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So, last but not least, our final speaker is Miss Rosemary Emodi, the Head of Global Affairs at the Royal College of Surgeons England. Um She will present the insights um from R CS England's latest report in her talk Today. Life on the line, reshaping humanitarian surgery. A call to action, shedding light on the future of humanitarian surgery. And she will be joining us online. Thank you very much. Can you, can you hear me? Yeah, we can hear you. Ok. Uh Great. Thank you. Um Just wondering, I can't see the presentation. Uh is, are the slides up uh at all? Excellent. Thank you so much. And um I'd like to um uh congratulate um the, my Myanmar doctors, the UK on your, on your wonderful conference. Um And uh what I see is a very successful day. Um If you can go to the next slide, please. Um Thank you. So, my name is Rosie Emodi. I'm Head of Global Affairs at the, the Royal College of Surgeons of England. And um I've been um the head of Global Affairs since um I joined the college in 2018. Um And prior to that, I was the head of International at the Royal College of Pathologists. Um and I occupied that post for 7.5 years and built the colleges um international program and helped to actually set up the College of Pathologists of East Central and Southern Africa. Um And then before that, I was for 3.5 years head of international development at the Faculty of Public Health, which is a joint faculty of the three Royal Colleges of Physicians, London, Edinburgh and Glasgow. So um I seem to be a serial sort of royal college um employee. Um Next slide, please. I'd just like to give a quick overview about the Global Affairs um department or team at the college uh our role and what we do. Um Overall, we are responsible or my team are responsible for uh the overall coordination and development of the colleges, international activities. Um And we are responsible for developing the colleges global strategy. Um We identify opportunities for the college college to um develop collaborations and alliances with um um both UK and overseas partners, international partners. Um And some of our strong links include um other uh colleges and surgical societies around the world. Um And we've been responsible for developing a range of um capacity building initiatives um and collaborations um which include um education and training. We run, we're my team are responsible for running the medical training initiative. Um We call it the International Surgical Training Program which is a program that brings um uh international medical graduates, overseas surgeons, young surgeons to the UK to train in the National Health Service for a maximum of two years. And then go back to share their knowledge and skills and experience with um their surgical colleagues and hospitals and um countries. When they, when they return, some of those do, some of those surgeons have gone on to take up senior roles within uh senior leadership roles within their hospitals um and also within um their countries and regions. Um Some have become fellows of the college or members continue to be members of the college and have taken up uh country advisor roles uh with the college. So they act as our country advisor advisors. Um And um we've been responsible for example, for training some of the first female urologists in Kenya um um as well as other other countries. So it's uh quite a uh a, a AAA progressive program and then there are other initiatives that we run as well. So um next slide, please. Ok. So I want to talk about the humanitarian surgery initiative, my colleague, um my good er colleague um Professor Bera, I understand has touched upon uh the humanitarian surgery initiative. Um And I apologize if there may be some um duplication or repetition of what I might, I might be saying. Um Before I start, I I'd like us to focus on this picture. Um This is a picture of Doctor Ahmed Al Maada. He was a uh, a, a awarded, a fellowship under the Humanitarian Surgery initiative and he was our um HSI uh fellow innovation fellow in Gaza. Er, Palestine, um, Professor B Bera talked about um, the work that we, we as the college had done in partnership with uh um map medical aid for Palestine in relation to, er, er, establishing the Shifa uh hospital in Gaza as a, an R CS Center for uh basic surgical skills and core laparoscopic um core skills in laparoscopic surgery. Um uh Doctor Alma Kma was one of the best beneficiaries of, of that training. And um he joined us in, in 2022 as our uh as one of seven humanitarian surgery Innovation fellows. Uh and um he sadly was killed during um during an invasion at Al Shifa. Um and he was killed. Uh we learned of his, of his death in um in Easter this year. So this initiative I think, um and as some of you will know, it's not, we don't talk about these things in the abstract. It is very, um it is very personal to a lot of people. And um uh we, we feel that it's important to recognize in particular the contributions um of health workers um in conflict um and the sacrifices that they make um every day. Um we sit here and um we, we must remember that. So the uh if we can go to the next slide. So the Humanitarian Sur Surgery Initiative was established um in 2021 July, uh 2021. So this was a few months and actually the timing is, is really important. Um When we look at the timing is really, really important, when we look at um February 2021 this M mod uh sorry to interrupt. Uh our online audience are saying that they cannot see the slide. So some uh technical issues going on. So we would like to fix that first if that's uh if, if you don't mind, will it help if I share the slides instead or, I mean, if you can? Yeah. Yes, of course. I'll share, uh I'll start stop sharing my screen. OK. Let me see if I can. Thank you. I don't really know. Let me see. Um Is that working for everybody? Um Yes, we can see your uh screen now. Is that I can do the first screen? Uh Can you maximize the screen, please? It's maximized. Is it not showing? Yeah. Does that work? Does that help or what, what are you seeing? Uh I can see the first light? Yes. OK. All right. So II think I'll just go forward. OK. So the humanitarian surgery initiative, as I said, started in, was established in 2021 a few months after the uh coup d'etat in uh, in Myanmar, er, which I understand took place in, um, occurred in February of that year. And there were two key questions that um it was established to answer. Um The first being, how do we build sustainable humanitarian, surgical capacity and capability and preparedness in resource limited settings? And the second, what role can technology play in widening and improving access to training, learning and mentoring? The, the um initiative was um it was an international collaboration uh led by the college and we focused on two regions. We, you know, it was clear that we couldn't focus on every region and we focused on two regions, um Africa and um the Eastern Mediterranean region. And we were using the language of the World Health Organization. So the Eastern Mediterranean region is that is essentially um the Middle East and North Africa region. Um And at this point, I'd like to acknowledge and thank, you know, our partners and collaborators, as you can see, there were a diverse range um our Global Surgery Policy unit, which is a, a strategic collaboration between um the College and the London School of Economics and Political Science, the Humanitarian and conflict res Research Institute at Manchester University, uh Medicine Sans Frontieres, uh the Journal of Medical Insight, which is a peer reviewed um jo um video journal of surgical procedures at Stanford University um as COVI which is a uh a human, a local humanitarian um surgical organization in er Cameroon. Um And we were funded by the UK humanitarian Innovation hub, which in turn is funded by the Foreign and Commonwealth Development Office. So, this was a very important um important um study and scoping exercise to look at uh to, to understand the structure and system of humanitarian surgery. The funding that we received enabled us to appoint seven uh fellows uh on a 12 month um research fellowship. And for the first time, um we were awarded um uh fellowships to non UK um surgeons, a diverse group um ranging from uh those in er, residency, er, who were in training right through to um er, those who were retired, right? So it was diverse, not just in terms of, of location, but also in terms of experience that, that was brought in terms of their location as well. Um And also in terms of, in terms of, you know, the skill set as well. So you can see, um as I've said before, Doctor Ahmed Al Maada was, was one and so we had um uh uh uh fellows from Kenya, Sierra Leone, Yemen, Egypt and Cameroon as well as the UK. I'd also like to just um recognize the core team in including myself. Um uh may my colleague um who you, who is with you um in person today. And uh we were also had the, had the expertise of uh Jonathan Barden MD, who acted as our humanitarian adviser and who has over uh uh 30 years experience um working in some of the most um um you know, um, violent war zones. So some of the things that the college um did, um, I'm gonna come back to that, er, slide in a minute. We ran, we did a, we undertook a number of activities. We, uh, conducted an international mapping of humanitarian surgery related courses. Um, and that mapping showed us that over 80% of the, the courses and fellowships that we, we were able to identify were based in high income countries, um UK USA. And I think Canada where the, you know, were, were, were really the dominant uh countries, they were highly inaccessible. Um And as I said, mainly located in, in high income countries, the fees and I think, um Professor B Bera also um mentioned fees, but in, in relation to uh lap laparoscopic um um skills training, the fees were inaccessible and, and one of the other things was that there was an absence of multidisciplinary training. Um The courses were focused on, on training or imparting knowledge to surgeons or trainees or residents who were based in high income countries wanting to um um you know, deliver or, or participate or volunteer in resource limited settings. And we are talking about, you know, the rebalance, it's not sustainable at all. And I've talked about timing. I've said that this initiative started a few months after the coup d'etat in Myanmar and a few months, about six months or seven months before, um the um the invasion of the Russian invasion of Ukraine. And then, uh, you know, more than a year after a year later you had, um, you know, the conflict in, in Gaza, but you've got Su Sudan, um, Syria Yemen. So there is, there is a proliferation and it will continue of, uh, of conflict and we've not even talked about, um, you know, natural disasters as well. So, um, the timing was everything in terms of, you know, a part, having a particular focus on humanitarian surgery. Um One of the other um activities that we undertook in this um uh initiative and this scoping was we was to conduct a multicountry bilingual study on the effectiveness of peer reviewed uh um of surgical surgical procedures and how effective the transfer of knowledge and skills uh could be through high quality peer reviewed videos in low and middle income countries. And we conducted that um study um in, in partnership with the Journal of Medical Insight and, and we will be a paper is being developed. Um a manuscript is being drafted at the moment, but we found, you know, in summary, it was highly effective. Um we, and for the first time that it was Multilingual as well bilingual, um we translated it in into French for our francophone er surgeons and residents in Cameroon. Um And um this is something I think again, there's parallels with some of the, some of the um the insights that Professor Pra has, has, has provided in his presentation you that this is, this is a low cost and, and effective way to go. And we're looking to, to build on that. Very, very little is also known about the impact of, of um humanitarian disaster, particularly conflict on the lo on the local surgical workforce um during that conflict and the issues that they face. Um and we, we've undertaken, one of our er fellows undertook a qualitative um er mixed methods study which included interviews with a range of, of key informants. Um and looked at the, the, the key things that happened, the health system collapsed, the breakdown of medical education and training structures, the loss of workforce and the introduction of task shifting as well. And um we were able to amplify that in terms of um support um and further work that we have done with um um in Ukraine to support medical students, both Ukrainian medical students and, and um international medical graduates, particularly um medical students from Africa and India who were studying in and training in Ukraine and who were subsequently displaced due to the conflict. And then I think uh Professor Pnda did touch upon our surgical voices uh webinar series, which was curated by our fellows and, and which provided a platform for um you know, those in the front line, the lived experience of, of not just surgeons but um surgical care teams, the um anesthetists, the er nurses, the midwives. We provided a platform for them to speak, you know, speak about their experiences and the need. And I think that during this period of this 34 year period of the Humanitarian Surgery initiative, what came through was the need to recognize the role that the diaspora. Yeah, diaspora play in, in the humanitarian health response. Um And that, and, and I think that, you know, that has not been recognized before and this is something that we want to build on. So I want to come back to um, one of the publications which we, um, one of the outputs of this um, work is the definition of humanitarian surgery as distinct from the definition of global surgery. And the, this was one of the challenges um that we came across, which was when we talked about hu when, when, when we talk about humanitarian surgery, um people think that it's global surgery, humanitarian surgery is um surgery that responds to, um, you know, um need or a lack of surgery. Um, but there is a difference. And so one of our, er, er, Gerard mcknight, one of our um humanitarian um innovation fellows um led and conducted a, an international Delphi exercise to develop an, an internationally agreed consensus on the definition of humanitarian surgery. What does it mean specifically? Um, and the um resulting paper was published um in the British Journal of Surgery. Um, and this is the definition. Humanitarian surgery is an area for study, research and practice that focuses on the coordinated provision of surgical care in conflict and post conflict zones in areas of sudden onset disasters and when the local health system is overwhelmed. So it's so what we've done um and this, this was published in, in February uh to this year. Um and it has not been contested. And so one of the key things as a as a as a starting point is, is is to promote the definition. This definition, the mcknight definition is what we're calling it, right as the start of being very clear of a, that humanitarian surgery is a subset of global surgery, but it is clearly defined. And that humanitarian surgery is a critical component of, of any humanitarian health response and therefore requires sufficient resourcing and f resourcing, both in terms of finance and human resourcing in order for it to be sustainable and it should be part of um you know, any country's disaster preparedness as well. Um I just wanted to touch upon um one other output of our work, which is um um an a, a low cost, we talked about frugal innovation, a low cost um simulation um um exercise that we came across as part of our scoping, um a scoping work and which we piloted, um which we piloted in Ethiopia with the Ethiopian Emergency Medical team. And this is, this is a AAA card. It's, it's a bit like a monopoly board, but it's a, a play board with cards, um which simulate casualties, um, er, casualties and patient diseases and uh, and, er, emergency medical team staff. So this is called Hospice and it's a classroom based simulation exercise. Um, it's been specially designed um by AAA gentleman called, um, a retired, um, army colonel, um, Doctor David Vasallo, um, who developed it. Um, and it, it mimics all the um mass casualty scenarios. Um, and um it's multidisciplinary, uh he developed it um in partnership with uh when he was uh working with NATO and it, it follows a range of different um er protocols. Um It's been piloted in the US with the US army um in Belgium and in the UK um uh with our army, but it had never been piloted or delivered or tested in um Africa or, you know, or anywhere else. Actually, it's never been piloted in a, in a low resource setting. And so as part of our, our work, we sought to, we undertook to pilot it with the Ethiopian um emergency medical team um with the permission of the Ethiopian Ministry of Health and in partnership with the Ethiopia um public in Public Health Institute as well. Um And it was extremely powerful and successful. It highlighted um a range of weaknesses in the design of the er Ethiopian emergency medical teams um field hospital layout um and also identified areas for team individual as well as team um development as well and helped them to begin to understand and work through their, their, their standard operating procedures. Uh One of the one of the key feedback um um comments from the team. And again, this talks to Professor Bondra's um um um point about active learning. Uh One of the key things was that um they were just um it engaged, they were engaged throughout the training. It was a five day training program with the first day where we trained um instructors. And for them, the the active learning um was, was, was very new to them. Traditionally, um they would be put in a room and they would be lectured to with powerpoint presentations. But this was very, this was very, very different and it was very, very multi multidisciplinary. And so this took place, this pilot took place in June in September. The instructors that we had trained, were able to run a second simulation on their own um with further learning coming out of it. And in um in, in fact, I it was just a, a few weeks ago, um we were uh a member of the team of the Ethiopian medical team presented the, presented at the World Health uh Emergency Medical Team Global Meeting in Abu Dhabi on, on this training and how effective it had been. So this is another model of looking at sustainability where we have trained locally and you know, built a cadre of local instructors and as a result of them presenting in Abu Dhabi Um We're now looking at and hopefully having discussions with um the Ethiopian Medic emergency medical team in Uganda to roll out this training to them, using the instructors that we have trained in Ethiopia as well. So um life on the line is our, our is our is going to be our, is our second major publication. Um We launched this um last month October the 31st of October and this is the first output in terms of the need for collaboration. Um uh And it builds on um the scoping work and our findings and our research and our findings. Um I would like to recognize that this, this report was um this call to Action was um was authored and written by um Mar Dubois who is an independent um humanitarian analyst and a former executive Director of Medecins Sans Frontier, um UK and Europe. Um And I think that uh I'm sure that you will have hard copies of this Call to Action um which may have um distributed, but it starts on the premise that we've, that I've just um mentioned that humanitarian surgery is, is invisible. Um He's mark has described it as iconic yet invisible. It's loosely defined and misunderstood there in lies the need to amplify and promote and a, you know, the acceptance of uh of a definition of humanitarian surgery. Um And yet the, the, the infrastructure and the funding around humanitarian surgery is, is, is, is, is very weak and yet it, it is a critical component. Oh, any humanitarian health response. Um And so in this call to action, we've identified four pathways um as the root as a route map to strengthen humanitarian surgery. The first is to strengthen the foundations of humanitarian surgery and establish it as a properly integrated and essential component of humanitarian medical action. Um And that, and in doing that, humanitarian surgery is not just the domain of your your usual suspects. In terms of medicine, San Fortier or IC RRC, there are a number of actors who are delivering um surgery, um you know, and who do not have the luxury of having access to, to funding to uh to build that. And in, in fact, that capacity building has to take place well before a humanitarian disaster arises. But at the same time, we can see that even with um you know, strong health systems, you know, conflict um can overwhelm and destroy a health system that we need to really um expand um the research and the evidence base for humanitarian surgery and its impact and, and as a way of influencing policy makers, decision makers and funders. Um and that in a sense, if that definition is accepted, then um if the the funding to improve um the research base and the evidence base also flows from that again, I think, um listening to Professor Pra, I think he's already touched on these four, these four points but building accessible and egalitarian um and sustainable communities of practice. Uh We saw um particularly with um the er conflict in Ukraine, the role that diaspora um communities um and health professionals play in, in, in supporting um the humanitarian medical response, not just surgery and what we found was that and certainly in listening to particularly um not just Ukraine, the Ukrainian diaspora, but also uh the Palestinian diaspora is the extent to which they're locked out of, of, of participating. And, and so therefore, created their own ways and strategies to help um and to contribute. So we need to look at how we, how we, how we connect all the dots and how we ensure that um particularly um all communities are able to contribute to that response in a, in a, in a, in a more equitable way. And then um yeah, key for us is around, you know, the building workforce, um training and capacity. How do we ensure that? Um but those, those who are, whose education and training is disrupted by a conflict and disaster, how do we ensure that, that, that we are able to um work collectively to step in and er maintain that? And there are some fantastic examples that are happening already and how do we ensure that we are able to provide support to er er surgical to care teams on the ground in the field, in the front line, those local teams and where should that come from and what platforms should we use? So, and making sure that we are engaging the whole surgical team, it's not just about the surgeons. Um in some places, there are no surgeons at all. And so we need to democratize how we, you know what we mean when we're talking about humanitarian surgery in the, in the real world and not just in the abstract. So my concluding remarks in terms of the key actions of this, of this call to action is that it's the start of a conversation. Um The key actions that um er this report is talking about is the strengthening the foundation of humanitarian surgery, improving the evidence base and research base, developing effective um and equitable communities of practice and um working collaboratively to develop um um uh workforce education, training and access to resources, um sustainable access to resources. I would, I would add um to have continuous um improvement of humanitarian surgery and access to high quality surgery in um humanitarian and low resource settings. We are, we will be launching AAA main report. Um Early next year, we commissioned the er humanitarian and conflict in Response Institute at er at the University of Manchester. Um And um they have written a report which is currently going through review um and that will set in train a further 10 key objectives. And one of the things that we are keen to look at is is to work with organizations, colleges surgical societies and diaspora led organizations such as yourselves, the Myanmar Doctors of the UK to begin to start collaborating um and building alliances to implement those. We want to ensure that um um that we are laying the foundations for real uh preparedness and resilience. Um And also to ensure that diaspora organizations and surgeons and um healthcare professionals are seen as a key and integral part of that response. One of the things that we are also doing is we are um we've launched a survey so we're trying to map um map the who is er involved in supporting surgical care in conflict in disaster settings. Um And this is a global, we're trying to develop a global picture of individuals and also institutions who are involved. Um you know, to try and I don't necessarily think we, we're ever gonna, you know, get um 100% AAA 100% picture, but I think it's important that we, we try and get some understanding of who is doing what and where so that we can start to join the dots. Um And not just the college, this is not just a college, um uh an English college thing. It's about developing those alliances and partnerships first, primarily to avoid um duplication but also to add value as well. And um and to bring in a, a level of efficiency and coherence across what we do and how we do it as organizations who are interested Um and I in supporting the humanitarian surgical response as part of a wider um health response. Um So in terms of our next actions, um we, we certainly like if you're interested to uh sign up to be getting in contact with, with us, um may is in the room. Um And so you can, you know, uh you know, tap her on the shoulder, um You have our call to action. Um and you know, we'd love you to share that call to action. Um It's on our website, you have hard copies. If you want any further copies, we are more than happy to um post them to you. Um And um this is just the start of the work that we are doing. The college is really committed to this work. Um And it will be a key theme, um a key area of work in our global strategy for the next 55 to 10 years. And so I'm happy to um answer any questions. Thank you.