderson (ReSurge International) to help us review our strategic plan and identify highest-value activities to be supported by our network. Member recommendations will be integrated into the secretariat's work plan and will be reflected in future activities. 

G4 expert working groups were also reviewed and reorganized to maximize efficiency and member engagement. Current groups include:

  • Advocacy 
  • Data Platforms (Member Mapping & Perioperative Case Log Data)
  • Membership
  • Advocacy for Improving Surgical Capacity
  • PC Meeting Planning

 

G4 PC Meeting Photos

Find event photos Here.


Thanks to all members who joined us for our 3rd PC Meeting in person or remotely. Your continued participation and engagement is essential to the success and impact fo the G4 Alliance!

 

Recap: Global Surgery at the 71st World Health Assembly

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Do not tell us that this cannot be on the agenda. Do not tell us that this cannot be done.
— Dr. Atul Gawande at The Safe Surgery for Women Advocacy Event

The global surgery network came out in full force for during this year's World Heath Assembly (WHA). In addition the largest global surgery WHA delegation on record, there was no shortage of advocacy events highlighting the cross-cutting nature of surgical care as part of the global health and development agenda. 

Keep reading for a summary of global surgery campaigns and events hosted in parallel with the WHA.  

  

WHO 5-YEAR PROGRAM OF WORK

On January 22-27, 2018, the World Health Organization (WHO) Executive Board met in Geneva to review the WHO's plan of work for the next 5 years. The Draft Thirteenth General Programme of Work (2019-2023) represents a guiding document that determines the priorities and scope of work of WHO for the years to come.

The G4 Alliance launched a campaign with our members to ensure the explicit inclusion of  safe and effective surgical, obstetric, trauma, and anaesthesia care as part of this plan. We submitted a letter of support to WHO Director-General Dr. Tedros on behalf of the G4 Alliance network and called upon Member States to prioritize this issue  as well as the collection of national surgical and anaesthesia indicators.

In the original draft of the WHO Programme of Work circulated in November 2017, surgical care was not included.  However, thanks to the collective advocacy of our network and surgical care champions, the latest version includes a mention of "safe and effective surgery" as an essential component of primary health coverage.  Additionally, surgical indicators were included in the 2018 Core Indicators reference document which includes health-related indicators relating to the Sustainable Development Goals. 


#SafeSurgery4Women Twitter Chat

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Around the world, women and girls are disproportionately affected by lack of access to safe surgical care - but why? And how can we close this gap for the advancement of women everywhere?
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In the lead-up to WHA71, the G4 Alliance, GE Foundation, the Partnership for Maternal, Newborn & Child Health, Women in Global Health, and Safe Surgery 2020 hosted a #TwitterChat to discuss pressing questions about women and safe  surgery with the global health and global surgery community.

Featuring Contributions From:

  • ACOG
  • CCBRT/Kupona
  • COSECSA
  • IntraHealth International 
  • Jhpiego
  • Lifebox
  • ReSurge
  • Operation Smile
  • Many Others!
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Key Themes

Safe surgery is necessary for women's health and economic and social empowerment. We must increase access to save women's lives. 

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Barriers to women in global surgery are social, economic, and geographical, both as patients and as healthworkers. Investing in the healthworkforce, and prioritizing women's leadership within the healthworkforce, is key to overcoming these barriers. 

To address gender inequities in global surgery at the individual and institutional level, we must collect data on women in global health and global surgery.

Does your organization have data on women as part of the surgical health workforce?

Share your findings as part of this WHO-led report!

Thanks to all for your participation and your insights!

 

Global Surgery: A Powerful Strategy for Advancing Women's Health

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On May 21st, 2018, more than 200 people gathered to hear from global surgery and women's health champions on the essential role of safe surgical care in advancing women's health. 

  President Michelle Bachelet and Dr. Edna Adan share a smile during the #SafeSurgery4Women panel. 

President Michelle Bachelet and Dr. Edna Adan share a smile during the #SafeSurgery4Women panel. 

Speakers discussed how innovation is critical to ensuring surgical care is accessible and affordable in low-income countries with high maternal and newborn mortality rates. They explored the role of female providers in safe surgery, obstetrics, and anaesthesia, outlining the challenges for women in those fields as well as strategies for meeting challenges head-on. They spoke to the progress that we have made in advancing global surgery and the distance we still must travel to ensure that all women have access to safe, affordable surgical care to enable a life of full of purpose and power. 

  Dr. Lauri Romanzi and Dr. Bisola Onajin-Obembe discuss the challenges that female health workers providing surgical, obstetric and anaesthesia care often face. 

Dr. Lauri Romanzi and Dr. Bisola Onajin-Obembe discuss the challenges that female health workers providing surgical, obstetric and anaesthesia care often face. 

We must support women working in global surgery, recognizing the challenges they face and providing proactive solutions. We must support the delivery of safe surgical care for girls and women throughout every stage of their life. We must ensure surgery is prioritized for local health systems strengthening, for national health plans, and for international action. 

 

 

The Message is Clear: 

Safe surgery advances women. 
Women advance safe surgery. 

My challenge to the world is…to allocate 0.001 percent of the GDP specifically for safe surgery and safer obstetric care. If our women and our children are not worth 0.001 percent, then we’re not worth anything at all.
— Dr. Edna Adan, Founder and Director, Edna Adan Maternity Hospital Former Foreign Minister of Somaliland & First Lady of Somalia

#SafeSurgery4Women Advocacy Event

Event Photos

Video Library

 

High-Level Panel
Featuring: President Michelle Bachelet, Dr. Edna Adan, Dr. Mpoki Ulisubisya, 
Dr. Atul Gawande and Ms. Terri Bresenham

Opening Remarks
Featuring: Ambassador Dr. Neil Parsan and Mr. Gustavo Perez-Fernandez

A Conversation with Obstetric & Anaesthesia Champions
Dr. Bisola Onajin-Obembe and Dr. Lauri Romanzi

Surgical Care Innovators in the Spotlight
Ms. Cheri Reynolds, Mr. Hannington Segirinya

The Patient Perspective
Video and story provided by Safe Surgery 2020


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The G4 Alliance Permanent Council Meeting

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G4 Alliance members met in parallel with WHA71 to discuss advocacy, policy, and resource mobilization. The meeting featured working group reports, networking and presentations, and an array of guest speakers including Dr. Walt Johnson (WHO), Ms. Ellen Agler (The END Fund), Mr. Jim Campbell (WHO), Dr. Roopa Dhatt (Women in Global Health), Mr. Vince Blazer (Frontline Health Workers Coalition) and Mr. Saul Billings. Thank you to all members and observers who joined us in Geneva! 

Find an in-depth recap of our meeting here.


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Unfinished Journey: The Global Health Response to Children & Road Traffic

Road Traffic Injuries (RTIs) are the leading cause of death among people aged between 15 and 29 years.  At this year's World Health Assembly, the Child Health Initiative and the FIA Foundation launched their new report on this global crisis at an advocacy side event hosted with partners including UNICEF, Save the Children, NCD Child & the NCD Alliance, the World Health Organization and the G4 Alliance. These organizations and individuals came together to support a call for a UN summit and integration of road traffic-related health issues into the mainstream child health agenda.

Ambassador Dr. Neil Parsan represented the voice of global surgery and highlighted the urgent need for stronger, affordable emergency health services, including trauma surgery, to stem the overwhelming casualties on our roads. 

Learn More

“The SDGs need to be all embracing, not just on the page but also in practice. Currently there are words but no money, no resources to mitigate the full impact of traffic on child health.”
— Saul Billingsley, Executive Director of FIA Foundation

Other Global Surgery Events

How a Checklist is Transforming Global Surgery

 Organized by Lifebox and the Global Health Centre at the Graduate Institute  in Geneva

  Credit: @JohnMeara on Twitter

Credit: @JohnMeara on Twitter

Attendees joined surgeon and author Professor Atul Gawande in a conversation with Professor Ilona Kickbusch, the Director of Global Health Centre, as they considered: How is access to safe surgery fundamental to meeting the SDGs? What influenced the remarkable spread of the WHO Surgical Safety Checklist around the world? What are mechanisms that can promote surgical equity when 5 billion people lack access to safe surgical care?

Website

 

Briefing: How Can We Scale-up Surgery and Anesthesia to Achieve Universal Heath Coverage?

Organized by the World Federation of  Societies of Anaesthesiologists (WFSA), Lifebox, the NESTA Challenge Prize Centre and the G4 Alliance

 Credit: @Challenge_prize on Twitter

Credit: @Challenge_prize on Twitter

This event featured an expert pane including Dr. Atul Gawande, Dr. Adrian Gelb (WFSA/G4), Dr. Lubna Samad (Indus Pakistan/G4), Dr. Abebe Bekele (Ethiopia), and Mr. Daniel Berman (NESTA). During this session, WFSA announced the first-ever joint WHO and WFSA guidelines to standardize safe anaesthesia. Partners also announced a call for the creation the first ever NESTA Surgical Equity Prize to stimulate solutions for improved surgical care in low- and middle-income countries (LMICs). 

 

WHO Emergency and Essential Surgical Care (EESC) Programme Technical Side Event

Organized by the World Health Organization

  Credit: @KrisTorgeson of Lifebox

Credit: @KrisTorgeson of Lifebox

This open technical meeting brought international experts in global surgery, obstetrics, and anaesthesia together to discuss the development of national surgical, obstetric and anaesthesia plans, from financing surgical care delivery platforms, information management and data, and current and future workforce needs.

View Speakers and Learn More

 

Global Surgery Day 

On May 25, 2015, the same historic year that saw the unanimous passage of resolution 68.15, InciSioN founded Global Surgery Day, a day intended to unite the global surgery community in advocacy and awareness. This year, the theme for Global Surgery Day was "Equity in Surgery", highlighting not only the need for surgical access for 5 billion neglected surgical patients around the world, but also for equity across all aspects of global surgery. 

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Global Surgery Day saw celebrations and presentations across the globe, as well as the launch of a new national working group. InciSioN hosted a Twitter chat in partnership with The G4 Alliance, the WFSA, the Harvard PGSSC, bringing a flurry of social media advocacy for equity in surgery. 

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“The world is shouting, all you have to do is listen.”
— Dominique Vervoort, InciSioN

Read More about Global Surgery Day Here. 

 

If you would like to share a blog post you have written on a WHA71 Global Surgery event, or give thoughts and comments on a session, please email communications@theg4alliance.org. 

 

Surgical Equity for the Forcibly Displaced

Every minute, 20 people are displaced due to humanitarian emergencies. Forced to flee their homes and everything they know, the displaced population is in a constant state of transience - typically characterized by uncertainty and dread. Their statelessness denies them the right to employment, mobility, and education, but most perilously, it denies them access to adequate health care. The deficit in health services for refugees is significant on the primary and secondary level, but the shortfall is principally felt on the tertiary level - meaning that access to basic health care is limited but access to surgical care is close to impossible.

According to a 2016 study conducted by the John Hopkins Bloomberg School of Public Health, we are currently facing the largest refugee crisis since the second World War. And within the crisis exists a devastating surgical shortfall. The study notes that at the end of 2014, 59.5 million people had been forced out of their homes due to humanitarian emergencies. At least 2.78 million
surgeries are needed annually for all the refugees worldwide - with children making up 52% of the demand. The study was the first of its kind to estimate the surgical needs of displaced persons, and only used the data of registered asylum seekers. As such, these numbers reflect the absolute minimum estimate of required surgeries. The actual sum is undoubtedly much more significant.

The target proposed by the Lancet Commission on Global Surgery states that the surgical volume should be 5,000 procedures per 100,000 population or higher. Only 15% of the world has met this target. The dismal percentage is reflective of the lack of surgical care globally, but also reflects the refugee population, whose surgical conditions are more often neglected than corrected. Refugees generally reside in countries with critically limited health care availability and, to add further difficulty, the first evacuated from conflict zones are generally the ill and injured. As such, the refugee population has a higher proportion of surgically disabled individuals and significantly lower chances of receiving the necessary referral or treatment. Thus, for refugees, the surgical shortfall is often felt two-fold and the unmet demand tragically culminates in unnecessary morbidity and premature mortality.

Despite the current shortfall, studies have demonstrated that the introduction of surgical care in refugee camps is both economically beneficial and realistically achievable. One such study, conducted in 2013 by Dan Poenaru and Victor K. Wu, examined the burden of surgically correctable disabilities among children in the Dadaab Refugee camp. By determining the cost-effectiveness ratio of the Disability Adjusted Life Years (DALYs) of each patient treated, divided by the aggregate cost of all surgical admissions, the study found the cost per surgically averted DALY to be $40 -$88. The values derived from the study reveal that surgery is both a “feasible and cost effective” intervention in refugee camps. Poenaru and Wu assert that this study, along with others conducted previously, reveal that surgical intervention often costs less in $/DALY than other medical treatments that are generally pursued within healthcare systems.

Refugee Stats II (2).png

Considering the high number of surgically neglected refugees and the feasibility of improving access to surgical care, there is no excuse for the perpetuation of surgical disability within the migrant population. Over the past two decades, the global population of forcibly displaced people has grown substantially from 33.9 million in 1997 to 65.6 million in 2016, and it remains at a record high. As such, it is increasingly important for national healthcare systems and humanitarian assistance organizations to include surgical care for refugees in their assistance planning, resource allocation, and strategic improvements. The void in tertiary care for displaced persons runs at a high cost. Without improvements to surgical capacity for this vulnerable population, lives will continue to be lost and destroyed.

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For further reading on the topic please refer to the two studies linked below:

Global Estimation of Surgical Procedures Needed for Forcibly Displaced Person:

https://www.ncbi.nlm.nih.gov/pubmed/27225996

Burden of surgically correctable disabilities among children in the Dadaab Refugee Camp.

https://www.ncbi.nlm.nih.gov/pubmed/23283220

Three Ways Smile Train is Using Technology to Better the World for Children with Clefts

This post is a guest post from G4 Alliance Member Smile Train. 

  Photo Credit: Smile Train

Photo Credit: Smile Train

 

Each year, more than 170,000 children are born with a cleft lip and/or palate in developing countries. Unfortunately, many of these children will not receive the care they need due to lack of access to the resources required for safe and quality treatment. The impact of an untreated cleft on these children’s lives goes far beyond simply cosmetic. Often, these children cannot eat, breathe, hear or speak properly. They are routinely ostracized and don’t attend school, ultimately barring them from being employable as adults. Since 1999, Smile Train, the world’s largest cleft organization, has pioneered new technology to help these children.

Smile Train’s innovative technology solutions support our unique model. Smile Train leverages the ‘teach a man to fish’ approach, focusing on training local doctors around the world to perform cleft surgery in their own communities.

Smile Train’s innovative technology solutions support our unique model. Smile Train leverages the
‘teach a man to fish’ approach, focusing on training local doctors around the world to perform cleft surgery in their own communities. Here are three ways Smile Train is using technology to drastically improve the lives of children around the world.

1) Speech Therapy App

speech app.jpg

Many children who are born with cleft palates require speech therapy post-surgery,
provided by skilled speech-language pathologists. However, some parents of children with clefts may lack access to speech-language services, based on their socioeconomic status, income level or geographic location. And even when initial speech-language services are provided, accessing ongoing therapy can be expensive or logistically challenging. To address this need, Smile Train – which has worked in 85+ countries
around the world – created a free, interactive smartphone application for children with
speech problems caused by cleft. This app uses stories, games, and songs to help
children with clefts improve their speech, and parents are encouraged to download this
app and use it to supplement their child’s cleft treatment. The app also lowers the
burden on families to travel for therapy, and the fun curriculum encourages children to
practice more often to yield better speech outcomes. The app is currently available in
English (“Smile Train Speech Games and Practice”) which will help not only children in
the developing world, but also children all over the world who may not otherwise have
access to speech services. It’s also available in Spanish (“Smile Train Habla y Lenguaje”).
To-date, the Spanish language version has 1,500+ active users in 15+ countries and has
been downloaded more than 11,500 times. Both versions are available on both iOS and
Android devices and can be downloaded in the Apple and Google Play stores.

2) Virtual Reality

Recently, Smile Train developed two virtual reality videos, truly bringing the work of our
local partners to life. The 3-D computer generated simulation allows viewers to fully
transport themselves to India as they follow along with two cleft children, Nisha and
Vikas, on their journeys to new smiles. The intensely immersive experience provides a
firsthand view of what life is really like for children in the developing world with
untreated clefts. While booking a plane ticket to India to see Smile Train’s local

programs in action may not be practical; taking a journey through the power of virtual
reality technology enables Smile Train to raise awareness for the millions of children
with untreated clefts still waiting for their new smiles and new lives. For more
information please visit: smiletrain.org/lp/360-smiles

Nisha Holding Before(1).jpg

3) Virtual Surgery Simulator

In 2013 Smile Train partnered with BioDigital Systems to launch the Virtual Surgery
Simulator, the first web-based, 3D, interactive surgical explorer for cleft care. Smile
Train’s Virtual Surgery Simulator provides surgeons around the world with next
generation surgical training technology for learning surgical techniques in cleft lip and
palate repair. By focusing on training local doctors to perform cleft repair surgery and
provide comprehensive cleft care in their own communities, Smile Train is able to create
a long-term, sustainable system. To learn more about the Virtual Surgery Simulator
please visit cleftsim.org.

While there is still a lot of work to be done, leveraging technology, brings us one step closer to achieving our goal for all cleft children to have access to safe, quality cleft treatment enabling these children to lead healthy and productive lives.

For more information about Smile Train and ways to get involved please visit smiletrain.org.

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