This on-demand teaching session is geared towards medical professionals and provides an overview of the importance of global surgery as outlined in the Lancet Commission from 2015, as well as introducing the Global Anesthesia Surgery and Obstetric Collaboration (GASO), the Oxford University Global Surgery Group (GSG), and how point-of-care ultrasound can be used to reduce mortality and morbidity levels of pediatric surgery around the world. With presentations from pediatric surgery trainee Ghina Naidu and an update on the Global Surgery Frugal Innovations course, this session will highlight the importance of collaboration, innovation, and unity in global surgery.
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Welcome to an evening of global health networking! This collaborative event run by GASOC and OUGSG will give insight into the speakers' experience in global surgery and research followed by drinks and networking. We aim to bring like minded, proactive individuals together to inspire the next generation of health professionals and help you find ways to get involved in global surgery.

GASOC (Global Anaesthesia, Surgery and Obstetric Collaboration) was established in 2015 to encourage trainees and sub-consultant grades (SCGs) to engage responsibly and impactfully in global surgery. This collaboration acts as an entry-level platform to signpost trainees and SCGs to information and resources that will enable them to further their knowledge and experience in this field. The goal is to increase trainee engagement in global surgery activity during their training and to facilitate career-long leadership commitment post qualification.

OUGSG is Oxford University Global Surgery Group is a multi-disciplinary team made up of clinicians and researchers striving to improve access and provision of high quality surgical care in low and middle income countries.

This event will bring together these two organisations and attendees will hear talks from clinicians about their global surgery experiences and research followed by drinks and networking providing the opportunity to ask questions and find out how you can get involved.

This is a hybrid event, running both in person at Osler house at the John Radcliffe Hospital, Oxford and also streaming online via Medall from 7:30pm. Both ticket types are available on registration.

We have an incredible line up of speakers with unique experiences and covering the spectrum of global surgery (Anaesthesia, Obstetrics and Surgery.

Dr Søren Kudsk-Iversen (Consultant Anaesthesiologist)

Soren is based in Oxford having recently been appointed as Consultant at OUH, he has an interest and increasing experience in practical and academic global anaesthesia, with a particular focus on humanitarian surgical systems and planetary health. He has completed an NIHR Academic Clinical Fellowship (ACF) in Global Anaesthesia through University of Oxford. Since the ACF, he has collaborated with a variety of leading aid organisations and academic institutions to undertake pragmatic research looking to quantify the role of non-governmental surgical care in humanitarian settings, and the quality of the care provided

Dr Isioma Okolo (ST8 in Obstetrics & Gynaecology) - Virtual

Isioma is a graduate of Harvard TH Chan School of Public Health, the University of Edinburgh and the Liverpool School of Tropical Medicine. Originally from Nigeria, Isioma is a global citizen, having lived and worked in Nigeria, Tanzania, Brazil, Uganda, the UK and USA. She is a member of the Royal College of Obstetrics & Gynaecology( MRCOG). In 2021 she was selected to join the UN Women UK as a delegate to the Commission on the Status of Women( CSW 66)- the principal global intergovernmental body exclusively dedicated to the promotion of gender equality and the empowerment of women. In 2022 she completed the Paul Farmer Global Surgery Research Fellowship at Harvard Medical School Program in Global Surgery and Social Change (PGSSC). Her research was funded by Connor’s Centre Global Women’s Health Fellowship grant.

Miss Gerlin Naidoo (ST6 in Paediatric & Neonatal Surgery and current DPhil candidate)

Gerlin is a graduate of University of Edinburgh, member of the Royal College of Surgeons of England, a higher surgical trainee in Paediatric & neonatal surgery (Scotland) and current DPhil student in the Oxford Global Surgery Group under the supervision of Professor Lakhoo at the University of Oxford. She has previous experience in South Africa, USA (Brigham & Womens Hospital, Harvard) and at the WHO in Geneva working on maternal and children's health policy. She is currently undertaking an OOPR to pursue a DPhil, working on implementation science in relation to technology in the LMIC setting within her research project related to Point of Care Ultrasound (POCUS) training in Tanzania for surgical care providers.

Dr Gabriella Hyman (South Africa - MRC Clinician-Scientist Scholar, interested in Paediatric Surgery)

Gaby is currently, a general surgery medical officer at Chris Hani Baragwanath Academic Hospital is the first ever surgical SAMRC Clinician Scientist to be appointed, has extensive Global Surgery experience, including having attended the 2019 OUGSG short course and been involved in the Namibia NSOAP process from start to finish and is currently pursuing a PhD in Global surgery supervised between Wits (SA) and the University of Lund. She is also an incoming member of the Harvard PGSSC and will be undertaking an MPH at the Harvard TH Chan School of Public Health

Learning objectives

Learning Objectives: 1. Understand the importance of the Lancet Commission of 2015 in terms of global surgery 2. Describe the background and career context of the guest speaker 3. Recognize high-quality yet cost-effective technology available for global surgery 4. Appreciate the role of point-of-care ultrasound and its importance in decreasing time to definitive care 5. Examine the collaborative research initiatives and methods of engagement to improve outcomes in low-income settings
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Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

Uh Good evening everyone. Can you hear us online as well? Someone just right in the chap, you can hear us. Uh Yeah. Okay. Yes, great. So a very warm welcome to everyone here at the house in Oxford. We're very excited to see lots of you here and a warm welcome to everybody online. I don't know the numbers, but maybe one of our tech people can put up how many people we've got online. So for those in the room, sorry, we'll be speaking to the laptop as well as to you. And during the panel discussion, we'll need to do some repeating of questions just to make sure everybody can hear. Um Fantastic. So let me see if they can move these slides. Here's the program for the evening. Um So some introductions, then we've got our speakers who Fungal will be introducing shortly and then we'll have panel discussion and then those online can go and rest and we'll have a bit more time to chat and have some drinks and things. So there's a feedback at the end. Um Do you remind me because I will definitely forget. Um So my name is Helen, please I'm the Presidente of Gas Och, which mostly has written out here for us all. It's got a long name because it is multidisciplinary and we're really proud of that. So it's the global an enthusiast surgery and obstetric collaboration. So it's a trainee group based in the UK, but with a really global reach membership is free. So please do join us. Um And we're really privileged this evening to be teaming up with the Oxford University Global Surgery Group GSG. And, and I will tell us a little bit more about that in a moment. Um, fun guy. You want to introduce yourself and tell us a bit about yesterday. Absolutely. Thank you, Helen. Fantastic to see so many familiar places here today. Um, obviously, it's, it's a pleasure to everyone in Oxford. We had a chat at work. Actually, we have a uh in the coffee room and, and, and we sort of came up with this whole idea that, you know, having the President's gas stock and it would be really good to get more regional involvement. And so, um uh, oh, you GSG. So that's the obstacle surgery group. It's a group of different people interested in global surgery and who are involved in a number of very varied activities, but meet regularly, so meet every week on a Thursday and discuss projects and, and other opportunities. But also we run a course and that's what the advert was up there. Just move that thank you, which, which is run every year. This has been a really successful course and it's been amazing to be a part of it with amazing alumni's, some of which are here today. Uh Helen and Gavi uh both NPR, oh, we're all part of the course, uh delegates and, and they've gone on to do amazing things. So, um if you're interested, have a look, I think this year's course might be closed now, but they, this course every year. So, um, definitely going to look out for. Um, so that's something you can come on to at some point. So I'll introduce the speakers in a minute. Um But we've had to change the order a little bit just cause it's always on the train from London. So the first speaker is to be just you go for it. Sorry. Just a couple of things because I know once we get into the speakers will have so many questions for them. If anyone's new to global surgery, I think a lot of the work that's being done has really come out of the Lancet 2015 commission. And if you haven't read that, please do go and read that these are some of the sort of headlines for that. That's really if you're new to this or you're a med student and you're, you're interested, that's why we're here this evening because of these facts that 5 billion people unable to access surgical carriage. So, um, um, I just want to quickly say who gas lock is, were established when the Lancet Commission came out. Um And it's an all encompassing training group with a focus on global surgery. Um And the aims up there about responsibly impactful e encouraging trainees to engage in global surgery. So it's fantastic. See, lots of, you know, this evening, um Our strategy is to collaborate, innovate and unite and there's lots of ways to get involved. You come and speak to myself. Is anyone else here in gas sock? No, great. Well, you can all fit the next meeting that you're all in gas up because what you can do is go onto the website and sign up as members to our newsletter. These are some of the ways you can get involved. We've got our frugal Innovations course, which is sponsored by the Royal College of Surgeons of Edinburgh. It's free eight modules, all online, all recorded. So you can go back and access them later about thinking about how do we engineer more frugal methods of delivering high quality um surgery? We've got mous with multiple groups. So if you're in a group that wants to work with gas stock, please approach me. We worked with the rims of virtual reality in medicine surgery group, Johnny at the back, there's worked a lot with them. We've got, our annual conference last year was on sustainability. We've got our bimonthly Journal club. The next one's in the 20th of July 8 p.m. and the focus on anaesthetics, we've got travel grants. Uh And then I'm super excited to announce this is uh sort of breaking news that isn't kind of out. And about yet, we're gonna have an annual conference this year in Oxford. And it's going to be, I can't say this properly. Is it blank Thick Blavatnik School of government practice have to say that it's going to be September 23rd, 24th, which is just after the EEG GSG Global um surgery course. So I was excited to be collaborating again then. So please, you come um tickets are very affordable and you'll see all of the information on our social media sites. Great to see without further a do come back over to Vonda. Absolutely fantastic. Thank you. Thank you, Helen. Um So first speaker is girl in Naidu who is a pediatric surgery trainee in Scotland. She's uh in credible person and also has a very impressive CV. She's been involved in global surgery for a long time. And um I think, you know, the point is she'll, she'll go through, I don't wanna uh take her thunder but, but she's essentially here doing a phd or D Phil under the supervision of professor like ooh um working on innovation and implementation of technologies in lower middle income countries. So uh thank you very much and guy and um to gas up for asking you to speak this evening. Um So I'm a pediatric surgery registrar. And I'm currently doing an out of pro program period, doing a reading for my D fill in Global Surgery here in Oxford in the Nuffield Department of Surgery. Um, uh, the image. Uh, there we go. Um, so like some of the other speakers, I'll speak briefly about my own road into global surgery. Um, the project I'm doing at the moment and also hopefully give you as medical students and junior doctors some advice as to how you might make similar moves. Um So in terms of my background, I grew up in Southern Africa at a time where there's a lot of socio political interest and discourse about the HIV and TB pandemics. At the time, I got some experience working in healthcare in the Childhood Cancer Foundation in South Africa, and also the National um laboratory Services. And I think the combination of these experiences for me, really under my underpin my interest in public health and global health and have been um foundations probably for the rest of my career. I did an undergraduate and then a postgraduate at Edinburgh University, which I thoroughly enjoyed and um went on to undertake an internship at the who headquarters in Geneva in the field of reproductive maternal and child health. And I was in the policy and programming department where we worked to help design China policy compendium to engage countries and policy dialogue, to help identify areas that they could improve on, to help them meet the Millennium Development Goals for Women and children's health. And the fact that we're talking about mdgs probably tells you about how long ago this was now. Um I then went on to undertake an X clerkship at Harvard um in their surgical critical care and trauma unit. This was a fascinating and incredibly educational experience, but what I really loved about it was working with attendings both in surgery and in anesthesia easier, who all of whom seemed to have combined global surgery or global work into their careers. And it carried it right through. I thought that was a wonderful model to see and practice and really opened my eyes to the fact that this was achievable for me as well. Um So in as a foundation doctor and as a junior registrar, I kept trying to engage in local surgery and Gastro has been a wonderful outlet for that as well as a global initiative for children's surgery, which I would very much encourage those of you interested to sign up to. And um I've helped host events like this this evening. I'm hoping to get other people and medical students equally interested in the field. Um So at the moment I'm doing my dificil which is in the field of implementation sciences. And as um from guys mentioned, um uh we're looking at trying to embed um high quality technology in some ways, could be argued to be frugal technology to a degree. Um in train pediatric surgeons in point of care, ultrasound and assessing the outcomes for this. I'm very grateful to my supervisors, proper care and proper under for supporting this work. And the Department of Surgery in Tanzania's moving Billy National Hospital and the International Pediatric Ultrasound Network who were collaborating with um in terms of what we're trying to do ultimately in the global surgery world and certainly within child surgery, we know again from the Lancet Commission in 2015 that there is a huge need to provide safe, affordable surgery for the 1.7 billion Children who lack access. A large burden is in Sub Saharan Africa where very important work has been done by for instance, Naomi, right, and her collaborators to identify more the huge difference between outcomes in pediatric surgery, between low and high income settings. Taking just for instance, one diagnosis into susceptive in which is an incredibly common pediatric diagnosis. There's over 100 fold difference in mortality and morbidity outcomes between high resource and no resource settings. Um Note uh diagnosis quite easily made by ultrasound. Um So the Lancet Commission, um some of the outcomes have been to really promote collaborative research, technology enable solutions and cost effective interventions to help address this. Gaff why pocus is so valuable is that in the last decade to do decades, portable high quality hand held devices have really come through in the market and made it more affordable for clinicians who aren't radiologist to gain the skills. And it's an easy, relatively easy skill to learn, which can help provide more rely, reliable um diagnostics, active bedside and fundamentally increase or rather decrease the time to definitive care for Children and adults. Um So there are very many examples of how point of care, ultrasound has been integrated into care, mainly an emergency surgery and intensive care and through uh echo in high income and in low income countries. Um but the work hasn't yet been been done done in pediatric surgery and in pediatric surgery, our cohort are extremely amenable to ultrasound. It, we use it every day to diagnose a huge majority of our illnesses. And it would make sense that um moving the skill into the hands of the surgeons and clinicians might be an obvious way to um speed up care and improve the accuracy of care in these settings. So I've been very grateful to start gaining bay basic skills myself and have become a basic ultrasound skills trainer on the international pediatric ultrasound um course which runs in Tanzania and it's mainly um focused on neonatologist and pediatricians and critical care workers. Um But it's been a wonderful, wonderful way for me to understand how focused training works more and hopefully, which will, if this will help underpin the work we'll do to train surgeons. Um the impact of this project, we hope that fundamentally will provide proof of concept that this can be done. Pediatric surgeons can be trained to safely and accurately use point of care, ultrasound. The model we develop will hopefully be able to be um scaled and used elsewhere. And ultimately, we would like to provide a mentorship and sustainable train the train of program so that the expertise fully moves into um the hands of of those in Tanzania and the region. So in terms of what I think looking back has been the most important experiences for me. Um along this trajectory is probably just gaining a level of exposure. And as a medical student, even though you might not believe that you're in a very, very um unique position and probably have the most time, believe it or not, and the most latitude to explore things and attend evenings like tonight. And a large part, I think of our work in global health and global surgery, finding people who inspire you, finding job plans that you think you might want into the future and attending networking events, attending conferences is such a large part of finding your way through things. So I couldn't encourage that more. Additionally, remembering why we're doing it. And reading the Lancet Commission is really important and thought provoking document. And as has been mentioned, there are 5 billion people who lack access to safe surgical care. And this is six times the number um in terms of impact and mortality than HIV TB and malaria combined. So the scale of the problem is humongous and it needs more people interested in it. Um in terms of taking an academic path into global surgery. What's been brilliant about the Lancet Commission? It's, it's finally defined global surgery as a real area of academic interest. And while, and this is means that funding opportunities for research are increasing and are available if you look in the right places, um the number of academic networks as you can see this evening, which you should definitely get involved in at whatever stage you're at. Um continue to find um opportunities for collaborative product projects of which there are many that even as a medical student, you can contribute to data collection in your region and use your out of program experience as a trainee wisely, these are some helpful links that you might be interested in. Again, they point to some of the main global surgery and networks or sites that give you, if you browse through them, you'll see a whole host of different projects and different ideas and different kinds of projects which are funded as well. And we'll give you a bit of perspective about what is going on out there. So I definitely recommend looking through these. Um and in medical school, I've mentioned some of this before but definitely join your surgical society and most of them will have an outlet or global surgery arm if they don't create it, um Use your your interrelation year if you do it wisely. Um and elective is a very important opportunity you have to again gain real experience. Uh Most hospitals will have a partnership with a hospital elsewhere. Again, utilize that and definitely find someone who's willing to be a mentor. The last thing to mention is just that it's remember, this isn't one way traffic. This is so hugely working elsewhere and being involved in global networks and global surgery definitely benefits us as clinicians in the NHS and the NHS as a whole. And even in terms of job satisfaction and well being and the resilience you build, I think is so important and I think we should all be humbled enough to realize that the NHS is a resource limited setting and ever more so and so many of the projects and I certainly hope with the focus work we're doing, we'll be able to employ that and the same model here for our trainees. Um So yeah, that's, well, I have to say thank you. Uh Thank you very much Gellin. Um We'll just save the questions to the panel. So if you just put some questions in the chat, if you, if you have any burning questions, then we can, uh we can go through this. But fantastic. Thank you very much, Kevin. Um So to follow this up, we've got Gabby who's going to be uh talking to us. So, Gabby's a medical officer in South Africa. She's uh such as a junior surgical trainee having graduated from FITS, uh, in, in Hotel in Johannesburg. Um, she was also alumni on our course, which is, uh, which is great and she's also got a very unique job at the moment where she's managing to combine her global surgery, academic work with her clinical job in her basically first appointment in, in South Africa of that sort. She's been involved in the Namibian and soaps of the National Surgical Obstetric an anesthetic plan which is uh she is involved in from the beginning to the end, which is fantastic. And also she is going to be doing an mph at Harvard uh starting in October. Okay. Oh, she will be in order. Cool. Thank you for that very kind introduction. Um And it's really great to be here. Thank you for having me hugely. I'm honored to be invited to speak on this panel again alongside. So Justine, um colleagues and really excited to engage the community. So my question was a little bit different. I won't speak too much about kind of my technical background, all the things I'm working on, but more give us talk, which I had hoped I got 10 years ago, uh maybe like here at the beginning of my career. And that's really about mentorship and meaning and reflecting on a trainee's journey through the global surgery maze. So, okay. So basically, we've established global surgery is a relatively new division of global health, arguably came about in 2005 with the first um wh a resolution that prioritized emergency and essential surgical care. Progressed to 2015, World Health Assembly, 68.15 the last Commission of Global Surgery Decision 70 now most recently, two weeks ago, the echo resolution which passed again to reinforce um or perhaps raised questions about operative cares position in emergency response response and pandemic preparedness. So I guess there's a lot of opportunity for development and contribution and that's what's so exciting about a new field. And I guess these opportunities to engage in like pointing at the screen should probably be pointing at the camera um in health equity research and publications, training, academia, innovation and technology already vast and can seem actually complex and overwhelming. Or at least for me, it does. And if you couple this all with your professional personal, um and I guess other public health interests, it can be difficult to uh find a pathway, right? And these could all actually serve as potential threats to navigating the maze uh without being too cliche, I will provide a compass later. So what I found most exciting about the field of global surgery in my experience is that in addition to it being cross country, cross country, cross country as well, but crosscutting and multidisciplinary is that I found that there's an overt commitment to diversity and inclusivity in the work. And I think that's quite unique and in the space of development Um And as a trainee from South Africa, I've always found this field to be extremely welcoming of trainees. Um And that's of trainees from diverse backgrounds, from the global North and South. And I'd be interested to hear other members of the audiences experiences with that and whether you think it's the same. Um Well, ultimately, maybe amazes the wrong word. It's more of a, like a milu for um that among the way like technical tasks and strategic entry points kind of amalgamate and give you an opportunity as a trainee to position yourself as a resource. And if you're really lucky, you'll work in a program where you also like an output. So I've been fortunate in that regard in working with uh like global Pizza and other multi center collaborations and trials. And with that the NHRNRHR group in Birmingham that your input is a resource as a trainee, often not remunerated and we can discuss that on the panel. Um But the the benefit from an hour point point of view is um this clinician scientist training program with which the South African Medical Research Council is piloting. And that's, you know, linking to, to what girl and said about your interrelated year. It's something really I think to grab with both hands if you do have access to that additional training opportunity um in your pathway. So I'll take this opportunity to flag some tangible things, global collaborations and interest groups, um scholarships and higher degrees. Um They tangible output vehicles for sustainable inputs, especially for interested trainees. I think at any level, um, we'll try the hour. So I guess in the face of the maze it's very easy to lose oneself. And this brings me to uh the question posed to me before speaking here today was, which is how did you develop your maybe profound position in global surgery? And what would you tell other trainees? So let me first say that this isn't an area proportional diagram. Um And uh do prioritize a value system as an entry point to developing the technical skills as like clinician scientists. And I'm not saying you have to achieve that duality, but I think it is extremely helpful and we'll make you a valuable resource and a resource limited where human resources are limited as there are global surgery. Um It allows for you to engage in purposeful collaboration and ultimately work as a like an active citizen and contribute to the global surgery community. So the way I kind of navigate it or develop this identity, I guess is through mental ship. And that's going to be the last kind of pinnacle how the talk culminates. But before approaching a mentor, I think it's important to have some kind of sense of self. And at the core of my uh at the core of my global surgery identity, I guess is a value system that upon like upon reflection comes from you know, an upbringing in a deeply unequal society with an inec with health system inequity that I can't help. But let frame the way I evaluate global surgery work and outputs in a variety of contexts. And I think global collaborations are fantastic avenues to explore, to reflect on your own lens, but also to understand the experience of colleagues. Um So tomorrow's Youth Day in South Africa, which is or commemorates the 1976 where the youth uprising which was against unequal education um at it's not at its core, but as, as an outpost or avenue. And I think I'd be remiss not to take this opportunity really to acknowledge and, and the uh activists and advocates too allowed for transformation and the establishment of the country where I've been brought up and where my global surgery work is housed. Um But in saying that I think it also brings up a commitment that we can make as trainees with experience or not um to really work towards equity in terms of access to global surgery resources. Um And this is access for trainees as well, not just for patient's. And I think that's something that um gas off of course, have done exceptionally while see 19 countries represented um through, through your membership. Okay. So I guess the most formative experiences so far in my journey have been linked or come directly or indirectly from mentors and they've advised on professional development and this development of the value system and sense of self. And I think really, they've given me also access to their network too. And I think that's something that I'm always, I'm enormously grateful for and humble about and, you know, working a lot of the time in research now, you know, there's sometimes a blurring of this line between what is a mentor, role model, supervisor, friend and a teacher. And I think a mentor can be but doesn't have to be all of those things. But I think what's very important is that through your mental, be quite purposeful in, in developing a mentor mentee relationship, acknowledge that it's bidirectional and that if you're clear about your deliverables, I think um it's, it's really your opportunity not, not to benefit from. And I think mentors benefit to and a very limited experience um being a mentor, but, but I do have some and you know, I'm like I say enormously grateful and I think that would be my key piece of advice, not so much the technical skill, but find the right mentor, be a good mentee. So the last bit um and this isn't a picture of the world drowning because I think that dogs still coming. Um But it is a demonstration, I think of the ripple effect you can achieve if you, if you have developed this value system or found a sense of meaning and I'd encourage everyone to maybe take a moment at the end of the panel just to think of perhaps where you derive a sense of purpose and meaning in your global health or global surgery work. Um And really, I think that's the kind of cross cutting element or the thread that takes you to the heart of the maze, which is why we do this work, which is essentially for health equity. Um And it's tempting to be kind of swept up in the like a professional development aspect and kind of the uh power and privilege that would come from developing a good reputation in the space. Um So I guess last year, I think it is possible to develop a sense of credibility regardless of your backgrounds and having an attitude of integrity and some kind of commitment to justice. I think that's more important than technical prowess alone. Um So what would I tell trainees? I'm a trainee, fortify yourself with research, um advocacy skills, um and other clinical competencies, but always remain committed to impact, um, not just impact factor. So any questions to the panel? Thank you. Fantastic. Thank you. That's brilliant. Thank you, Gabby. Really insightful. Lots of great anecdotes. Um So we're moving on to our third speaker that's sore in, um, he's, we're really fortunate to have, um, he's been part of this global surgery seen in Oxford for a while now. Um, he start off as an academic uh anesthetic trainee and has been involved in multiple humanitarian organizations. Been involved in lots of different aspects of global anesthesia and, and really flown the flag that this is a multidisciplinary environment. And I've been privileged to be close by watching his rise to consultant now here in ou Waitresses. Fantastic. So um sort of thank you very much. Thank you so much for inviting me. I feel incredibly honored to be on this panel in many ways. And you've asked me to come and speak at a time of extreme self reflection. Um So the top might not be as, as in credible as the others, but hopefully still insightful to degree. Um So I, I have gone through 20 years now. So 20 years ago, I went into medical school and these are the things I was thinking, I was thinking, I'm going to be a global citizen. I am gonna make a difference. I'm gonna be part of a greater whole. I'm gonna make a difference. It makes sense to do this. Uh Looking back at previous application forms. That is always, it makes sense to do this and it does, doesn't it, this is what we hear this global surgery. But then looking back at my journey, I think in many ways, there's been luck as part of it. I've just been right place right time opportunist in to a degree, you know, hearing about the cause of that sounds pretty good. I'll apply for that. That's really good. Uncheck privilege has been huge living back I've had so many lifts without really knowing that I got propelled forward. And then so many million assumptions I've gone into global surgery in many ways, thinking I can do better. But in many ways, something also thinking I know better and I think that is not the right attitude, but often you don't know until you look back at what you have done and where you have been. So why am I still doing it? Why haven't I left and run away? Um I guess actually, because there's been so many incredible partnership, so many incredibly patient people guiding me back into the right fold, the right direction. And it's given me a much greater sense of the world is given much better sense of what's actually happening. Where am I placed in the greater scheme of Global surgery, global anaesthetics and aesthetic consultant? Um And it's giving me a journey of continuous reflection. Initially, I just wanted to get impact factor. I just wanted to get in there and get my name on things, make sure that I could continue to the next step in my journey. You know, I wanted to be something within this environment. I wanted to leave a mark, but that's it started, you know, looking back, it's really grating. Um And with that, you start coming up, interpreting things can be better. Now, of course, this is 20 years of a journey and a lot of it has, has has sort of unfolded and I've been able to change the direction of the and the things I've been doing. So during medical school, I was very involved with friends from a safe setting up the national friends um safe system. Um After medical school, I've worked in South Africa for a while. I've done research in Zambia, which has been credible into his partnerships. A lot of my research has been around humanitarian corruptive systems and increasingly looking back, it's been around creating networks, creating partnerships and not being the one guiding the questions between one trying to help. And so what little bit I could do in terms of other our research skills that I've been fortunate to gain or the, you know, huge wealth of resource available through the University of Oxford. So maybe it's time for a different approach and it's easy enough to say 20 years later and it's easy enough to say having gone through this. And I think actually a lot of people have already done leaps and a way ahead of where I now eventually ended up. But I think one thing that's happening a lot in the global health community as a whole and global surgery, I think is trading a bit behind, but hopefully it will come and pick up is the attempt to try and re examine. Actually, where are we when we're doing this? A lot of research coming out, you know, looking at the first author, last author, a lot of it is centered around the global North. A lot of it is coming out of us UK and that shouldn't be the case. It shouldn't be us centered coming with the answer, tickle surgery, it should be centered in the areas where the global surgery is happening. So I've started really checking, where is my worldview? Where am I coming from when I'm trying to answer these questions? And I'm am I having the right approach? And then there's been a lot of talk about becoming the ally ship. So not just being a part of global global health as a whole that becoming an ally of it, checking where you are, what can you add to global health as a movement? And if you're not based in the areas that you're trying to help and maybe you need to readjust and actually say, how can I become a better support to lift up and center that as the focus? And it comes back to the last thing and there's been hints to it. So I'm really involved in sustainability. And I think in the grand scheme, sustainability is just another way of living health equity and it links in with global surgery so beautifully because that's really what it's about when we say global surgery. It sounds like it's all happening out there. You know, I'm going to go out there and save the world, but actually, it's happening everywhere is here as well as their. Um And that's such a need to just focus in and not just be focused on being part of research is happening elsewhere, projects happening elsewhere, but also what you can do in terms of advocacy, not just research, not just being a surgeon or a decision, but also being an advocate for health equity. It's mentioned several times before and it's so nice to know that that's sort of a unifying force. But for me increasingly that's what it's becoming about last meeting. Thank you. Ok. That's fantastic. Thank you so much. Sorry for doing this. Uh Just as you finish this um is walking through the door, I'll give her a second to get to get ready. But uh is that ok? We're just gonna load up our slides actually and get that set up. I'm not introducing that. Yeah. Okay. Yeah. Uh uh a uh I just take my friends with uh Mike is on, hello, sorry for that short break. Um So I'm just going to introduce the SOMA uh um actually was at medical school with me. Uh It's great to have her here. Um She is uh fantastic and I think uh CV and her experience speaks for itself. She's a graduate of the University Edinburgh, but then also went on to do an mph at Harvard and as a poor farmer, global Surgery research fellow, um she sat on a un uh women's Health Commissions and she is also a member of the Royal College of such a gynecology. And, um, she is an ST eight in Edinburgh, uh, final, final year. It goes up to seven, in, in, in Edinburgh, uh, were recently caught up with her and, and is doing and she's hopefully gonna be doing some amazing work with the Scottish government as well. So, fingers, correct. Fingers crossed. Thank you, Joe. I feel like I don't need to present anything anymore. You stole my thunder there. Thank you. Thank you very much for having me. It's really good to see obviously from any excuse to see guys. Wonderful and also some familiar faces. Uh Last time I was in Oxford was September 2022. And that was actually, yeah, that was with global Surgery course. So that was really exciting exposure to the group in person. And prior to that, um uh kindly invited me to presenting my research, which is essentially around Cesarean section variation. So as soon as I know the last speaker and those of us in the room and online want to get to networking and drinking. I always through this presentation, this is gonna be very exciting because I am a crazy fanatic. Um but these have been converted to Pedia. So who knows what they're going to look like? But uh if you do want to have a look and experience the slides in pretty real time, you can go ahead and scan the QR code in the middle, I promise I don't have shares of practice. I just really like the way it manifests so very quickly, what I'm going to try and share is my experience is using this framework of what, why, how when and then a couple of top tips um and then focus on how to connect. So the what for me is has been a kind of like a lifelong up until now, reflection on what I think global health, global surgery is so just any volunteers in the room, what do you think global health is when you say global health? What do you think? Just words and people online as well? Can we hear people online? Uh No, that's fine. But they can, they can type so people online type people in the room. Shout out words, equity. Uh huh. Yes. Health for all. Absolutely. Any other words? Yeah, those, those all makes sense when I speak to people who are not really in global health or global surgery space, they tend to think that it's focusing purely on um I guess health in low resource settings that that tends to be uh people's focus and I don't, I don't think that that's necessarily wrong, but that's just not how I view global health. I think I should probably share that up front. Oh, this is looking good. Okay. So I, I really have started to think more critically about global health and global surgery about addressing inequalities within countries and between between countries. So I guess you know, for people who tend to focus on, you know, health and low and medical countries as their mindset, that's perhaps the inequalities within countries that comes to mind when you think about economic development. But the reason I really think about it with this framework is that, you know, we're here in Glad. And so I went in Glasgow were in Oxford and where I live in Edinburgh, where I'm from in Nigeria, where I've worked in Uganda in Brazil. There are health inequalities everywhere. So we don't have to travel very far to find them. And what we are trying to focus on as a community is addressing these inequalities. So the next thing is asking ourselves why, like, why am I in this space? You know, you will go to conferences as I did this week and people will start with the conflict of interest and it's all the shareholders and everybody funding their research, but people never talk about their position, Al Itty. And I think that should be the number one conflict of interest you declare and for me position Al Itty is essentially it's your perspective with regards to what you are facing, whatever it is, let's say it's research, let's say it's some policy work, let's say some interest. So insuring my position, Al Itty, I, I have to tell you the story of who I am. So I uh one guy said, you know, we went to add um a medical school before that. So I was born in Nigeria and then grew up in Nigeria and then moved to Edinburgh, uh joined from guy in medical school in 2006, I think, was ages ago. And, and then just through the course of my life, I've been educated and lived and worked in many different countries and I guess having experienced life in different settings, there are things that are very obvious to you, particularly when you live and work in a so called low and middle income country. And so regardless of your economic backgrounds, I would have said, like my, my family are probably quite middle class, but despite being quite middle class in Nigeria, there are just things that are very glaring and obvious even from a very young age being six, I remember. And, and I guess with that perspective, haven't left my country. Um I didn't realize I was Nigerian until I left Nigeria. I didn't realize that I was a black woman. And so I left Nigeria as well. So there are loads of other aspects of my identity that I guess came more to the forefront when I, I left my home country and my lived experience is literally a hodgepodge of was just wild, you know, depending on who I'm speaking to. My accent will vary from Nigerian to Scottish to like some weird American accents. So in many ways, a very much, a 3rd, 4th 10th culture child and then thinking about position al itty, particularly in global health, we have to think about power and what it is about identities and our experiences that give us power or take away power because that really depends or determines I think who you decide to work with and how you work with them and ultimately the outcome of the work. Um then this slide speaks to the main question I tend to get with people connecting with me around, particularly people are younger who want to get into global health, the global surgery, which is the how, you know, frequently asked question how and you know, this is not an exhaustive uh diagram. But I think when people delve into global surgery or global health, they team they tend to put because on clinical work often called mission work, medical education research. Obviously, that's a very classical and advocacy policy. And then miscellaneous, you know, that could be anything from I've come across colleagues who have done work with, you know, like med tech development, for example, in low resource settings. So that's the kind of the how and then this I think is a very important question for us. I'm guessing the audience is made up of maybe a few medical students, maybe a couple of foundation doctors, maybe some registrars, a couple people who are consultants for CCT. And I think this is a really important point to focus on for a bit. And then I guess I will share my story of what I've done using this lens. Not that when I did it, I was thinking about this, but in retrospect, it kind of fits into this. So people will often ask when is the best time to get involved, you know, is it too early? Is it too late? So I've, you know, just reflecting on my experience have broken it down into four stages. So the basic training, which for me is everything you do up until um just before you get your membership exams. So for I'm, I have to use obstetrics and gynecology as a framework. So you do medical school, you do foundation year, hopefully you do f three maybe before live your best life and then finally settle into found it ST training. So for us, the first two years are called our basic training years. And by the end of that, you really should have passed your part one exams. And then when you get into your, the stage of intermediate training, that is when you passed the part two and three. So these are the more clinical Viber exams. And really until you've done your part two or three, you are not considered a registrar. So with your basic training, you would probably be on the tier one router or an essay. True. And then by the time you get intermediate training, then you're considered a registrar. So reflecting on my experience. So, you know, I what I did was so went to medical school. And then for me, every time I went home, there was always some kind of global health experience. So I didn't really follow this rigmarole. But that experience really was I was working in a hospital but not in any clinical capacity at all. So I was literally working at the front desk, um like helping people come in at a reception and just observing a bit more about how things work in medical school. I did a medical elective in Brazil in Cardiothoracic because, you know, I once thought I would be a cardiothoracic surgeon, how it would have been an obstetrician gynecologist. I don't know. And that was very interesting. I did a bit of Pedes there as well and really the focus of that work was a lot of shadowing and then some early exposure to research. Um And then by the time I, I guess I was ST three, by that point, I then got involved with the Royal College of Obstetricians and gynecologists. Um And they have a lot of global health work. A lot of it focused some of it focused in Nigeria, quite a lot of it focused in you gone. And uh and I did a very short research fellowship, it was more actually a teaching research fellowship called the Marcus Phil She Fellowship. And with that, it basically involved emergency of cedric skills training. So it kind of like train the trainer model around emergency obstetrics and gynecology as well. And then coming back from that, that was really when it hit me that I hope if you've not had this experience, it comes to you that clinicians get to wear many hats and it's a privilege. But often I don't think we have the skills or the experience to wear those hats, but we get away with it. And I really felt really acutely when I worked in Uganda because prior to that, you know, I have been doing more clinical work. This was kind of the first time I was placed in a position to almost like project, manage things in a global health project. So even though I was helping with a bit of research, do some monitoring evaluation, I was also tasked with um having discussions around what the next iteration of the probe of the project would look like. And that involved speaking to non clinicians, administrators in the hospital and then um also speaking to some people who were involved in a very local level governance, so like counselors, so nothing major like the Ministry of Health or anything like that. And that was when I realized that perhaps, you know, the kind of knowledge and skills I thought I had I definitely did not have. And that was when I started getting interested in structural determinants of health. Because what I committed to at that point was to explore health inequalities within my own community. So even though I grew up in Nigeria, having worked in Uganda. When I came back, I intentionally connected with Ugandan related NGOS in my community just to find out what was going on and to see as well if I could connect the networks and some of the stuff we've been doing out there with what was going on in the UK, specifically in Edinburgh. And then that was what made me because I sort of glaring gaps in my CV, decided to do a master's in public health. So I set out to the master's in public health. And I, you know, I didn't choose Harvard for any specific reason. I looked around, you know, I looked at London, I looked at Edinburgh way, I went to school. But what I liked about the Harvard program was this flexibility um in that you could be a stewed, you know, the public health school where you could also cross register at the Kennedy School of Policy and Government and the Business School and even the law school if that was what you wanted. And that really spoke to me because as well as understanding the structural determines of health and kind of finessing my research methodology and thought process, I wanted to learn more about the business side of things in terms of how you embed sustainability into whatever work you're doing. I also wanted to learn a bit more about international policy as well. So that's what really attracted me and then somebody heard that I was applying to the NPH Harvard and they were like, oh, we think you might be a good fit for this fellowship last year there. And that's how I came across the poor farmer Global Surgery Fellowship. I have never heard of Global Surgery up until that. And so when they approached me, I thought, what is, what is global surgery? Um, and it's quite, it was quite embarrassing then at that point to realize that, well, actually global surgery, I mean, the name is obvious, isn't it? But quite humbling to then sit back and realized in terms of what people focus on in that space. I mean, the commonest surgical procedure in the world is, uh exactly and then a hysterectomy. So it's a bit embarrassing. I was asking what Google surgery was because I guess if you think about the neglected surgical patient, it's essentially women and girls. Um So I thought, okay, this is interesting and this is a fellowship targeted at surgeons, oppositions and gynecologists, anesthetists and people who were just focused on improving the quality of surgical care in low resource settings using research, I guess is the foundation's answer questions around policy advocacy. And again, the business end of things, and it was a wonderful experience. I think I was quite lucky because I was paired quite nicely with a mentor who really aligned with me. And that was again, pure luck. And I think in your journey in global surgery, global health. You have to be intentional with finding mentors, mentors, maybe organic, they may be assigned to you and but definitely focused on getting a mental because that can be very um life changing and career changing. And with my mentor, Dr Alan Botin. So she was a OBGYN as they call them in the States who was both a clinician and researcher from Ghana. But doing quite a lot of research in Uganda and had basically worked with a group in the west of Uganda. Mbarara over 10 years and had slowly built up their research capacity. And so her, her research portfolio was actually shared by her Ugandan co colleague, Dr Henry Luego be who also became a bit more of a mentor for me. And um it was just very interesting to through her learn how to collaborate uh equitably and effectively in a global health setting as they say. So that was really, really good for me because I was the only option Gynie resident as they call us. Um I had to also work with a lot of the other general surgery and anesthetic projects. So I hadn't set out to do that. But it was very fruitful for me because, you know, whatever they were working on, they would always as you know, it's really hard to avoid women and girls in your work, whether you're an orthopedic surgeon, a neurosurgeon anaesthetist, you know, which is everywhere. So it was really good to kind of experience, um you know, very special uh surgical specialty and the research being done in that capacity and in that space and then backtracking a bit. So I landed in the States the day of the Capitol Hill incident and I landed not knowing what the hell was going on. But I knew I landed on my husband, we knew something was wrong and we were like, what's going on. And so I was there at a very interesting time politically, I was also engaged in the fellowship, you know, around the time of the resurgence of the Black Lives Matter um uh movement. And what had happened around that time was the PGSSC had taken an intentional back step to kind of look at what they were doing around anti racism uh in the context of global health. Um So it basically moved from a lot of listening exercises too. Um The, the evolution of an anti racism curriculum, which was co designed and co developed and then kind of expanded out to uh inviting experts from all over the world to share their perspective of how this manifests in the global Health, global Surgical setting. Very interesting aloes of colleagues from the Global South. Initially, we're not able to um I guess describe how racism manifests in there setting. It was very much thought to be a US UK problem. And I have to say I would have felt like that 15 years ago, you know, just when I moved from Nigeria. But the truth is that, you know, with the history of colonialism and the slave trade, um and the history of um I guess cong conquest with religion and economy and capitalism and the history of um colorism and even let's call it natural hair is, um it was always in my back yard, but I just didn't see it and it just manifests in very different ways and even classes. Um you could say so it was really, it was a difficult process at the PGA SSE very difficult. Initially, I was like, I didn't come here to do this, what is going on, but I eventually leaned into it and it was very fruitful and it's very positive to see that the PGS SC is continuing in this work of anti racism and kind of centering it using it almost as a lens with which to evaluate the work they're doing. There's been a lot of learning and growth, particularly around collaboration, authorship, conference attendances, all these kind of things. Um So it's like details. So finish that wonderful experience. The I guess the the work I focused on was variation in Cesarean section, looking at the kind of patient provider and facility characteristics that contributed towards this variation. Why is this important? Not only is the zero sections, the common a surgical procedure performed globally, but they are on the rise and there were concerns around the long term impact of this on patients' and other facilities. So it's really interesting with one body of work to uh explore, investigate impact of Hae Cesarean section rates and the volume of other surgical procedures being done. Because because you can imagine if you are working in the health center for in Uganda and you know, I'm doing 10,000 Cesarean sections and hugging their anesthetists as a orthopedic surgeon, you don't have that theater space for your patience. Also, obstetric patient's also use a quite a lot of blood. So there are knock on consequences of the overuse of caesarian section beyond the proximal patient and health provider setting. There's also issues to do with financial toxicity as well and it can be um with the inappropriate caesarean section, a cause of uh impoverishment and poverty in these settings. And we have the same problem in the UK. They have the same problem in the US. And uh we're not quite sure how to address it, but it's really interesting to do that work. I also did some work around cervical cancer. I'm not grinding on colleges. So my special, my focus areas are early pregnancy. I do enjoy benign gynecology as they call it even though it's not benign uh advanced labor ward. But with cervical cancer, what we were focusing on was exploring, I guess, task shifting and task sharing with the workforce. There's a big focus on vaccination and what you might call it screening in cervical cancer less focused on the surgical capacity around it. And we know even with upscaling uh screening and HPV, you, you will get a cohort of people who are missed because they're not eligible for the vaccine or they're not screen. And a lot of these will be early cancers that can be managed and treated surgically. So a lot of work around that and then also so some work around gender based violence in Mexico and exploring where people present and the impact of being pregnant in these presentations. So when people present in the non obstetric setting, where they being referred to and um what is the kind of um demographic features they present with? And then finally, I also found myself doing some work around pelvic organ, organ, pelvic organ prolapse, prolapse, vaginal prolapse is very common. But when you look at the literature, African women are invisible, um there is a narrative that African women are not impacted by prolapses and this is not true. And what we found in our research is compared to the rest of the global population, African women in that setting where we studied, uh we're more likely to get prolapse is the younger age and have more severe symptoms. And we were looking at it within the context of weight bearing. So in communities where uh women and girls have to fetch water and carry water for distance to wherever they're going. Because in these settings, it would be the women and girls fetching the water, not the men and the boys. And we were looking at the impact on that and interesting as well to reflect on the impact of things like climate change and that when you have droughts and when you perhaps have to walk a bit further to get your water. So focusing back on this, even though I didn't follow this kind of um you know, linear path with regards to at what point I go involved in global health and global surgery. I do think it's important to, to think depending on where you are in your training. Uh What works best for you in terms of your skill set, your knowledge set and your networks. I think we should be cautious of doing any clinical, predominant clinical work before you're an independent practitioner. What independence is, I don't know, you have to decide. Um I would never do anything I wouldn't do in the UK setting abroad as they call it. And so definitely consider that, but there are many ways to be involved even if you don't leave. Um you know, Oxford or Edinburgh, there are many ways to be involved in medical education again, in research virtually and, and certainly as well in advocacy and policy. So we're getting very close to the end. So finally, a couple of tips I wish before I, I embarked on this journey, I've learned more about history. I learned about history, maybe in the last three years. But I wish that had been front and center when I intentionally decided to, I guess, advanced my global health with the surgical career and the history of our, of our community is rooted in, again, this history of oppression to do with colonialism and the slave trade. And people often ask me, well, what about thinking about other things like, um you know, other forms of oppression, like sexism and homophobia and classism. And I say, absolutely, we must focus on those, but we must realize that in our settings, particularly in Europe or America, uh slavery and colonialism are foundational to our history and they intersect with all these other forms of oppression. Um So I think that's why it's important to start there and then evolve and group, but certainly learn our history, learn about Decolate d colonial Itty. I can never pronounce it and, and reflect on what that means to you because I mean, I toyed of putting this word in the presentation because sometimes it's a very annoying thing to think about. But I think you should as a global health surgeon practitioner, think about it and certainly reflect on power. Um I guess if there was one more tip, as you can see there, I would say, connect with an NGO in your, wherever you live, who is affiliated with, you know, similar to the country you're working in. So, in my setting, I was doing work in Uganda's when I came back, I made an intentional step towards um connecting with Ugandan related NGOS in my community times. Yes. Fantastic. Thank you very much. Uh um So I think what we might do is power on and do the panel discussion and then we can do some networking. So if there's any questions again, put them in the chat really interesting and thought provoking journeys that I've and shared. Uh I certainly have some questions but, but we'll see. So, should we get the panelists to sit at the front? Uh Yeah, that works really well. It's, uh, yeah, I think, uh what you're on. Okay. Yeah. Uh uh Can you rest right now before we start the panel? Uh uh I'm fantastic. No idea. Mhm. Uh Okay. Um We're just about to start the panel discussion. So, um, we've had some really interesting, uh, journeys. I've been shared some interesting discussion as well. So I think it's, it's uh fantastic. Um, we might have some questions from the floor, first of all, which I'll open up to you and then I'll start with a few of my own. Could you stop screen share? NG but she's always turned back because I asked me for you. I think, uh I think I caught specific section times like I want, I want the beautiful country to be more sustainable, like whatever if you can have and I want to be more sustainable. I'm looking to, it's more taking public health care and maybe an infrastructure that I should ask for them. I think my concern, um we're going to order Sergeant was I'm just going to go and just pick something temporary because I actually want to assist Fletcher work in the future. Um So how, because you are a similar position that you lost volunteering, so I'll be able to combine your work and go to surgery and also like a public health. So it's about doctor to Nigeria now and they talk about how this uh system that needs to work and you have the best doctors put the wrong system doesn't work. So taking the skills in public health and the experience of involvement in that, how do you kind of combine with traction short batch of impacts? Actually Singapore, not just temporarily. Yeah, just repeat the question because the mic is, is not that obvious. The question was essentially, you know, as me personally, as somebody from Nigeria reflecting on sustainability, how do I I think ensure whatever efforts I'm involved with essentially amount to sustainability wherever I work. For example, whether it's in Nigeria because as as, as you just kindly noted a lot of the chair challenges in the health system are due to their structural problems. And I guess what we need to be mindful of is avoiding parachute, endeavors and parachute endeavors look different. They can research, people tend to think that parachute endeavors is just mission work, but no, no No, I think research is actually quite effective parachuting because you can do the virtue and, and I think the way to address that is to be intentional with who you work with. And that can be hard as we are more junior because often it's just serendipity. So for example, I didn't know Dr Watson before I joined the PDSSC. It's just really fortunate that she in her practice has really embodied the spirit of equitable working and sustainable work with her colleagues in Uganda. So by that, what I mean is so she started out as a registrar resident and has come up alongside Doctor Google Big, Mr Kewpie I and he now basically uh in his capacity and do with phd now also have mentors other people, has his own information. So this is very still a great to research. I think you, you also need to think about when you, if, if you're based here, you need to be created around what else is going on. So there are many NGOS that relate to work great on back home. So the first example is I have an interest in female genital and addressing female genital cut mutilation, which is a problem in Nigeria. And so over the course of the years, I have been volunteering with an organization called Quiza, which is African Women in Scotland. And we are set up to address the well being of African women with the focus on gender based violence and initially by voluntary in and just helping with odd things here and there like that worked my way up and I know one of the directors. So even though we are not in Nigeria, we have Nigerian women within our community, we have Kenyan women, we have Egyptian women. Um And essentially what help do is when people arrive, we, we kind of speak to and feed into elements of their well being was there in, in uh local setting, Knight in November. So that's, that's you just have to be intentional and just ask the question, why am I doing this? Who is this? What are the power dynamics? If anything feels uncomfortable to you, if you feel like, you know, this is a bit dubious, this is a bit parachute e then I would uh raise redback out quite Oscar. So I'll open this up to the rest of the panel. Um I think it's really interesting area often. Uh One of the issues particularly research is that people with the money set the agenda. Okay. And that's just true everywhere. It's true here. It's true in all aspects of academia. So how do you reconcile those things? Because if money is coming from the global North, they've got research priorities, they've got money, the money that sustains many programs and many different sort of agendas. And so, you know, what, what do you think and open South, the rest of the panel, what do you think about how you can deal with it. How do you grapple with this? How have you dealt with this yourself? I think I have a quick mentioned. Um So I guess in my, in my research work together with humanitarian organizations, particularly I've been doing research with MSF and Red Cross and Emergency, which is intended that you're working search with. Um It's really interesting because humanitarian organizations have exactly that dilemma in a sense that their stakeholders to degree of the donuts, you know, the individuals that are sitting, you know, the global North posting money into governments. I want to see an output and the output might not necessarily be the output that the organization would necessarily want to see or the local population that receiving the age would want to get and be that good quality of care or high throughput of patient's. I think we have the same as going through into a little surgery is the same dilemma and, and go back to what you said, you're checking, what is that initial? What is the intention underneath? Well, what is that you want to get out of this? Is that picture in front of the new built hospital? Is it 1000 operations or is it 100 operations? But, you know, every single one of my quality could follow. Um and then it comes back to the visit to say no, I guess if you see something that doesn't seem life and back out which has been difficult that enjoy because you want, you know, uh very hard. Yeah. Um yeah. So on the back of that, I think there's been a lot of common themes that have maybe come through in our talks, one mainly being sustainability intentioned. And then you spoke about impact versus impact factor. And why is it that you're doing this way? And I think in terms of funding actually, and uh hinted out of when you say, and actually global surgery has been neglected. And when we look at the money that's gone into TV, in an area, noncommunicable um or communicable diseases. Um Actually, on the global health agenda, global surgery, we know in terms of what impact peoples' quality of life and the populations and economies through trauma and other um preventable or correctable surgical disease or obstructive neighbors. Um Actually, this is where we're doing need investment, but certainly within even that world. Um It's, there are so many competing interests and I think one, one of the things that I've been lucky enough from my mental and supervisor, proper coup to um their witness to is her um partnership with a specific hospital, a specific team in one center. And that partnership has been over the period of 25 years old and she was invited there initially to help train certain local surgeons who had lost some of their older mentors and to come in almost retin mentor. And the initial um reason for going. There wasn't about research, it wasn't about any particular kudos to yourself other than just to provide surgical training for the local pediatricians where they didn't have seniors you could do for them. And over time that's been a very natural partnership. Um That's Rome um and has looked into research infrastructure and has attracted in different projects and funding. But I think one of the key to aspects of sustainability is not thinking that you're gonna arrive somewhere. And like you say, parachute down and have a wonderful idea that's going to change things which within the period of your refill or your masters or whatever it is and then leave and it'll continue. I think appreciating that a lot of this work has to be done with yes clinicians with, with hospital management, with Ministries of Health and at a policy level over a very non period to have a meaningful and sustainable impact is probably a realization that lots of people don't want to accept because you want something that will give you impact that very quickly as opposed to a career of being committed, even to one small, very small area of very small district and or whatever it might be, that might have a bigger impact in the people who live there. Um rather than something that is quick and easy and no kind of group. So again, picking your in how you get involved quite well. And I think it's from a if you have the X factor or that's something about this doesn't feel right or it doesn't sit right with you. Hey, he to that and really think about that and digest that before just jumping in because someone's offering you something. Uh um, great question, especially now because health and global surgery financing is, I think that mirroring top of the global surgery agenda and discussion's. So the question is what is in the corner of financing? And I think it's perhaps the more difficult in global surgery because of other stereotypes and challenges we face as a division of global health in general. Um being new and being maybe um less popular, although that's changing where the long term economic and population benefits of investing in global surgery or maybe um still lad and in terms of advocacy and acceptance, um I don't think we've reached a critical mass yet, which can back us into a position where perhaps unethical finding sources are tempting. So, uh my personal value system have quite a utilitarian approach to ethics and maybe financing as well. And developing a balance between that vertical parachuting model and a long term horizontal model, which should be significantly delayed by uh you know, declining financing and then finding something regular model in between. I think they're that with the correct kind of mentorship developing critical mass so that it is less tempting to take a shortcut. And I would see a political financing as a shortcut um as well as the other vertical programs as being that, um I would say it's a, it's this report, it's a hard catch, should be on it. So I think that's a very important question and I think that's why it's important to have a mentor who's value system, as well as the technical capacity align with your own value system where you're able to reflect on your own prejudices and when having intra and inter country partnerships where there are asymmetrical relations, whether it's financial power or other, it's important to be aware of those, those lasers. And I think that would be the way I would answer the question and address the case by case. Thank you very much. That's an interesting question. Any anything else? Thanks. Uh Thanks uh talks. Um And yeah, so I'm at the point where I'm very open to think my first chemical year surgery, uh whether that's domestic globally humanitarian work that is doctor. So we mentioned work of MSF also had good conversations with doctor Young guy about longevity, the sustainability and perhaps the difficult ethical questions about humanitarian aid and relief. So I guess my question kind of thinks to whatever the conversation that has been ongoing, but how can we reconcile and marry these two concepts of our priority should be from long term sustainable change where countries are, are not dependent on say the global lot. But then also recognizing the reality that there is a need right now as the statistics speak. So what value do say organizations such as the one I'm aware of, uh doctors are orders MSF or uh what value to they play right now. And as medicals to be looking prospectively, what considerations are taking to play and deciding which path I want to go now. Yeah. Okay. So just, just to paraphrase that just in case you didn't hear all of that, but essentially Francesca was asking that from the perspective of medical student, looking at many sort of humanitarian organizations um and opportunities to get involved, how you make good decisions about ethically getting involved uh and, and addressing urgent need. Um but also not uh for going the sustainable or long term approach that might be attractive, you know, on paper. So any thoughts from the panel, uh I think that's a brilliant question and that's one that I've grappled with for a long time. Um And I think um there's a combination of different ways to look at it, I guess one, if you, if you just look at organizations really knowing the organization before committing to anything is crucial. MSF is a huge brand. But of course, they also have an incredibly established frame of how they work in terms of a bear witness to what they do. They are not kind of shy away from saying that something is wrong. Um And, and they have very clear remit working within humanitarian in terms of fragile conflict affected or natural suspect settings original. But then of course, as time go on, they are wrapped into chronic emergencies that are rolling on here and here and they have to reject their structures and they are dealing with long term sustainability projects or stain think projects which look at development rather than sort of that initial, hard and fast, quick infrastructure just to deal with immediate immediate problem. And increasingly more, more the humanitarians of the class of humanitarian organizations are dealing with in particular dilemma, more and more that are moving across to having established hospitals and acknowledging as a long term commitment, others are trying to still keep on to that sort of short term missions. MSF being one in the department. So knowing which organization go with and then read the increasing the literature and I guess if I could just mention one thing that will be Haiti, it's a great example of how you can just go so wrong. So humanitarian organizations is effectively a label that you can fly to anyone. You know, you can go out with your, with your Paxil and say like you are humanitarian certain doing them amputations, which degree is what happens in Palpating 40 years ago. Um And then you have major organizations coming in, of course, with incredibly clear established most how they operate and the quality that they have to meet. And there's great research coming up both from Harvard, but also from Kuala institute showing that actually quality of care depending on the organization went with was very, very and in many parts that negligence, detrimental um worsening compared to uh if you go down the route of humanitarian aid, which is something that, you know, if you're not aesthetics, you only work a few months of the time, it's incredibly attractive from that point of view. Um But then you're not working with the population, then you can use that in between your problem and that in theory could be anywhere you want. So you need to know with yourself position anti in terms of what you want to bring what you might get adding to that. Well, I would say is this, I think this is the role for people don't like this word politics, medicine, health is political. You know, our medical education is conveniently a political and the historical. And I think if you're in a global health, little surgeon space, you cannot afford to take that uh stand. So, you know, there is always a crisis somewhere and the submarines have evolved to chronic crisis as well as and there will always be a role for humanitarian work. And I think that's something people should get hold further down the line with a bit more senior. But what can we need to, again, historically, understand the origin of these crises at the particular chronic ones, which is unfortunately, again, to do with history with regards to political and economic dominance of uh the global minority in Europe and North America. And we need to speak to that and were witness to that. How can you do that as an advocate in your local setting? You can write to your policy makers, you can write to your MP, you should know who you're obviously security, right to them. All right. Listen, whether or not there response, but you can actually do that as medical students and as registrar HMAS consultants and you can engage and volunteer with organizations to particular advocate in that space. Um So that's another way to build a global surgeon, uh and just a touch. Um, what's been said, I mean, um, certainly, I think that's an excellent question and I think the answer is probably both those views are needed and there's absolutely stellar role and a very imperative role in healthcare organizations like NSAID. So you can deal with crises and provide care the point of um, in the longer term. And in terms of what, you know, your surgery that's done in something like you, because we all do care quite a lot about is the research in the field. And I think while the last commission has been very good at outlining um issues and put in giving us a platform, what you're speaking about in some of the work you've done is actually there's still a huge blind spot as to what's actually going on healthcare provision in so many countries in bloating with incomes and in Africa particularly. So I think part of trying to figure out what is needed and what projects are sustainable is actually acknowledging that we still don't have a lot of data on what the main healthcare issues are and nuance in terms of that surgery and anaesthetics and not separate. And a lot of research that is defined in the state of play and building referred, research infrastructure and empowering people will encourage probably forward for choice of word but encouraging and giving uh thought to how we build, help build and support research infrastructure in lots of places that you might care about. Um is probably a very integral step two, then understanding the problem and then you can argue, debate what the solution is. Um But I think that's for me, is quite a reporter that if we have to acknowledge how much we don't know, I don't understand about the, the real uh the needs are and about how we best address those needs. Fantastic. I mean, there's some amazing stuff coming out and I think it's, it's really good and I'll just back up a lot of what's come up from the panel um as general advice, which is just making sure that you still try to educate yourself. So, you know, it's great and obviously participating in saying that this is really important but trying to read and actually know something about this is actually important. So having all the intentions in the world is great. But it is also important to get a sense of the context and, and sort of a second point alongside that is uh there's a lot of nuance about different countries and settings. So, you know, if she always talks about leaving Nigeria not knowing she's a black woman, I can tell you every single person in Zimbabwe who is a black woman knows they're black woman. All right, because in Southern Africa, history is very different. And so it's, it's important to understand that when you go. So there's a sort of temptation generally to sort of homogenize these experiences and people uh to, to think that it's all the same. But actually, there's a lot of neurons and so I think it's worth considering. And, and second to that, actually, because you've all worked in lots of different countries. I was going to ask actually, how have you managed that actually, because Brazil is very different to Uganda, which is different to Nigeria, which is different to Syria and South Africa and again, uh Tanzania and, and South Africa. So it's really interesting to hear what your experiences have been working these different contexts. I learned from doing things wrong with me. Sadly, I worked in my favorite against my favorite. So when I, when I went to work, firstly in Uganda before Harvard, it was with the Royal College. And even though it was an ongoing project and actually it's now been embedded into the healthcare system that's now run by local Ugandans, which is great and the sustainability. But when I went there, um so, first of all, it took a while for people to acknowledge that I wasn't you gather and that specific, I I've come with the college and I'm not sure whether it's because I definitely look younger than I actually am. And obviously, I'm a black woman after woman. So maybe I've blended in and also I'm a woman. So I'm not sure which layer of oppression was working against me or in my favor. But it helped because one side and once I had been there for a couple of weeks and people were like, oh, it's just not, it's based off from college. I sussed out some things that had been going on with previous volunteers. So people opened up to me and kind of let their guards down and I was like, oh, really? That's interesting because that's very different from excess. Uh And then it clicks that I was working with. Yeah, but in that role, even though, you know, it kind of works against me and worked my favorite, then I was able to, I guess media and address some of these issues that had happened. But I, I definitely stepped away from my experience with a strong acknowledgement of power and then bring it back. However, I now apply this whenever I get asked to do any global healthy related work. And so I asked him critical questions. So who, who's funding this work, who's involved, who's going to lead it? And I was asked recently to go and do some work in Egypt. And it was a senior ask from our vice president. I ask these questions, who's going to lead it? What's it going to lead to? And I guess it's not easy for me because I'm more senior and I have experienced, you know, I can maybe afford to us that and turn things down. Um And I also wanted to know if I was traveling to do this. Am I traveling with people who speak Arabic as well? Am I traveling with Egyptians who can like cover my cultural blind spots? There's only so much about Egypt I can learn in said timescale and we were working specifically against the medicalization of FGM, which is a very different setting from where I've worked, which has been patient focused. This is where doctors are doing 70% of FGM. So all that to say, I love by doing it wrongly. And now I ask critical questions, who's funding, who's in charge? I want to see that people on the ground are reading things and that speaks to sustainability. And if, if question, if any of those questions is new, he said, I think that's a good place to wrap up. It's been a really fantastic evening. I really like to thank the panel. You've been excellent. They've given up their time come from far and wide, uh under and also a difficult time as well. You know, I, well, the strikes on to come and support this event. Of course, everyone in the room has also been really good and, and it's, it's fantastic to see all these people in, in person. So thank you very much. Fantastic. Just acting. My thanks to all of you coming. I'm also from going too terribly expression. It's just been really interesting, diversity of opinions and specialties. So thank you all for coming in person. Um I hate to have more in person events. Um Of course, you can drink but also any heroes as well. Uh uh just gassing conferences. But I think two years ago actually. Um so if you're not a member of get you come today because you're interested in this sort of thing. So you should definitely have a member and get our newsletter. You don't know too much about you GSG group here in Oxford. You should definitely engage. It's a fantastic group of academics and clinicians. There's a website for those who would like to, if you just Google Hospital Reserve Group, you will find it and they are, they're amazing group. I think about the Oxford Global Surgery because I can't see highly enough of it. Um Please do eat snacks, drink things because it all needs to go, please to come to our annual conference in Oxford, September 23rd 24th. Because anyone who would love to see speak on any of these effects, let me know if you're looking speakers and if someone who's inside you, we want to be uh um anything else to say? Yeah, you're fine feedback, feedback link, carry it on it. You will all if you sign up to Medal, the Metal Link, by the way, Metal has been amazing. Medal. We love you. Our conference will be hybridized by the way. So anyone you know who doesn't live in the UK, who wants to join, it's free for anyone from an LLIC and it will be done two medals. So it's quite far, right? Why not? And you all have a few that with your emails to sign up by a metal or use the QR. Thank you. Thank you. Yeah, I know. Okay. Uh uh