Off The Table: A Global Surgery Podcast

Welcome to our seventh episode, featuring the inspiring husband and wife duo, Dr. Nandakumar Menon and Dr. Shylaja (Shyla) Devi.

In this episode we welcome two extraordinary individuals who have made an enormous impact on improving healthcare accessibility and delivery for indigenous populations in rural India. Shyla, a gynecologist, and Nandakumar, a surgeon, selflessly dropped a successful practice and comfortable lifestyle in the United States to follow their dreams of starting a hospital for underprivileged populations in their home country. They landed in Gudalur Valley with dreams of aiding the Adivasi, a historically persecuted tribal indigenous population in India. The Adivasi have suffered from hundreds of years of prejudicial colonial oppression leading to their complete societal isolation. Abandoned by the government and cut off from modern medicine, the Adivasi lived in extremely poor health with debilitatingly high maternal and child mortality, and rampant casualties from treatable health conditions and complications.

This egregious neglect inspired the duo to help the Advisasi obtain adequate healthcare, and so, the Association for Health Welfare of the Nilgiri (ASHWINI) was founded in 1990. ASHWINI is a charitable organization with the mission of establishing healthcare facilities to serve the Adivasi. Most importantly, Shyla and Nandakumar knew that if they were to gain the trust of these individuals and truly make a difference, they would have to empower the Adivasi to embrace their own medical autonomy. They decided that these institutions must be both owned and managed by the Adivasi people themselves. Thus, in one of the most pristine examples of capacity building and decolonizing healthcare, the Gudalur Adivasi Hospital was established. This hospital has grown to have 50 beds and 8 community sub-centres. It trains and employs the Adivasi people as nurses and other healthcare personnel and is self-sustaining. They have managed to completely transform health outcomes in the Gudalur Valley, all while generating an impressive revenue stream for the people. Their secret to success: build capacity and trust first. If you can empower someone to take their health into their own hands, and give them the tools to do so, the rest will fall into place. In their eyes, the foundation of global health and surgery is altruism. They emphasize that “Healthcare has no beneficiaries”; if one wishes to truly make a difference, everything you do must be for the greater good of the people you are doing it for. Tune in to hear their incredible story.

You can learn more about their mission and accomplishments here: https://ashwini.org/new/ 

Check out their recently launched platform where health professionals can find job opportunities in rural areas in India and make a difference just like them: https://ruralhospitalnetwork.org/. 

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This episode we welcome the man who wears many hats; Dr. Abebe Bekele, founding Dean of the School of Medicine and Deputy Vice Chancellor at the University of Global Health and Equity (UGHE) in Rwanda. Dr. Bekele is a renowned thoracic Surgeon and a Professor of Surgery at Addis Ababa University, School of Medicine in Ethiopia. He is a fellow of the College of Surgeons of East, Central, and Southern Africa (COSECSA), the American College of Surgeons (ACS), the University of Washington, as well as the Foundation for Advancement of International Medical Education and Research (FAIMER). He has published innumerable journals, reports, and book chapters and has received international awards and recognition for his monumental contributions to the improvement of surgical care in SSA and worldwide. With Dr. Bekele, the term “many hats” is an overwhelming understatement, as his titles and accomplishments are far too vast to enumerate without composing a comprehensive memoir.

In addition to his clinical and academic ventures, he has taken on a prominent role as a global surgery advocate while demonstrating his infinite passion for health equity in all of its representations through his work and activism. He is the epitome of a global surgery and surgical education champion, and his proactivity in the promotion of gender equity, sustainable partnerships, and the decolonization of global health shine brightly in this field. This episode sees Dr. Bekele share his experiences and wisdom, beginning with a detailed description of his career path, ambitions, and moving through to his establishment of the School of Medicine at the UGHE. He details the pragmatic solutions that UGHE has adopted in order to tackle issues in gender equity as well as provide training on social justice, human rights, and social determinants of health to their medical students. If one thing is emphasized above all in this episode, it is the importance of establishing resilient and multifarious training programs for medical professionals. He accentuates that clinical training must be centered around district hospitals in order to create well-rounded acute care surgeons. Students may then attend larger urban referral centers for specialized procedures to top off their skillsets once they have mastered treating the most common pathologies that they will encounter first. Dr. Bekele proclaims the importance of the altruistic humanitarian aid that is being offered to address barriers to care in Africa, but emphasizes that this help must come in the form of an equitable and sustainable partnership in order for it to succeed. To facilitate this, the UGHE has designed a model –  The Seven Steps of Sustainable Partnerships.

Learn more at https://ughe.org/ 

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We are delighted to be joined by the incredible Dr. Brian Madison, president of South Sudan Orthopaedics and Trauma Society. Dr. Madison is an orthopaedic surgeon with a passion for global surgery. He is a dedicated advocate for the improvement of surgical systems in Africa. Born in Eastern Equatoria, before South Sudan was even recognized as an independent country, he comes from humble beginnings. After medical school in Khartoum, Sudan, Brian returned home to Torit; a no-man’s land of healthcare infrastructures. He loves his country, and describes his province as “paradise”. With passion and drive, he created his own career opportunities. From a surgical residency position in Tanzania to an orthopaedic trauma fellowship in Canada, he acquired the skillset needed to become one of only 11 orthopaedic surgeons in South Sudan.

He discusses the geographical, socioeconomic, and political barriers to accessing surgical care in South Sudan and provides insightful commentary regarding their current healthcare environment and how it may improve. We discuss the implications of low resources, brain drain, and conflict hindering the progression of South Sudan as a country. He excitingly announces the recent launching of his country’s Orthopaedic Surgery Society, of which he is the president. Their goal is to build a training program for orthopaedic surgery in their country, and partnerships with high-income countries’ academic institutions can help play a supportive role through clinical exchanges and capacity-building in research. Tune in to hear the astute perspective of Dr. Madison regarding the evolution of global surgery and the importance of establishing infrastructure which supports the sharing of knowledge and training.

Dr. Brian Madison on Twitter: @madisonbrian85

South Sudan Orthopaedics and Trauma Society: https://ssorthotrauma.com

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Welcome to our fourth episode, featuring special guest Dr. Bret Batchelor. Dr. Batchelor is a renowned Family Practitioner and Chief of Surgery at Queen Victoria Hospital in Revelstoke, B.C. He completed his medical degree at the University of Calgary before undertaking Rural Family Medicine training at the University of British Columbia and an Enhanced Surgical Skills residency at the University of Saskatchewan. In addition to his clinical work, Dr. Batchelor is the provincial lead for remote presence technology enhancements in BC’s Rural Surgical and Obstetrical Network Initiative. He is also a passionate advocate for the sustainability of rural surgical and obstetrical care across Canada. Check out Dr. Batchelor’s own medical podcast ‘Really Rural Surgery and Obstetrics’  for more. https://podcast.rccbc.ca. 

In this episode we sit down with a Canadian physician to discuss some of the implications of the advancement of surgical care in rural Canada and how this interconnects with global surgery affairs and advocacy in Sub Saharan Africa. Dr. Batchelor provides an insightful perspective on the core challenges of providing quality surgical care in hard-to-reach places. He reflects on his experiences in Africa, both learning new procedures and educating others. He speaks on the importance of sustainable capacity building in developing regions, and why it is crucial that these relationships are organic and orientated to both the current and future needs of the region. Dr. Batchelor sheds light on the logistics of ESS training for physicians, speaks about his podcast, and shares some extraordinary experiences with us. He anecdotally demonstrates the scalability of remote learning and how the new era of virtual education can solve a variety of global health and surgery obstacles. We are at the forefront of a constructive healthcare communications revolution, and Dr. Batchelor inspires hope that the future is bright. 

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This week we are ecstatic to be joined by the renowned Dr. Dieudonne Lemfuka, a general surgeon from the Democratic Republic of the Congo. Dr. Lemfuka is passionately involved in surgery, surgical education, global surgery advocacy, and Christian SIM missionary work. Dieudonne received his medical training from the Pan-African Academy of Christian Surgeons (PAACS) out of the Bongolo Hospital program in Gabon. He is a certified Fellow by the College of Surgeons of the East, Central, and Southern Africa (COSECSA). He currently works and resides in Monrovia, Liberia, as a General Surgeon and Surgical Education Coordinator at ELWA Hospital.

Tune in to immerse oneself in Dieudonne’s captivating memoir. Together we delve into his humble beginnings and navigate through the series of obstacles he’s conquered throughout his journey. After touching on some of his inspirations for pursuing surgical care, Dieudonne expresses his admiration for the organizations COSECSA and PAACS. He highlights the shared visions between the two, as well as the equitable opportunity for salvation that they provide financially-limited physicians with. Dieudonne articulates his concerns with doctor shortages in Liberia which lead to physician burnout. Fervidly speaking on the critical challenges that surgeons face when working in demanding environments in underdeveloped regions. Nonetheless, he remains optimistic regarding the future of these challenges and is committed to providing and teaching widespread, affordable, and high-quality surgical care. We then shift gears and discuss some of his thought-provoking contributions to academia, as well as his advocacy for equality of surgical care throughout Africa. He touches on his work as a Christian missionary, before providing us with one of the most compelling definitions of global surgery that we’ve received from a guest to date. 

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Introducing the awe-inspiring doctor and feminist extraodinaire, Dr. Marcella Ryan-Coker. Born, raised, and currently practicing in Sierra Leone, Dr. Ryan-Coker is an esteemed physician and global surgery advocate at the forefront of the inspirative humanitarian movement to improve surgical care in West Africa. She completed her MSc in Global Health and Development in 2018 at the University College London, and is currently completing another MSc in Surgical Sciences at the University of Edinburgh. She currently leads the International Students Surgical Network Sierra Leone National Working Group and is an active member on the Research Council of the Gender Equity Initiative in Global Surgery. Presently, Marcella has set her ambitious eyes on becoming an Orthopaedic Surgeon and we eagerly await the greatness she is destined to achieve.

In this episode, we discuss the complex journey of becoming a healthcare professional in Sierra Leone, as well as some of the challenges that this country faces in terms of supplying quality emergency and surgical care for their residents. After examining some of the solutions being implemented, Marcella passionately touches on some of her own experiences working with the Ministry of Health’s NGO hospitals, as well as her academic journey that evoked her passion in public health and global surgery. She stresses the importance of international agencies tailoring training and care directly to low income communities so that adequate and sustainable solutions can be brought forth. Finally, we have an important conversation regarding the intersection between gender equality and medicine, with specific regards to the barriers faced by women within this field. Marcella emphasizes the significance of having other female role models for support and guidance and she provides some advice for policy improvements that can amend gender equity in training and practice. 

Dr. Ryan-Coker's Blog: https://www.scrubsscalpelshighheels.com

Contact: 

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Dr. Emmanuel Makasa does not require an introduction, and he tells his story and career path better than anyone else. In short, he is an orthopaedics and trauma surgeon turned global health diplomat with senior management experience at the Zambian Ministry of Health as Deputy Director responsible for Emergency Health Services. He was Secretary General of the Zambia Medical Association (2007-2008) and Secretary General of the Surgical Society of Zambia (2006-2007). He is a counsellor for the UN and an advisor for several global health organizations such as the G4 Alliance and the Global Surgery Foundation.

We talk about the Lancet Commission, how he became involved and his perspective on the (lack of) practical applications of the Commission’s recommendations. He speaks passionately on the importance of engaging patients in global surgery initiatives. He highlights the importance of doing research on the social and economic impact of surgery on people’s livelihood and productivity. He encourages surgeons to be better advocates for their patients by leaving the cocoon of their operating rooms and speaking up about the positive impact of surgery and challenges they face. Emmanuel believes that we can help by creating partnerships between high-income countries and low-middle income countries’ academic institutions for graduate programs. When asked to choose a single actionable item he has the simplest and most impactful answer: “put the patient first”.

Thank you Dr. Makasa for this phenomenal conversation. We look forward to having you again on the podcast.

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