Global Surgery

Capacity Building and Systems Innovation

Global Surgery

Problem

According to The Lancet’s Global Surgery 2030 report, more than five billion people lack access to safe, affordable surgical and anesthesia care when needed. Meeting the actual global surgical disease burden would require adding a minimum of 143 million operations every year, primarily in the poorest regions of the world where there is a severe deficit in healthcare workforce and infrastructure. Moreover, of those who can access surgical care, 33 million individuals face catastrophic health expenditure each year as a result of costs incurred.

Approach

The CSPH’s Global Surgery Program is professionalizing global surgery to reach the neglected surgical patient. Through deep capacity-building, developing global surgery leaders, and linking to broad international surgical assessments and advocacy efforts, the Global Surgery Program is working to improve access to surgery for all.

Impact

From the program’s early days working on the World Health Organization Surgical Safety Checklist, which helped to reduce surgery-related deaths and complications around the globe, Brigham and Women’s Hospital has been a leader in advocating for the indispensable role surgery plays in global health.

Affiliate Faculty

Staff

Senior Project Manger – Wendy Williams, JD

Fellows

Rachel Koch, MD

Supporting the Next Generation | Education and Innovation

contextualizing continuing medical education and engaging in parallel professional development of future leaders/champions of increased access to quality surgical care for vulnerable populations.

Rwanda HRH Program

Brigham and Women’s Hospital serves as the coordinating partner for surgery for the Rwanda Human Resources for Health (HRH) Program. Going into it’s seventh year, the institutional twinning program, facilitating the training of physicians, nurses, health managers, and dentists, has introduced competency-based training and pedagogic innovation into the medical education system. A dozen general surgeons, surgical specialists, radiologists, and anesthesiologists travel to Rwanda to serve as faculty, lowering the ratio of faculty to residents and supporting the professional development of junior faculty. With 300 new SAOs (surgeons, anesthesiologists, and obstetricians) trained by 2023, the Rwandan surgical workforce has nearly quadrupled since the Program’s inception.

NOTSS-VRC

First rolled out at the University of Rwanda for a multidisciplinary cohort of surgeons, obstetricians, and anesthesiologists, Non-technical Skills for Surgeons: Variable Resource Contexts (NOTSS-VRC) is a contextually-adjusted course designed to improve operating room behaviors that impact patient safety. The course was developed and implemented by a team of CSPH and Rwandan faculty and trainees, utilizing text and video content created in Rwanda.

STARTLE

Surgical Techniques and Repairs in Trauma for the Low-Resource Environment (STARTLE), is a cadaver-based operative trauma course designed to teach surgical management. First taught in Mbarara, Uganda, this course was designed by a team led by Dr. Deepika Nehra for mid-level surgical residents. It has been replicated in Rwanda and Haiti.

Implementation | Policy and Practice

partnering with ministries of health, professional societies, and NGOs to incorporate evidence-based policy and practice into global health agendas.

  • NSOAP and Implementation
  • ACS Academic Global Surgery Forum
  • COSECSA, RSS partnerships
  • G4 Alliance

Recent Publications

General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits.

Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review.

Disparate outcomes of global emergency surgery – A matched comparison of patients in developed and under-developed healthcare settings.

Identification of the Critical Nontechnical Skills for Surgeons Needed for High Performance in a Variable-resource Context (NOTSS-VRC).

Using mobile health technology and community health workers to identify and refer caesarean-related surgical site infections in rural Rwanda: a randomised controlled trial protocol.

Critical Care Management of Peritonitis in a Low-Resource Setting.

Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes.

Improving Surgical Safety and Nontechnical Skills in Variable-Resource Contexts: A Novel Educational Curriculum.

Prevalence of Untreated Surgical Conditions in Rural Rwanda: A Population-Based Cross-sectional Study in Burera District.

Assessment of hemodynamic response to fluid resuscitation of patients with intra-abdominal sepsis in low- and middle-income countries.

Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti.

Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis.

Building Workforce Capacity Abroad While Strengthening Global Health Programs at Home: Participation of Seven Harvard-Affiliated Institutions in a Health Professional Training Initiative in Rwanda.

Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative Study.

Epidemiologic Characteristics of Pediatric Trauma Patients Receiving Prehospital Care in Kigali, Rwanda.