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Offer any sort of intervention. So the most important aspect is you have to have some sort of a combined meeting with the fetal uh maternal fetal specialist. The same way you would have your combined meetings with pathologists, radiologists and everybody else. So that's the primary aspect. The second thing is that I think every sensor, every pediatric surgeon has to be trained in terms of how to perform an exit procedure safely that I don't think is negotiable. I think every single pediatric surgeon should know how to do that. Uh That doesn't necessarily mean they may have to perform an operation under placental support. They don't have to worry about doing that part, but to perform an exit procedure where you can maintain an airway or establish an airway before delivery of that baby. I think that's that should be standard uh pediatric surgical care and that's something that can be taught fairly quickly. But it is a team approach and each center should have a team that team includes anesthetist, an obstetrician and a pediatric surgeon who have the skills that are, that um are needed for that. But in terms of public sector, you have to have the meetings with them. Every academic unit should and then you can start looking at other things. But in terms of exit procedures, every single unit offering pediatric surgery should be able to offer that option or be able to send it to a center fairly close to you. Yeah. Um, I agree. I think even the antenatal care we severely lacking in the public sector. I mean, we had two gastrosis that showed up as a surprise in the last two weeks. So they, they're not even getting the 24 week scan. So I agree with you. We do need a proper relationship with the antenatal team and we can take it from there. Um But there may be patients that do come to us um and it would be good to offer them, you know AAA center that we could send them to and where even pediatric surgeons in training could rotate through. Cause like you said, exit procedures should be part of our training. So maybe we could consider that in the future and for a lot of the developing countries that are involved in this talk, I think that could be something that we should look into. Uh because like you say, the anesthesiologist also needs to be uh quite highly trained to handle these procedures. Uh specifically, um tha thanks SDA um many years ago, I'm talking about 1520 years ago. There used to be uh one obstetrician at Prayer hospital. Who was accredited uh to do uh fetal ultrasound. And we used to run uh sort of uh a fetal clinic. And uh then Professor Hoffmeyer used to do it and he used to contact us. I think we need to establish contact with uh obstetricians who are doing uh antenatal ultrasounds and uh establish a relationship. I think that just needs to be done once again. Uh but uh thank you for your comments. Um And it's something we need to look at. I see uh Doctor Nira Patel from uh Baragwanath Hospital Johannesburg has uh has a query or comment. Nira, please unmute yourself and, and ask your question or comment. Uh Thanks prov. Um uh Yeah. Yeah, most of my questions have actually already been answered in the discussion with the shoulder, but I just wanted to say uh thank you so much. This is so inspiring. It's, it's unbelievable. It's amazing. Um what you've done and what you've shown us is, is, is, is possible in our country. It's, it's, it's really cool. Thank you so much. Uh Thank you, Nero, doesn't it? Uh look like something from a sci fi movie? But i it's reality and we should be so happy about it. I see. Doctor Sabina Siddiqui is here. She is the chair of the Education Committee of the GS and she's a pediatric surgeon in on Ursa. So Sabina, any comments uh from you. Um Nothing more than what's already kind of been reiterated. It's a very impressive work. I think. Um, one of the, the, the messages I hear constantly from, from, uh, people who are working in, in South Africa and Africa and India has been that, you know, we don't have the resources to do this, but I feel like this talk and, you know, the congenital twin work that, uh, Doctor Ka is doing in Uganda. I think all of that proves, you know, contrary to the fact, I think you all are quite capable and definitely have the resources. Um I think it's just a question of building infrastructure. But um let me ask the professor, I think there's also a lot of uh room in fetal surgery for, for device development and an opportunity perhaps um to build devices uh specific to what your resource needs are. Do you have any common stuff? Uh Professor shape on that? Uh Thank you. Uh Yeah, I think uh innovation is a huge thing in terms of fetal surgery. When we first, when we put in our first stent or pleuroamniotic shunt, we actually used uh uh biliary stent for that particular case. And II mean, people are talking about making sidle bags uh on our own to use that. So there certainly is a role for it. I don't think it is something that's going to interest the major companies because it's a fairly limited area. But a number of things that we use some of the things that we use in our hospital are, in fact, hand uh are made specifically for this. The stents are one of them. The actual TRCA we've adapted uh TRCA that the cardiac people use for the angio cats to use as a trer for the procedure. Uh the balloons, uh We've actually had a smaller one made uh for us for the tracheal occlusion based on a design that the radiologist use. So, yeah, certainly there is there is that, but it's usually for one off or two off type of um instrument development rather than uh something that is going to be marketable, I think. But uh yes, uh innovation is necessary in this particular area. All right. Thank you so much. Uh Last I think, question or comment from our consultant, Doctor Nikola Masha Knox. Any question for prof um Thank you prof for the very informative talk. Um Very interesting. Um No, I do not have any questions. Thank you prof uh somewhat. I think uh I would just like you to give us a concluding remarks or a take home message. I think the message which I have learned is yes. Uh in, in low and middle income countries, there is a shortage of resources. We are always struggling uh to provide best quality care to our patients, but innovation cannot stop. I think whatever, within limited resources, we have to continue innovation and that's the only way to progress in science. So just maybe your final concluding remarks. I think what, what you've just said at the end is important. Uh George, you've got to remember that even though most of this work was done in private practice, the resources are also limited within private practice. We've got to show the funders that there is a worthwhile outcome from any intervention that we are doing. Saying this though there are a couple of aspects. The first thing is that for um the majority of the widely accepted fetal procedures such as the 2020 transfusion syndrome, the laser coagulation for that and the insertion of shunts and uh even the tracheal occlusions, they do not require an expensive infrastructure. Most of what, most of the instruments and things we have are available. We can adapt a lot of instruments. I mean, if you use, if you want a Fosco that measures one millimeter, all you've got to do is look in the ent trolley and you will find one there and you can adapt these things. So the actual cost of the uh that is required to develop the infrastructure is not that high for a pediatric surgeon since he uses a lot of the small uh small bits and pieces of equipment. Anyway, the second aspect is that if you look at the way we are in Durban and it took, it took time to get um the support from the medical aids and the uh the hospital groups and things of that sort. But one of the things that we have developed here is that we actually can offer the option of a state patient coming into the private sector hospital if they don't have the resources or take our instruments from the private sector and go to the state hospitals. If there is a good indication, our hospital group in the initial few operations didn't charge for any of the procedures that we performed. And since then, they have offered one procedure to a public sector patient for every five procedures that we do in uh in the private sector. So what you, I think in terms of infrastructure, in terms of costs, in terms of trying to get these things out, there are ways in which we can do it and we should not just say not possible, we can't do it. I think if we make an attempt, we can actually go get there and, and try and get this done. Uh So it is something that we have to have available. But my emphasis is that you've got to get involved in the antenatal counseling of these parents, get to see them early on. And if there's any message that you can leave with here is that you try and see every single pregnant uh parent with some sort of uh fetal pathology before the baby is delivered in your area. Uh in terms of fellowships, uh somebody asked about fellowships, there are a few uh overseas. Unfortunately, in Europe. And in the UK, it tends to be mainly obstetric based. So you need to really get into those. But there is, you can do a couple of them there. And in the United States there are a number of fetal uh fellowships there as well. But like uh I see, Doctor Sidiki said they are quite um variable. You, you are very, you are more likely to spend your time in the clinic. As people in California have uh discussed with me. You are more likely to spend your time in the clinic, seeing antenatal patients and very rarely actually getting your hands into doing any uh procedures. So once again, thanks, thank you Melin for this opportunity to share whatever little we've been doing here in Durban and with our colleagues from outside the country. Uh I am more than willing to take a consult if you want to call it that from anybody. It doesn't matter whether you're in the private sector or in the state sector who needs some advice. And there are, we have offered uh and we have performed procedures on patients from outside of the K ZN uh by using different sorts of nonprofit organizations to help with that way it is necessary. So, thank you once again. Uh uh Thank you so much. This has been really an exciting and enlightening lecture. Uh Thank you for your time. I know how busy you are, but uh thank you again. Um I will uh convert this into a youtube video um later today and then share it on the youtube and share the link of that video on the various platforms on which we usually uh uh keep messages about these meetings in a month's time. We will have a talk by a consultant radiologist from Oman, who is a personal friend of mine, uh who will talk on MRI and pediatric surgeon or Mr the role of MRI in pediatric surgery. So I will post the invitations for the meeting a week in advance. It will be on the second Tuesday of August. Um Nilesh, I will send you Prof's email ID separately. Thank you all for attending and uh we will see you next time all the best.