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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