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Summary

This talk will discuss Health Education England (HEE)'s fellowship program that strives to promote mutual learning and benefit between the UK and developing countries. Through this program, medical professionals in the NHS can gain global learning opportunities, leadership skills, and support for international projects. The program has had great success and features fellows currently working with partner organizations in Eastland, South Africa, and Zambia. The talk will cover the model the program is built on, the partnerships that have already been created, and other fellowship opportunities that are currently in development.

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Description

Welcome to the GASOC International Conference 2022, we are delighted to have you join us either in person or virtually.

Join the conversation online by using #GASOC2022

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📮 Contact support@MedAll.org with any questions about the platform

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Links from Chat:

Twitter is @GASOC_2015. The facebook is GASOC UK. The conference hashtag is #gasoc2022

https://youtu.be/Hl7c3oDxIU8

Prof Mahmood Bhutta - 'The Real Cost of Healthcare': https://www.youtube.com/watch?v=Hl7c3oDxIU8

Dr Hixson's twitter: @ICUdocX / Twitter: @oceansandus

https://www.incisionuk.com/about-4

https://www.fmlm.ac.uk/clinical-fellow-schemes/chief-sustainability-officer%E2%80%99s-clinical-fellow-scheme

Miss Hunt - https://bjssjournals.onlinelibrary.wiley.com/doi/10.1002/bjs5.50122

References from Michelle Joseph: References:

https://gh.bmj.com/content/4/5/e001853

https://gh.bmj.com/content/5/7/e003164

https://gh.bmj.com/content/6/2/e002921

GASOC Mailing list - https://www.gasocuk.co.uk/join-now

https://www.gasocuk.co.uk/ Is our website for the Keith Thomson travel grant info

Phil - You can set up your own teaching organisation and get going straight away at https://MedAll.org/host

Or feel free to find at time that works for you to jump on a call after the conference and if we can help, we always will: https://calendly.com/phil-medall

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HOUSE KEEPING - once you have entered the event, on the left of the screen you will find the following icons:

🎤 Main stage - this will be where all our talks will happen - you can use the chat on the right to ask any questions

💬 Breakout session - this is where you will see our coffee rooms where you can network throughout the conference and also sessions

ℹ️ Event Info - you will find our schedule - we will try our best to keep to the times listed

👀 Sponsors - we have a few some incredible sponsors here - please do take a look

📃 Poster hall - this will open in a new window for you, you can browse these and click on them to read them - click on them a second time and this will enlarge it for you. Please do 'like' the posters as well as ask our poster presenters any questions

SCHEDULE

(subject to change | 'Skills Sessions' 1, 3 & 4 can be found in the sessions tab on the left of your screen, Skills Session 2 is on the main stage )

08:00-09:00 | Poster Hall and Sponsors

✳️ Welcome

09:00-09:10 | President's Address | William Bolton

09:10-10:00 | Keynote Speech: "Global Surgery: The State of Play" | Kee Park

✳️ Sustainable Global Surgery

10:00-10:25 | Human Healthcare and the Oceans| Richard Hixson

10:25-10:50 | Sustainability in surgery: A circular economy for medical products | Mahmood Bhutta

10:50-11:15 | Sustainable surgery, Making each day count| Katie Hurst

11:20-11:30 | Break | Sponsors and Posters or chat to others in our coffee break session

✳️ Sustainable Global Training

11:30-12:05 | Sustainable Mesh Hernia Surgery – Can Dreams Come True? | Mark Szymankiewicz & Mugisha Nkoronko

12:05-12:30 | What can the Sierra Leone surgical training program teach UK surgeons? | Lesley Hunt

12:30-12:55 | HEE’s Global Health Partnership Team: Global Learning Opportunities | Fleur Kitsell

13:00-13:45 Lunch | Sponsors and Posters or chat to others in our Lunch break session

13:15-13:45 | Sponsor Breakout Session

✳️ Sustainable Policy and Advocacy

13:45-14:10 | Health Partnerships: for sustainable and mutually beneficial health systems strengthening | Kit Chalmers

14:10-14:35 | Sustainable surgical solutions in LMICs, how do we achieve this? | Tim Beacon

14:35-15:00 | Climate Change and Global Surgery Policy | Lina Roa

15:00-15:15 | Break | Sponsors and Posters or chat to others in our coffee break session

SESSIONS **(use tab called 'session' on the left of screen)**

15:15-16:15 | Skills Session 1 - Trainee perceptions of Global Surgery and our role as advocates| Catherine O’Brien

15:15-16:15 | Skills Session 2 **Main Stage** - Research skills in Global Surgery | Michelle Joseph & Kokila Lakhoo

✳️ GASOC Projects updates

16:20 - 16:40 | The Future Surgical Training - Sustainability and Challenges | Moiad Alazzam

16:40 - 17:00 | Uganda VRiMS and Events Update | Helen Please

Sunday 23rd October

✳️ Welcome

09:00-09:10 | Secretary and Conference Organiser Address | Pei Jean Ong

✳️ GASOC Trainee Prize Presentations

09:10 - 09:20 | Ethical challenges in the implementation of global surgery: The Non-Maleficence Principle | Ana Toguchi

09:20 - 09:30 | A case report of multiple urogenital abnormalities detected during the post-surgery in a 20 year old primipara in Uganda | Paul Stephen Ayella-Ataro

09:30 - 09:40 | Designing low-cost simulation model for laparoscopic appendectomy and its application for surgical training in lower and middle-income countries | Bishow Karki

09:40 - 09:50 | Prize presentation including announcement of Keith Thomson grant recipients

09:50 - 10:00 | What are the challenges facing the development of pre-hospital care service in a low resource setting? | Elizabeth Westwood

10:00 - 10:10 | Speech from President of FoNAS | Michael Kamdar

✳️ Sustainable Global Development

10:15 - 10:30 | Why Global Healthcare Education Matters | Phil McElnay

10:30 - 10:55 | Patient-Centered Impact Evaluation in Global Surgery | Mark Shrime

10:55 - 11:15 | Sustainable Strategies for Global Surgery | Salome Maswime

11:15-11:45 | Break | Sponsors and Posters or chat to others in our coffee break session

11:25-11:45 | Mentoring in Global Surgery (EADP) | Omar Ahmed

✳️ Sustainable Global Innovation

11:45-12:10 | Design Challenges for Affordable and Reusable Surgical Devices for Low-Resource Settings | Jenny Dankelman

12:10-12:35 | Environmentally Sustainable Change in Theatre - Our Experience and How-to Guide | Katie Boag

12:35-13:00 | Frugal Innovation in Healthcare: How to Do More and Better with Less | Jaideep Prabhu

13:00-13:15 | Conference Close and Prize Giving | William Bolton

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A Global Conference

The GASOC International Conference 2022 will be hosted in Sheffield City Hall, UK, on the 22-23rd of October. Everyone is welcome, including medical students, trainees and allied health professionals from all surgical specialties, anaesthesia, obstetrics and gynaecology with a passion for global health. There will be something for everyone, with a range of keynote speeches from inspiring leaders in global health, breakout skills sessions, and opportunities to present your research through our e-poster hall. Finally, delegates will have a chance to meet our sponsors and exhibitors both online and in-person.

Sustainable Global Surgery

The theme of this year's conference is Sustainable Global Surgery. This is an exceptionally important topic as sustainability impacts every aspect of healthcare training and service delivery. Through this conference, we hope to not only tackle areas concerning environmental sustainability but also take on a broader approach and explore sustainability in other aspects, including sustainable training programmes, sustainable global partnerships, and sustainable innovation.

Click here to view our conference programme.

Posterhall

We thank all poster presenters for your enthusiastic participation. Please upload your posters by 17th October.

*Important information regarding registration*

Delegates from the UK can only register for in-person attendance, until our venue capacity is reached.

  • UK: in-person tickets only, virtual option will only be made available when venue capacity is reached
  • LMICs: free in-person and virtual tickets available, subject to a strict vetting process. Please note this does not include accommodation or travel expenses etc, these must be covered by yourself
  • Any other countries: in-person and virtual (fee-paying) tickets available, please save the date for now and we will open this option at a later date

LMIC is defined as per World Bank LMIC country classification, please do not pick the Fair Medical Education ticket if you live/work/study in any other country.

All delegate registrations will be reviewed to ensure that the correct tier of payment is selected. We take probity issues seriously and reserve the right to refuse admission to delegates who may have been dishonest in their application.

Please do not hesitate to get in touch via gasocuk@gmail.com if there are any queries about payment.

Refund Policy

GASOC is a trainee organisation and will have to shoulder the burden of the costs when people cancel their tickets. We seek your understanding in this matter. Should you require an urgent refund, this will be considered on a case-by-case basis. No refunds will be considered after 6th October. Please get in touch via via gasocuk@gmail.com in the earliest instance to discuss.

We look forward to seeing you soon!

Please visit our GASOC website for more information on the conference programme, food and accommodation. You can also follow us on Twitter @GASOC_2015 for the latest news updates!

Learning objectives

Learning Objectives:

  1. Explain the importance of the Global Health Partnerships report from 2007 and its influence on the creation of the fellowship global learning opportunities.
  2. Identify the difference between positional leadership and personal leadership in the context of these global learning opportunities.
  3. Describe the mutual benefit approach of these global learning opportunities, and explain how this supports strong partnerships between UK and overseas organisations.
  4. Recognize the different fellowship programs available and their focuses, including the IGH Fellowship, the Thailand Public Health Fellowship, and the Diagnostic Imaging Fellowship.
  5. Appreciate the experiences of two current fellows including their project, the support they have received, and the impact they have had on the international partnership.
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Computer generated transcript

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

that we've got flu market. Still, she's the senior lead for Global learning Opportunities in Global Health Partnerships. Directory for Health Education, England. She focus on on developing opportunities for NHS staff to gain global learning opportunities. These programs are co developed with the overseas partners, and the schemes aim to have clear mutual benefits. She's got a background as a physiotherapist and has worked both clinically and in academia. So thank you very much. Flare kits off. Good morning, everyone. Nice to be here. Um, I'm going to talk to you about some fellowship global learning opportunities that health education, England offers, and health education. England is the organization. So, um, that, um, Leslie Hunt probably works for, um in terms of her training role And, um so health education. England is an arm's length body of the N h s. And its mission is to have the right numbers of healthcare staff with the right skills, Um, and with the values and behaviors And as you know, in the UK at the moment in the NHS, that's a challenge for us. Um, but things are hopefully will get better as things do. What I want to talk about today is I'm part of a national team that offers some, as I say, global learning opportunities and the health education. England has only been in existence since 2013, and it was set up when the NHS was trying to make sure that money for education and workforce development was not raided for the provision of day today. Healthcare. So it's set up as an as a if you like, um, an arm's length body so it could do its workforce planning and, um, quality assured and plan the education and training for all the healthcare staff in England. So I am in England organization talking about, um, and that is what we attempt to do. You'll probably be aware that come April 2023 the N. H s various arm's length body is emerging back again to one overall arching organization called an HSS England. And so all the all the bodies will be back together. One of the reasons for that is that it was felt that had become some separation between workforce planning, an actual the needs of the healthcare, um, provision of healthcare, not only for uh planning, but also for financial. Um commitment. So things change. Things go around in circles. I'm at the end of my career, um, and do to retire quite soon. And I've lived long enough to see many circles. Um, and, uh, that's good. That's good. Each circle solve some problems and create some new ones. And it keeps us interested. Um, as as we go forward, Um, but these fellowships, I'm going to talk about that. They came about back in 2007 when Nigel Crisp, who's a name you may know, in the field of global health. He was coming up to retire from the equivalent role as chief executive of the NHS in those days, and he wrote a very powerful and important document called healthcare Partnerships. And for the first time, it was a government sponsored of work for the first time, it said very clearly in a government sponsored piece of work, the mutual benefit gained from when staff from the UK and by implication, other well educated Western world to if they went to work overseas. Whatever their motivation to go, often their motivation predominantly, was altruism sharing, giving back wonderful, wonderful motives that actually they gained a huge amount, uh, themselves at a personal level, and sometimes that might have been recognized anecdotally but hadn't been recognized, if you like in that same way by the government. And, um, it enabled that the regional structure of the NHS at the time was strategic health authorities. I worked in one of those in the Workforce Development Team and enabled us to explore and get some funds for innovation and development. And so a group of us multi professional folks got together and decided. Wouldn't it be great if we could set up some kind of a program that capitalized on the this report that said how beneficial it was? Two. Both parties if you K healthcare workers spent some time off working with the UK with a partner overseas as well as at that time, we were looking again to try different ways to help NHS staff develop leadership skills and behaviors. And this wasn't just leadership skills for those in charge. This is the kind of leadership behaviors for anyone anywhere in the system, and we talk about positional leadership, which is very clear if you're in charge and we also talk about personal leadership and the behaviors are the same. You just may emphasize different ones, depending where you sit in the system and what the context that you are in. But that is how these fellowships came about. So we we devised program in in a year, and we decided it at its heart must be upfront, this idea of mutual benefit and that that would signify partnerships. Always, if you've got an imbalance with one group feeling they're going to give back and to share and to do something good, that is wonderful. But it all it intrinsically sets up perhaps an imbalance in partnership. And I think Leslie's example just now just shoot beautiful example of that is not the case. Your motivations can still be to share your skills and build. But there's a huge learning back. And I think Leslie alluded to that very well, as did keep Park. I think he talked very much about the mutuality that we've come to learn from these things that there isn't There isn't a sort of a primary partner. Everybody brings different things to the table and and everybody takes away different things. And that's what we were aiming to do from the start Um and the focus is on a bit about what we're bringing back to the NHS, because this is an NHS organization and these might be opportunities you might be interested in. But fundamentally, this is about mutual benefit. So we set up the scheme with one pilot partner in Cambodia and, um, we had the first group we had were to GPS and to mid wives who went out and did fellowships. The important thing here, and I put it on many of the slides, is that this fellowship is does not provide any direct, clinical or patient care. And so I'm pleased. Don't think I'm against those things. It's just that this was a new thing. This was a gap. There are many other schemes that provide opportunities for people to provide direct clinical patient care or clinical education, and this was just a different offer. So there's no inherent criticism of other offers just to give you a bit of a an overview, we've got a number of fellowship opportunities. The first one we started is known as the I GH. Fellowship has the rather grand title of improving global health, which seemed a great idea back in 2007. Now it feels a little bit grand, so we use. But it's got quite a branding. Uh, so we use the I G h to to to cover that because a lot of people have heard about it and the things we've written, the evaluations we've done have got that branding. So that's what started off, and you can see the summary up there. I won't read it all through to you because hopefully you can read it. I presume you'll get the slides later, so if you're interested, you can read read up on it. But the model and I'll talk a bit about the model we use has enabled us to build on different types of fellowship. The But the key thing for the i GH fellowship is that fellows on that who spend time working with an overseas partner, typically in a lower middle income country typically in a resource poor setting or poor resetting that were used to in the N. H s is that they work on a project. So the kind of thing you might do in your day to day life you work on a project on top of your day job. The idea of doing this instead of it being on top of your day job would be that you would learn how to do it really well. Uh, and you would have the time to do it really well. And you would have support from a mentor to help you to do it really well. So it goes back to that some of those things that Leslie shared with us about satisfaction and challenge, Um, so but it's enabled us to open up opportunities. So the Thailand public health means that we can offer the same opportunity, the same model, but the vehicle, if you like. The thing that you do is public health research in Thailand. Um, and the only diagnostic diagnostic diagnostic imaging model again is the same thing. But it has a particular focus on diagnostic imaging. Unsurprisingly, um, so we're in developing a number of other fellowships at the moment. So one on planetary health, which we heard a bit about very passionately earlier this morning about the sustainability agenda, and it's a huge, huge topic. Um, we're working closely with Greener N h s, which is an organization I didn't know existed until earlier this year. So again, that's a quite a useful organization to get to know we're doing some work with the various diaspora networks in the country because we are very aware that we have many healthcare workers who's heritage is from overseas, many of whom may have been trained overseas. Or at least, um, done. Some have strong links with their country of heritage, and we're doing some work with various networks there to see if we can set up fellowships to help support people who want to find some way of still supporting the country of origin, the country of heritage, but in a dignified partnership way to do that. So that's an ongoing piece of work as well. We're looking at some fellowship digital again. We learned about that a bit. Mark mentioned that this idea of using technology enhanced learning, whether it's whether it's sort of augmented reality or whatever it is, but using that both in the UK but also with our global partners. So these are things that will come on stream subject to funding subject to nothing unexpected happening in the next couple of years. So I just tell you a little bit about the Oh, yes, if I just tell you a little bit about the fellowships. So again, you've got two people among you among your number today who are involved in this, uh, this program. So you've got John. If I may put you out sitting here on the front table, who did a fellowship back in 19 2020 I think, just before the pandemic, working with a partner organization in Eastland and South Africa. And you got Hannah, who was the one who announced me who's doing a virtual part time fellowship with an organization in Zambia. And she's currently doing that alongside her NHS job with one day a week devoted to to that program of work So typically and I'm talking typically, if there is such a thing as typically. But typically people on and I g h or GDP type fellowship, as I say, work on a system strengthening project. And the key thing about that is the project is determined by the overseas partner. So we don't get we don't fall into the trap of saying we think we know what you need. The project is determined and owned by the overseas partner and the role of the fellow is to convene and coordinate and be that wonderful person who's got the time, the energy, the enthusiasm and the requirement to coordinate and get that project moving. So it is not their work. They convene and make it happen, working collaboratively and then with the ti PHR, the Thailand Public Health Research. Obviously, that's about public health research and fellows, which is what we call people who we are able to recruit to. These programs develop skills in project planning or research and evaluation, um, quality improvement, cultural competence, which again we can go into if you want, um, but probably don't have time today, but also this idea about thinking differently, that ability to pause and think differently. So what we offer fellows is it's a very managed program, so this will not suit people who are looking for a break from some of the bureaucracy. It's a very managed program. There are many requirements before you go. There are requirements while you're there, Um, but we give quite a bit of relatively speaking infrastructure and support for that, Um, and we are able to fund it. That's what again makes it unique, were able to fund it because of the going back to the 2007 start because of the effect were able to show on the individuals and how they are then able to put that new thinking that new learning those new behaviors into their role in the NHS on their return. That is why we're able to fund it. Uh, and we fund it through. We pay international travel. We pay for all the pre preparation, learning and development, and we pay a monthly local cost of living allowance. So if you're spending time overseas, for example, in Cambodia, we pay you a stipend that covers the cost of rent food, um, Internet access, things you will need to live while you're there. So it will not keep up your mortgage payments in the UK while you're gone or your rent in the UK Um, but it does allow you to live overseas. If you're doing the part time virtual placement, as Henry is doing, we pay the equivalent of that to cover one day a week of your work. It's interesting. The virtual placements came around because of Cove ID Um, and as with many other areas of the NHS enabled us to innovate more quickly and more effectively than perhaps we would have done had we not had that impetus to do so. Um, but now some of that is over, and I'm the video clip we saw early. So it's over. An international travel has opened up. The partners we work with are so keen to have fellows back out with them. So we have a small number of virtual fellowships which I know are very attractive and popular amongst the NHS workforce. But the overseas partner we currently work with overseas partners we currently work with very much prefer having people there with them if I can. Oh, if I can give you some examples, these are These are a list of examples of recent projects of the three fellowship types that I just talked about. Um, so you can read those, but hopefully that gives you an idea of the breadth of work, but also how clinically relevant they are. So you're not, as I say, providing direct patient care. But these are very clinically relevant. Um um projects the concept of mutual benefit, which, as I said, is key. We've tried to be very clear about what the benefits are to the overseas partner as well as what the benefits are to the N. H s. And in health education, England's global strategy. We we layer it, talk about the benefit to the individual, the benefit to the N. H s as a system and also the benefit to the wider world. And so obviously we're concentrating on the benefit, if you like, from an MS perspective to the individual. But then those individuals themselves create a huge benefit to the NHS on their return. And the worldwide benefit is because, well, they're on the fellowship there, obviously contributing to global health in the work that they do. I mentioned earlier that we base this on a development model for the NHS fellows, which we do, and that feels important. The interesting thing before I share that model with you is that we developed it pretty much as it is. We have obviously improved it it in a regular way, as hopefully we do with all things over the years, as we learn more and understand more were able to to make improvements to it. But fundamentally the model has remained. What it was back in 2007, Um, and in 2014 came across this work of somebody called Nick Petrie, and he described beautifully what we felt we were doing, and he had a great theory base underneath it. So isn't that lovely when you can? Actually, it's probably the wrong way around, but it's lovely when you can find a theoretical model to fit something you're doing in practice. But he talks about something called the Vertical Leadership Development Model, and he says it has to have three elements to it to make it an effective learning experience. There obviously loads of other ways of development, but this is the one that we base our work on. So you have to have something he describes as heat experience. It's an experience way out of your comfort zone, Um, and in a very new and strange environment, if you, uh when it's it's strange and it means strange, I mean new and, uh, you know, unusual for you. So as you can see, going overseas to a new healthcare system could very well fit that bill. It could just be moving hospital in the N h s, but you can see how it works for for global work and that again, going back to this concept, that is, it can remember how she phrased it now. But this idea, it has to be stretching. Um, but you need some support to help you that be a very positive learning experience rather than overwhelming where it might become a negative experience for you. So it's That's the kind of balance we're looking for. Um, and for that to be a useful learning experience, you have to have an open mind to to respond to that. And you have to be curious about this new place you're working in, why people do things the way they do, what the context is, what the culture is. And if you have all those elements that actually it's a very, very positive learning experience. He also talks about as a result of those new new experiences, new context that your perspectives make allied your behaviors. Your values may collide with those of where you are, and again that can be really good. If you're curious about that, rather than judgmental, Um, and then that's how you move and how you both benefit Both all parties benefit, and then finally, this ability to make sense of it. When we set up, we set up people, a mentor and the terms mentor and coach so varied in their understanding and interpretation. So we describe it as we have a mentor who uses a coaching approach to both support and of a challenge to fellows during the program, and that relationship is owned by the fellow. The conversations we, as the program organizers, know nothing about their confidential unless there's a safeguarding or any kind of issue, then we will get involved with permission. But that is a private relationship between the fellow and his or her mentor, and that feels really important in terms of allowing that process or that magic to happen. Um, but it's also important that it is managed by the mentor, but by the sorry not by the mentor by the fellow. So the fellow, we give guidance about how often they should interact, but the fellow owns that and manages it, so it's not like a requirement. You got to talk this many times for this long on this topic, and that feels important as well that people have the opportunity to own that and manage that, and some most take full advantage of it. Occasionally, people don't, um, and that just feels like a bit of a shame. But that's just one aspect. The model that we use to, if you like, frame the development. Using those three elements that I talked about early is the NHS healthcare leadership model. And again, this is a behavioral model designed for all healthcare staff. Doesn't matter whether you're got any kind of clinical background or if you're a manager or anything, any anyone who contributes to the healthcare, and it doesn't matter where you sit in the system. It is designed to be accessible and usable by anyone, so it's not positional dependent, Um, but it's a really useful tool, and we encourage people to use that and do some kind of self assessment pre and post, and to use that to focus on some areas that they want to develop themselves, and then the other roles that we have. We have the fellows that we talk about and the volunteer roles because even though we pay expenses, we don't pay salary. So the volunteer roles. We have mentors and a lot of arm enters our alumni of the fellowship programs who come back trained to be as mentors and then offer that to new fellows. And we have a roll of a partnership link lead, which again tends to be for people who have been mentors for a number of years, understand the program and take on that role, which I can talk about another time. And if you're interested, we have a microcyte, um, there we can get more information. And, as I say, I think you'll get these slides, Um, and very happy to take questions if anybody's interested. The key thing is you have to finish for people. If you're all doctors, you have to have completed F two by the time you take up the fellowship, not at the time you apply, Um, and you have to be able to undertake these if it's an overseas experience unaccompanied. Um, so again they will suit people at various times of your life. The bulk of the people who can who take up these opportunities are early career, but that can be anything, you know, early career. That's whatever you want. It to mean, Um although I'm not early career, so I'm very clearly outside of the scope. Um, but I hope that's useful to you. And I'm happy to take any questions. Thank you. Thank you all so much for such inspirational and fantastic talks. Um, if I could invite marksman's give it back up onto stage, we'll have, uh, magnesia back up on the screen. And if, uh, Leslie and for kids also stay here Great. Thank you. Um, so, um, all really, really interesting talks about global sustainable training. And I think our first question is from medal. So if anybody wants to add any more questions on to meddle, we'll try and get through as many as possible. But the first question is to mark. So how do you support training? Virtually? Is this from a mentoring or a training perspective? And is it a monthly or an ad hoc basis? Um, that question is from Kathryn. How long medal thanks for that. I think that's a really important question. And actually, it's a big challenge. I think throughout the coated pandemic to to do that. Actually, I think magnesia is probably better suited to answer it because What he has set up is a lot of virtual training and support through, um, digital media, For example, one of the challenges that we we're trying to overcome. When I was talking about the Google glass project was is it feasibly possible to have somebody operating in another location and for us to be able to observe that, but also provide feedback e in the glasses of all your incision is a little bit off or you want to go here? Do you know what this is? And we just didn't quite get to that. So to answer that question, I think we've supported the training in certain ways. But actually, I think it's probably a good question for magnesia if he's able to, uh, to answer that. Okay. Maybe she did. You hear us? Oh, repeat this. Um, So I guess the question was in, um, with regards to the virtual, um, training. Was this more of a mentoring or, um, uh, kind of training approach? Um, and Marks mentioned that, um, you, uh, were wondering about real time teaching in surgical settings. So, magnesia, do you want to just mention what you've done with the Netcare Foundation? in terms of linking up with a number of sort of global tutorials, right? Thank you very much for the for the questions. I don't know if I get this correctly, but, uh, it's true that as Netcare Foundation, we are really working hard to make sure that we, uh we provide an opportunity for continuously surgical education, uh, for people and, uh, many times. You know, after graduation, many of us don't tend to go and operate there level of knowledge. And therefore, we have a different menu, uh, different programs that we run around. And these are online platform, and you can get engaged. Uh, we have tried, uh, level best to engage some of our colleagues, including Mark, who has been part and parcel of the program during the teaching and trainings on how to best manage the, uh, the international standards. And because it has the African experience in a particular Tanzanian experience, he has been, um, uh, so instrumental to make sure that we continue having some support lectures, direct lectures and some really state of the art technology that you're using the in the UK and exchange level of knowledge. I think with that uh, it has really improved, uh, the understanding And, uh, to me, I consider that to me. I consider, uh, that, uh I consider that when you have the right knowledge, you have the ability to make the right decision. And when you have, uh, make the right decision, you're almost improving quality and gearing to manage your patients very correctly. Thank you very much. Thank you. Magnesia. The next question is also from medal and, um, is directed towards Mark. Quite importantly, I think need some clarification. Um, and it's specifically from Emmanuel, a rider who just wanted to check. You heard right. Are mosquito nets actually used or is it a different material used but borrowing from the design of a mosquito net? Uh, so thank you. I think that's a really, really important question. And if I didn't make it clear, it is important to do that. This isn't just a standard mosquito net mesh, and the reason why that's particularly important is because they're impregnated with lots of chemicals. What's this mesh is is that it's been manufactured in the same way, so even commercial meshes is produced in vast bolts of material. So what RAV be tokin are did is he's produced the PTFE mesh, which is produced in the manner of a mosquito net. And and literally, you've got huge roles of these things. So we take out a big bolt of mesh to Tanzania. Um, and it's repaired that way. So it is a very specific type of mosquito net mesh. It's not just something you buy in the shops, which would be a disaster to try. Thank you very much for those. So just a few questions for Leslie, if that's all right. Um certainly medal has blown up with praise for you. Everyone's very impressed with your talk, but one specific question I've got from Ryan Ellis, um he wanted to ask about the quality of the non physician trainees. Is there still such a need for the physician 20 target? Or are we focusing now more on the non physician training? I have to confess my ignorance. I don't know the physician. 20 targets I'm sorry about. Can somebody fill me in on that right? The same as we were looking at the surgical providers. Yeah, to to my mind you can they function at exactly the same level. Yeah, And as you saw from the slide, a lot of them There's two bell curves and they intersect. So we have health officers who are outperforming doctors and vice versa. Yeah. Yeah. The reason you would become a health officer rather than a doctor in Sierra Leone is purely down to parental income. It is nothing to do with intellect or aptitude. If you kind of think of your cohort medical school, the top 10% who went to the poshest private schools would be doctors, and everybody else would be a health officer if they had been born into Sierra Leone. So, to me, we're not doing it down at all. Thank you. Um, one question I've got is so much of our training. Here is service provisions. And if you're condensing everything into such an intense surgical training program, who is providing that service provisions? And how can we kind of shift that into our workforce? Yes. Not all the service provision we get you to do is of value, is it? You spend hours and hours on a computer doing stuff that surely we can rationalize. So, you know, I don't see why it has to take an hour to write a t t o. Do you know t t o. Is that just Sheffield? Yeah. Tablets to take home. Yeah. So right in the patient's discharge summary when it used to take two or three minutes on hand. The technology is really, really letting us down in the UK, And that is what is bogging down lots and lots of the junior levels. The house officer level, et cetera. Um, increasingly, we're using other grades, aren't we Position Associates? A. M. P s. We've got them on awards so that we can free up the guys who want to go into surgical training to do the more valuable work. Yeah. Thank you. Not the more valuable work. That's the wrong expression to do the more valuable for training work. Uh, thank you for that. And then a question for flu. This is one from medal from John Dalton. He'd like to ask, How do you find your partners? And how can you institutions join the program? Great question. We found the first partner serendipitously. Um, and then we got involved in a network again, back in sort of 2008. 2010 There was a big United Nations program called the Millennium Villages Program, and we got known on that network and all the other partners we currently have found us. And these were overseas partners, found us and invited us to work with them. And that was at a time when we ran the program as a kind of a little, um, I don't know, a little fringe program on the end of all the more established programs. Since about 20 years now, 2022 we've been part of health education in Global Directorate, which was only formed in 2019. Now we're part of that and we have this expansion idea. I think there will be opportunities. As I said, in terms of expanding that I know Mark is waiting to ask me some questions about that. Um and we have to link because we're now part of the government organization and funded very much by government organization through foreign Commonwealth Development Office priorities. Their priorities going forward are East and Southern Africa and the Endo Pacific Rim, as well as UK overseas territories and dependencies. So there are the areas where are overseas partners for expanding and going to come from and that we have to do it via There has to be some kind of link government level for us to expand. So I don't know if that helps in some ways, that feels like it puts barriers in the way, but it it will enable our program to be sustainable in and of itself. Whereas up into the point until we joined this team in, um, the global team in health education, England are funding was as precarious as any other global program. Um, basically, um, and then another question for flare. So this one's from Remember, she'd like to know. With so many discrepancies between different sceneries, how would you suggest trainees getting time out of training to do these fellowships? Yeah, Another great question. And it is exactly as you described, and as you know, so we find so as it's a multi professional program. So anyone, as I said earlier, who works in the healthcare? Do you any type of clinical roll or manager can apply? Um, we find the bulk of the people who do apply are doctors in training who have made their own decision to take an F three or a break after core training to do something else and fit it in that way. Um, absolutely as possible. And in the earlier days, we had many more doctors in training who would apply for and get an out of, um, an IUP. What does that stand for? Out of program experience? Yeah, and did it that way. They are increasingly difficult, which I think is behind the question because of numbers. Um, and Dina is having to do their best to populate rotors, but they are still possible in many deliveries, so it depends what route you want to take. But there are two ways of doing it. Currently, we do it on an individual application. There is talk about in the future whether we will do it through Dean Aries applications so that there's a bit more ownership, if you like at scenery level, Um, but again, as you can imagine, and what's behind the question is, Dean's quite rightly have different contexts and different views. There's a huge amount of support for this type of work. Um, in many sectors, there is not universal support for this type of opportunity. Um, so there are differences, but I hope that helps to some degree, but at the moment it's individual application as a safe for people such as yourself. It's either you decide to take an actual break, which again, your dinner. We won't like to hear, uh, talked off necessarily. Always. Um, but you will do it anyway, um, or apply for an out of program experience opportunity with the ordinary. So I hope that helps. Um I'm definitely quoting a friend here, but I think it's interesting that we refer to as timeout when perhaps we should be thinking thinking of it as time in, um So, um, my question and having the stage and getting to, uh, this moment, I actually could direct this to any of you, but I think I'm going to direct it to magnesia. Um, a lot of these talks have been extremely positive and inspiring, but there must be huge barriers, and we've mentioned many throughout, and I wanted to ask magnesia if you can hear me whether or not there is a key barrier that you find inhibits training in your setting in Tanzania, we're just catching him in. Yeah, there are a couple of barriers, and, uh, this includes to the the unlimited really limited resources. And, uh, we do not have the, uh, uh the number of a good number over training facilities and training institutions that can be trains Doctors at the level of, uh, at the level of the surgical specialties we need, Uh, as you can see, if from the our data that we are having 0.3, uh, surgical providers 100,000, uh, to really go and, uh, improve our improve our capacity to manage this particular, uh, conditions that were experiencing We need to increase the trainings and, uh, the number, uh, trainers very severe trainees also is another barrier that it doesn't match always all the time. And having now the double, uh, pardon that we're experiencing here, and particularly in Tanzania, non communicable disease and communicable disease, all in the surgical particular, uh, surgical portfolio. And you find that the resources are so limited and therefore you may not be able to achieve exactly, especially at the level of the governments are planning and, uh, policy. And, uh, these are the issues that we are trying to mitigate with what we're doing and give capacity. Uh, employing colleagues from different parts. And the last point that I want to finish up as I as I am reacting to the questions at hand is, uh, you know, we we we we have experienced the limitations. Uh, the limitation that we have seen is also in the technology, uh, in Tanzania we are We are We are now in the basic laparoscopic procedures while the globe is moving to robotic surgeries and you can see we are doing a lot of conventional open methods and a few basic laparoscopic procedures, and, uh, that is limiting us, since the world is growing very fast into in terms of technology. And then, uh, we don't have the national data for, like, a log, uh, to always see our our patients book our patients at the national level. We have individualized XL. She needs a hard copy books, and we need all those things to be included so that at least we can have a platform. As I was talking about resource, uh, at the level of the of the ministry, you find that that we are almost considering non, uh, noncommunicable now. But the dashboard that that that that informs the policy makers at the ministry level is is Leslie, including the the the surgical portfolio and therefore we need to create some dashboard so that they can give them They can inform the Polish makers and therefore include, uh, surgical plans in their in their in their in their in their in their working, uh, portfolios. And then stop has just come recently. It's two years now we're implementing the insulin program. Uh, it is a five year program, and we're looking forward to see if it will come out with some of the good, uh, outcomes to improve the number of surgical, uh, providers and the quality of care that we we want to see. Thank you very much. Thank you very much for that. So thanks all for a fantastic morning session. So we're breaking for lunch now. I just like to say during the lunch session, we've got a few announcements about some of our sponsors, so we've got a striker and die a medica. So strike will be talking about Neptune Waste management, um, and man systems and safe air. And Diane Medica is going to be talking about appropriate technology for L M. I. C s and a personal view of current and emerging big issues. So we've got lunch now. We're starting the next session at two o'clock, so if everyone can make sure they're back here by two.