Global Scalpels: A Global Surgery Podcast

Each surgical subspecialty has unique sets of challenges when performing their specific procedures. In plastic surgery, procedures for complex burns, hand injuries, and congenital deformities can require tissue/skin graft preparation and microscopic reapproximation. These challenges are only exacerbated when resources are limited - both in terms of personnel and materials. Meet Dr. Metasebia Abebe, the first female plastic surgeon in Ethiopia and one of only a few specialists in her country where there are more than 1 million people per plastic surgeon! Join us as we discuss the complex care involved in treating hyena bites, the effects of climate change, and international fellowships for LMIC surgeons. This is one episode to remember!

​​The dawn of a new year brings new resolutions, new perspectives, and new hope. And what better way to kick off 2024 than with our latest episode – one that explores global surgical topics as well as life lessons. We are proud to present our guest, Dr Myron Rolle, a former American football (NFL) player turned neurosurgeon. In this episode, we will explore the finer nuances of positions of power within hierarchical structures, public health education models, neurosurgical access in the Caribbean, and racial disparities within medicine. Dr Rolle reminds us that each one of us possesses a unique and immeasurable value, and we must not allow anyone to diminish our worth. As we begin our journey into the new year, let us stand our ground, pursue our dreams, and remember that we are all capable of achieving greatness. Join us for our semi-centennial episode, as we celebrate 50 episodes of global surgeryl content! We hope this episode will help start your year the right way!

Leaving behind everything to escape war, persecution, or even natural disaster poses its own unique challenges. Forced relocation is difficult, creating a unique set of problems including housing, food, finances, and importantly, healthcare. Accessing these resources as a refugee is extremely difficult and uniquely convoluted. Refugee camps seek to be a safe haven for these underserved populations but pose their own unique challenges as well. With limited resources, experts like Dr Zachary Enumah are fighting to help provide essential healthcare in these settings, most recently in Tanzania. With over 500 live births per month, OBGYN services are vital to life, including c-sections and other emergency surgical services. Strategies to allocate funding, work with public health officials, and coordinate with medical boards to expand care are difficult but essential. Join us in this exciting episode with guest host Ashwin Reddy as we discuss the medical ethics behind care delivery in the camp, e-health to facilitate access, referral systems, and preventative strategies currently being deployed by Dr Enumah and his team!

As professionals working on a global scale, even the simplest of things must be challenged. Surgeons, lawyers, administrators, and many others, must adapt to become multifaceted individuals in this space. Surgery doesn’t just start and stop with the drapes. It involves supply chain, personnel management, legislation, advocacy, and so much more. In order to tackle these issues, it requires groundbreaking research to act as journalism to paint a picture of the story on the ground - the story of what is really happening. It is this research that helps to identify problems that can then be used to advocate for funding and innovation. Indeed, to challenge the current system. Our guest today exemplifies all of these attributes - a truly multifaceted and forward-thinking global surgeon. Dr Kiran Agarwal-Harding acts as the founder and president of multiple organizations including the Harvard Global Orthopaedics Collaborative and SONA Global, two organizations tackling both research and sustainability on a worldwide scale. Join us as we discuss GPS transportation barriers, shipping of implants, and even the invention process - conception of an idea, patents, and product testing, all the way to large-scale production of life-saving devices. You won’t want to miss it! For more information about these organizations, please see the following: HGOC: https://www.thehcorp.org/havard-global-orthopaedics-collaborative SONA GLOBAL: https://www.sonaglobal.org/

New year, new episode! After a brief pause, we are excited to be back to share with you more about the amazing initiatives happening around the world and major concepts within the field of global surgery. The episode today is focused on a topic relevant to every listener because we all have one - mothers! Women’s health is at the very core of medicine with the unique overlap of the creation of life with also the prevention of death. Our guest host specializes in several unique aspects of this cornerstone of healthcare, namely support for access and dissemination of contraceptive postpartum (the PPIUD project) as well as advocacy and education about the practice and effects of female genital mutilation or cutting (FGM/C). Working to create safe, culturally competent change around this practice is extremely charged - politically, culturally, and even religiously. With more than 200 million women subjected to FGM/C worldwide, there is a great need for education on harm reduction, teaching about women’s health/menstrual health, and so much more. Join us as we speak with Dr Anita Makins about advocacy at all levels with bidirectional teaching and education for the prevention of harm.

Delivery of surgical services in low-resource settings is extremely difficult. Supply chain issues, funding, shortages of supplies, and even lack of healthcare professionals are each enormous hurdles in and of themselves. What about when civil conflict arises and a war begins? Increases in different types of injuries start to plague the already fragile system. How does one get life-saving supplies via the already scarce supply chain when roads have been taken out by bombs or blocked by military personnel? Doctors, nurses, and support staff, all risking their lives each day just to show up and provide care. Join us with guest host Ala Magzoub as we talk with Dr. Shahrzad Joharifard about her work in the Democratic Republic of the Congo during civil conflict and the unique challenges inherent to surgical delivery in this space. In this robust episode, we also learn about anti-racism and helping people to self-identify racist, sexist, or homophobic actions and comments. As a healthcare team, safe and conscientious spaces are vital to the delivery of surgical services and each of us can do our part to encourage these practices from ourselves and others.

Global climate change directly affects every person on the earth today. Whether this is a simple temperature rise or abnormal weather patterns to complete displacement of one's living situation due to rising ocean waters, climate change is happening all around us. Many industries have sought to do their part to slow the progression including the migration to renewable energy resources, home solar panels, electric vehicles, or even recyclable cutlery. In medicine, we often discuss saving lives but this can come at a cost of not saving our planet. Join us as we speak with Dr Cliff Ewbank and guest host Vennela Avula as we discuss the impact of medicine on the climate and the effect that small things can have on our overall carbon footprint such as changing anesthetics, turning off operating room lights, migration from disposable instruments, or even restricting traveling to academic conferences. The question becomes how to save a life while not simultaneously putting all lives in danger…

When we discuss global surgery, we often focus on the physical workforce that it takes to support a patient through their surgical needs. The other side of this process is the digital or mechanical support that makes surgery all possible. It is easy to take for granted the countless computers, x-ray machines, ventilators, and more. We often don’t recognize the biomedical engineering that takes place to make all those tools function - we just know it works (but often not how it works). Acquiring these machines in low-resource settings is important, however, understanding how the machine works and how to maintain it is equally as important for its longevity as a surgical tool. In an effort to help, there has historically been a flow of second-hand or cheaper machines from high-resource environments to low-resource environments however often without the needed tech support, product manuals, or training to upkeep them. End-of-life equipment can be common and its utility is limited. Donations are vital to the progression of surgery in these settings but can sometimes create more of a burden than a support. Join us as we speak with Tom Monahan, the prior director of Biomedical Engineering at Health Equity International and previous Master Biomedical Technician at Massachusetts General Hospital about the engineering challenges of surgical equipment and strategies for tackling this problem at the grassroots through apprenticeship and training models.

In commemoration of Pride month this month, we wanted to highlight a population within society, but particularly in the field of global surgery, that is often left behind. The LGBTQ+ community has experienced high rates of discrimination and ostracization resulting in higher rates of mental illness, suicide, and even drug use. Further, LGBTQ+ patients encounter a very unique set of barriers within healthcare globally. For example, in many countries, significant others/partners of LGBTQ+ are not recognized as legal unions. This lack of legally legitimate status can pose issues when healthcare proxy decisions need to be made. Further, LGBTQ+ may have decreased number of children due to society and logistical pressures not experienced by heterosexual counterparts. This leads to a lack of access to needed elder care in regions where children and offspring predominantly handle elder care. Lastly, access to “luxury treatments” such as hormone therapy and gender-affirming surgery is extremely limited around the world leaving many transgender patients without access to potentially life-saving medications and surgeries. It is the job of clinicians to treat all patients fairly and with respect. Fair, does not necessarily mean the same, however. Recognizing how to interact with, respect, and support people of all backgrounds is essential as human beings. Putting ourselves in the shoes of other people brings new perspectives and insights. Join us in this special episode with Dr. Steven Orr as we highlight implicit bias within the surgical realm, the promotion of diversity and inclusion in surgery, and how to encourage the health and safety of all patients - regardless of sexual orientation or gender.

Lights, camera, ACTION! With the continued evolution of social media and technology, content creators can share their talent widely throughout the world without the need of a stage crew, make-up artist, costume designer, scriptwriter, director, etc. etc. etc.; in fact, you can do it from your very own living room with your iPhone! While it doesn’t take an army to create the content, it can be just as powerful and impactful as anything on the big screen. Many of these posts can reach tens of millions of people in a matter of hours and have the power to create movements (think the ice bucket challenge), shape culture, influence fashion, and even affect finance. All from the press of a button. Our guest today is doing just that. With more than 40,000,000+ impressions across TikTok and his other social media platforms, Joel Bervell has become an “influencer turned medical educator” who is tackling health disparities, racial bias in medicine, and global youth empowerment like no one else. Join us on one of our most interesting episodes to date as Joel shows us the man behind the screen, his views on how anyone can become a content creator for a cause, and how to challenge what we think we know. You won’t be disappointed!

The beautiful thing about surgery is that it has the power to change lives in ways that no other field can. Surgery is often used to correct physical deformation. Whether that is a fractured femur from a motorcycle accident, a craniotomy to relieve pressure on the brain, or an appendectomy to remove a ruptured appendix, each of these procedures helps to restore a person back to “whole”. What we don’t often talk about is when these procedures are needed to help bring a person back to whole when many places in the world do not acknowledge that this person has a deficit or even needs to be fixed. They fail to recognize the dissonance between the person’s soul and body. As one of the most vulnerable citizens in society, transgender individuals have staggering rates of harassment, discrimination, and violence. Although their fight is not seen as a medical issue by some, our guest today is helping to tackle this issue to provide safe access to gender-affirming surgery. Join us as explore these sensitive and important issues including the personal, legal, medical, and surgical process of gender affirmation surgery, female genital mutilation, and clitoral restoration surgery. This is an episode you won’t want to miss!

Asking questions is at the very core of education. Surgical education specifically is a unique circumstance in which “learning” directly affects the lives of others - sometimes in very negative and real ways. Thus, tackling training of new surgeons around the world has very real consequences that can help increase access to needed care around the globe but in safe and competent ways. The goal of surgery is to be effective, safe, and have the desired outcome. Learning how to ask questions and learn essential procedural skills through accessible materials is the goal of Drs. Priyanka Naidu and Zach Collier. Join us as we talk about how they are using hackathons, self-assessments, apps, language translation, and dynamic education materials to learn and/or refresh surgical skills to be able to address the current gap in surgical knowledge and open doors to safe and affordable surgery globally.

Imagine if you arrived at your house and there were dozens of Amazon boxes at your door. None of which you had ordered. You open them only to find random items – a hairbrush, t-shirts that are way too big for anyone in your household, a toaster, and ice cream that is now all melted since you didn’t know it was there and should be refrigerated. Further, this doesn’t happen just once. It happens over and over again. Each time with a new set of items, all of which you didn’t order and may or may not even need. The items start piling up and boxes are everywhere. Despite your best efforts to keep up, stuff just accumulates and clutters your house. The items are unusable to you and impeding your access to your own space and effectively just becoming trash. Now imagine if you got a knock at your door. It’s a random person unknown to you, claiming to be a contractor. They let themselves in and start accessing your home and telling you they need to tear down this wall, re-route a pipe, change light fixtures, etc. They may even start doing these things without consulting you first or getting your permission. They never present any type of license or ask your opinion “because they are the expert and know best”. This is how it can feel in some global health situations. While people are trying to help, external aid can often be misdirected and create new, additional problems. The sending of supplies to resource-poor settings is often ill-informed and becomes like the Amazon analogy – trash. Incredible resources that are donated but unusable in their setting, incomplete material sets, not sorted, or frankly, not needed. The receiving institution may not be equipped to deal with the influx of these donations, and they become a burden rather than a help. This is compounded by physicians and surgeons offering their services regardless of the stated needs of the area, often leaving the local physicians to clean up the aftermath of post-operative checks, new medication management, and physical therapy needs. Join us as we talk with Dr. George Dyer, an orthopedic surgeon/professor at Harvard Medical School and orthopaedic advisor for Partners in health, about trash (disguised as donations) and the need for need-directed donations, education, and effective surgical support. You won’t want to miss this!

4 hours? 7 hours? 10 hours? Look around you. Chances are you have a cell phone, tablet, or computer within reach (you are reading this after all). The number of hours an individual spends on their electronic devices each day continues to rise every year. With mobile devices reaching almost every corner of the earth, access to technology has never been easier. So how can we use this technology to do good? And how can we harness it specifically for surgery? The term “virtual reality” is often used but it’s not something I know a lot about. Simulating an experience in which the user can interact with a created world around them is the very heart of virtual reality. This is what Dr Fabio Botelho is trying to tackle - using virtual reality to teach paediatric trauma care. Using virtual scenarios where a clinician can talk with nurses, order tests, and work with patients, this simulated world enables just about anyone to gain knowledge and training in a real but standardized and measurable way. Surprisingly, it is actually cheaper than many other forms of training and the power to be able to disseminate the course is diverse and scalable. Join us as we explore a range of topics including virtual reality, pediatric trauma training, and burnout in this exciting new episode!

Our episode today covers a debilitating and life-threatening condition that disproportionately affects those in developing countries around the world. Affecting more than 150,000 people annually, Noma is a fatal infection of the face and mouth with the mortality rate approaching more than 90 percent and the morbidity/sequelae are permanently debilitating. Noma is a result of acute necrotizing ulcerative gingivitis (infection of the gums) which can rapidly spread and destroy other facial tissues. This can lead to struggles with eating, talking, and even breathing for affected individuals - if they even survive. Not only does this affect their activities of daily living, but it also affects their social interactions; often becoming shunned or excluded from societies and families due to the severely disfiguring and unpleasant aftermath. Further, the social and economic deprivation and political insecurity are staggering. A simple internet search before this episode will put the condition in context. Despite the high fatality rate and crippling aftermath, noma is a sorely neglected disease that can be prevented with multidisciplinary treatment. Join us in this episode as we speak with Dr. Bukola Oluyide and Charity Kamau as we discuss Noma as a condition, efforts that are being done to tackle it, and the sociological/anthropological aspects that remain following disease in its many forms.

Children are one of the world’s protected populations. Indeed, they are the very make up of our future as a race. They bring new life, ideas, and opportunities we can only dream of. Unfortunately, not all children around the world have equal opportunities to contribute to this future. In 2019 alone, more than 5 million children under 5 years died from preventable and treatable causes - many of which are due to lack of surgical access. While there are many initiatives to help combat these alarming findings, many projects are condition specific (e.g. clubfoot, cleft palate, etc.) or have teams that work in silos from other parties that may benefit. They lack a “we” or “us” mentality and rather an “I” phenomenon. To help address this issue, the Lancet Commission on Global Surgery developed The Global Initiative for Children’s Surgery (GICS) in 2016. Join us today as we talk with Professor Kokila Lakhoo, a paediatric surgeon at Oxford, as she shares with us her insights into global collaboration as past president of GICS. We also explore the importance of trainee programs, advocacy, and training true doctors that have no borders.

Findings from studies published in The Journal of the American Medical Association (JAMA) report that more than 45% of resident physicians experience burnout and the numbers are continuing to climb. If that number didn’t surprise you, then you are well aware of the psychological stress and struggles that doctors and other healthcare workers experience on a daily basis - particularly during this recent pandemic. As a result, more than 1 in 10 physicians said they had suicidal thoughts. Unfortunately these thoughts often become action with suicide deaths among physicians is 250-400% higher than similar counterparts in other occupations. These suicides lead to more than 1 million patients losing their medical expert in the US alone - leaving a substantial number of underserved and vulnerable populations without healthcare services. As these statistics show, mental health is a major issue among physicians and our speaker today is attempting to help alleviate that. Join us as we talk with Dr Paola Fata about protected spaces (including protected nap spaces!), increasing positive feedback and value, community ties, and helping to bring ourselves back to center in safe environments.

Undergoing surgery is an extremely multifaceted process that includes physical, mental, and social aspects to make it successful. Often when we talk about surgery, we focus on the physical and neglect these other important parts. This is where social work can bring all the pieces together to include the biopsychosocial approach to surgical care - an inter-disciplinary model that connects these three important patient factors. Join us as we talk in this episode about how Drew and Alison are helping to tackle this issue for pediatric populations around the globe!

Humans are inherently social creatures. For centuries we’ve learnt to survive, adapt and overcome through collaboration and unity. Medicine, in particular, highlights the value of taking input from multiple specialities and healthcare professionals to optimise patient care. However, with the power of modern technology, does this collaboration need to be confined to a single hospital? Why shouldn’t we collaborate with experts from around the world? Intersurgeon.org aims to establish a new paradigm to ensure the standard of clinical care is high no matter the setting. By harnessing the knowledge of over 600 specialities worldwide, this free service drives the pursuit of equitable and safe surgery. Join us as we dive deeper into the work of Paediatric Neurosurgeon Dr James “Jim” Johnston, co-founder of Intersurgeon with Guest Host Daniel Lowe a passionate Medical Student from Australia as we discuss how to facilitate regional LMIC collaboration and the value of ‘coral reef’ networking.

Healing takes time. To heal means to regenerate, to align and to gain strength. Wound healing, in particular, highlights the power of the human body in times of crisis – manipulating its resources and cells to restore homeostasis. But what happens when that fails? What happens if it’s a traumatic wound that gets infected, fails debridement? In high-income settings, the simple answer is negative pressure wound therapy – which costs thousands of dollars a device. But that’s not sustainable in every environment around the world. Here creativity and innovation rise from the ashes as Hattian and International surgeons and engineers were able to push the boundaries of function and cost for low-resource settings. Join us in this incredible episode as we talk with Haitian orthopaedic surgeon Dr Christina Dejean Soray on her low-coast “Turtle VAC”, finding solutions based on what you see clinically, and advice on being female and navigating a heavily male-dominated speciality!