Sister Surgeons

Sister Surgeons reviews evidence on the where, what and how global health is undergoing transformation through remedial decolonization, and how it supports the work of students, health trainees and accomplished health professionals who are, or who hope to, "be the change they want to see in the world".  Here are some tools to guide your journey as an equity champion, particularly when engaged outside your home countries. 

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Prof Madhukar Pai, Chair of Epidemiology and Global Health, McGill University in Forbes "Global health research needs more than a makeover"

Winners take all: The elite charade of changing the world - by Anand Giridharadas

No White Saviors on Twitter 

Velin L, Lartigue J, Johnson SA, et al: (2021) Conference equity in global health: a systematic review of factors impacting LMIC representation at global health conferences BMJ Global Health; 6:e003455. Dr. Michelle Joseph is the head of this project at the Program in Global Surgery and Social Change, Harvard Medical School.

Dr. Michelle Joseph on Twitter

Hudspeth et al: Reconfiguring a one-way street: Equity in training - includes California's ground-breaking Guest Physician licensure process

Whetstone S, Autry M. (2018) Linking global health to local health within an ObGyn residency program. AMA JournEthics 20(3):253-60

Arora G, et al: (2017) Bidirectional exchange in Global Health: moving toward true global health partnership. Am J Trop Med Hyg 

Adams LV, et al: (2016) The future of global health education: Training for equity in global health. BMC Med Educ 

Umoren, et al: (2014) Fostering reciprocity in global health partnership through a structured, hand-on experience for visiting postgraduate medical trainees. J Grad Med Ed

Umoren, et al: (2012) Evidence of reciprocity in reports on international partnerships. Hindawi

Sister Surgeons shares Global Health Equity and Ethics for health professionals seeking global health opportunities. This installment of Stay In Your Lane rolls through portions of Lauri's 2020 presentation entitled Equity, Ethics and Evidence: a lens on doing no harm while being of use overseas at the Department of Obstetrics, Gynecology and Reproductive Health at University of California Health Sciences: San Diego. In this episode, we roll through the Equity and Ethics portions. We'll cover Evidence in a follow-on podcast. 

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Here are the links we review in this episode:

WHAT IS GLOBAL HEALTH

American Association of Family Practice: Clinical Care – Public Health Venn diagram

United Nations Sustainable Development Goals 2030: Reducing Maternal Mortality

WHO: Health Systems Equity vs Equality

WHO Health Ethics Homepage

Consortium of Universities in Global Health (CUGH): Monitoring and Evaluating Global Health

CUGH WEIGHT Guidelines homepage

Zaidi MY, Haddad L, Lathrop E. Global Health Opportunities in Obstetrics and Gynecology Training: Examining Engagement Through an Ethical Lens. (2015) Am J Trop Med Hyg. 

Hung KJ, Tsai AC, Johnson TR, Walensky RP, Bangsberg DR, Kerry VB. (2013) Scope of global health training in U.S. obstetrics and gynecology residency programs. Obstet Gynecol.

Fostering reciprocity in Global Health Partnerships for post-graduate medical trainees 2014 J Grad Med Ed

American College of Obstetrics and Gynecology Committee Opinion: Ethical Considerations for Performing Gynecologic Surgery in Low-Resource Settings Abroad 

ACOG Global Health fellowships and residency program opportunities

Ethics in Global Health prep – Stanford University 

Hopkins Global Health pre-departure preparation program

Unite for Sight Cultural Competencies training

Dr. Shukri M. Dahir is a woman to watch in global health and a General Surgery resident at Edna Adan University Hospital in Hargeisa, Somaliland. Shukri joins Lauri and Suzy to launch 2021 Season 2 of Sister Surgeons, sharing her experiences and professional visions as a champion for Somaliland, a talented physician and surgeon, a healthcare strategist and an Africanist leader in the making.

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Edna Adan Hospital Foundation

College of Surgeons of East, Central and Southern Africa 

Annals of African Medicine 

The PanAfrican Medical Journal 

Ethiopian Journal of Reproductive Health

International Federation of Gynaecology and Obstetrics

NIH Fogarty International Center: opinion piece- Decolonizing and democratizing global health are difficult, but vital goals

Honorary "Sister" Geoff Cundiff joins Suzy and Lauri to consider what it means to be a privileged white male academic Obstetrics and Gynecology leader navigating anti-racism and the decolonization of healthcare as these forces transform the very landscape he helped to shape. To quote Bette Davis' line in the Hollywood classic, All About Eve; "Fasten your seatbelts, it's going to be a bumpy night!"

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Professor Geoffrey Cundiff, University of British Columbia

Nell Irvin Painter: The History of White People

Professor Geoff Cundiff, honorary "Sister", worked in the United States for many years before emigrating to Canada to work at the University of British Columbia. Together we tackle the burning question: Is Canadian healthcare "healthier" than healthcare in the United States? Comparing and contrasting the health systems and the Obstetrician/Gynecologist physician education and training processes, Geoff and Lauri explore the much-welcomed shift in health systems research to include the perspective of the patients in measures of success and failure. If "we treasure what we measure", which do we care more about - the patients or the profits?

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Related links:

Professor Geoff Cundiff, University of British Columbia

National Bureau of Economic Research: Comparing the U.S. and Canadian Healthcare Systems

Olga Khazan in The Atlantic: What If America Had Canada's Healthcare System? (hint: Medicare for All)

Suzy and Lauri anticipate impacts, both negative and positive, of the 2nd wave of the pandemic on global health collaborations. 

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Related links:

Voice of America: In Tackling COVID-19, Africa Gives World Lesson.

CDC: Is it COVID or Ebola?

UNICEF: Is it Ebola or malaria? A diagnostic challenge

British Medical Journal: Positive effects of covid-19 and social determinants of health: all in it together?

British Medical Journal: The positive effects of covid-19

In this episode, Suzy and Lauri take a break from living inside COVID19 challenges to ruminate on the not-so-evident, emerging and potential future positive impacts of the pandemic on global health. As the pandemic enters the 2nd wave that is sure to wreak havoc on resource-poor and poorly implemented health systems, we take a moment to remember that disaster also brings opportunities. In this episode we explore the revitalizing aspects emerging in global health, either due to or accelerated by the COVID19 pandemic. As the 2nd tsunami wave crests over the heads of all who live in the USA and UK, we consider the potential for favorable circumstances behind the immediate and most dire impacts. Global work requires a constant revision and rethink on how we do what we do - hint keywords - sovereignty, reciprocity, bilaterality, resilience, strategic dialogue replacing one-way monologues...

And here's more for the student inside each of us:

The challenges and opportunities of a global health crisis: the management and business implications of COVID-19 from an Asian perspective https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216126/

COVID-19 as a global challenge: towards an inclusive and sustainable future 

https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30168-6/fulltext

Dr. John Varallo is the Global Director of Safe Surgery at the Johns Hopkins Program for Global Education in Gynecology and Obstetrics, also known by its acronym, JHPIEGO. John works both overseas, running JHPIEGO programs in low-income countries in Africa and Asia, as well as with marginalized communities in the USA. During the COVID pandemic, he has been working with underserved communities in Alaska.  

In Episode 5, we explore the ethics of providing health care in poor communities in other countries and in our own here in the medically underserved zones of the United States. John shares his lens as a teacher, health strategist, global health leader, and lifelong champion of global, and local, heath equity.

Global health ethics: critical reflections on the contours of an emerging field, 1977–2015

It’s far too complicated’: why fragmentation persists in global health

The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals .  "We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context."

The roots of global health are anchored in historic programs designed to keep colonizers healthy during flares of endemic illness. The underpinning goals included maintaining apace the flow of resources out of the colonies to the colonialists' home country, even, and especially, when these endemic illnesses decimated the colonized, indigenous populations whose health was excluded from colonizers' programs to combat, for example, malaria, yellow fever and cholera across African and Asian colonies. 

Today, the decolonization of global health is gaining momentum. Sister Surgeons will explore this topic in a series of podcast episodes. 

With Episode 4, we begin unpacking of the decolonization movement with Dr. Sierra Washington, Director of Global Women's Health at SUNY Stonybrook's Renaissance School of Medicine in Long Island, New York. Dr. Washington has a broad platform of global health experience including years lived in Tanzania and Rwanda where she supported academic and non-governmental organizations to build capacity and strengthen systems for women's health. What does global health have in common with white supremacy? What does the movement to decolonize global health have in common with anti-racism and Black Lives Matter? Dr. Washington spells it out...

Here are a few links for Sister Surgeon fans who want to explore further-

Ethics in Global Health trainings and publications include works such as:

https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-018-0278-1

https://www.who.int/ethics/publications/global-health-ethics/en/

https://journalofethics.ama-assn.org/article/global-health-ethics-home-and-abroad/2010-03

Harvard University's platform: 

https://twitter.com/DecolonizeGh

Uganda US woman starts charity, plays doctor, kills children, no regulation 

https://abcnews.go.com/International/renee-bach-doctor-treated-patients-uganda-lawsuit/story?id=63930370

Uganda - No White Saviors grass roots organization

https://nowhitesaviors.org

https://twitter.com/nowhitesaviors

Dr. Sierra Washington, Director of Global Health for the Department of Obstetrics and Gynecology at the State University of New York/Stonybrook Renaissance School of Medicine, talks with the Sisters about the history of the Eugenics Movement, contraception/family planning in the US and across the world, egg freezing for professionals and forced hysterectomies for detained immigrants within the world of reproductive health and rights.

https://www.pbs.org/wgbh/americanexperience/features/pill-eugenics-and-birth-control/

https://www.usatoday.com/story/opinion/2020/07/23/racism-eugenics-margaret-sanger-deserves-no-honors-column/5480192002/

https://www.cdc.gov/tuskegee/index.html

https://www.rollingstone.com/politics/politics-features/hysterectomies-ice-allegations-whistleblower-georgia-1062429/

https://www.cnbc.com/2019/01/18/egg-freezing-start-ups-funded-or-run-by-women.html

https://www.techrepublic.com/article/how-egg-freezing-is-keeping-more-women-in-the-tech-industry-the-inside-story/