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Hello, everybody. Um I hope you are all well. Um Thank you for joining today. Uh We have um a really great speaker today uh who is an inspiration to us and I hope to you guys as well after listening to her talk, um, Miss um Professor Klaa is a pediatric surgeon at the Children's Hospital in Oxford and the um Nuffield Department of Surgical Sciences at the University of Oxford. Um She has research interest in global Surgery with a vast number of publications. So she, I'm sure she's happy to advise on anybody researchers um in this talk. Um She's the chair um of the International Forum for the British Association of Pediatric Surgeons and is personally developing pediatric surgery through a link in Tanzania. Um And she is a director of um global initiative of Children's Surgery, um which has um followed on um from the Lancet Commission of gen um Global Surgery. Uh She's an editor of four books and uh she has up to date contributed to 70 chapters in surgical textbooks um of pediatric surgery and has over 300 peer reviewed publications which is a great feat. Um Today she'll be talking about her experiences in global surgery and specifically from the advocacy per perspective. Um And how important it is to partake in global surgery um as well. Thank you, Miss, thank you very much for that kind introduction. Um I think some of you in the audience may, um, heard me speak before or I've met. Uh but it's a great, great pleasure to be addressing an audience like yourself because you are the future. And if your introduction to global surgery is at this level, uh there's a lot of hope for global surgery because we are gonna go very, very far. So what I'm going to do is um uh talk about um global surgery and where it stands and also relate a story through which my work will come into light. Uh II ran a global surgery course last week and this question kept coming up, what is global Surgery? And we went through the audience and the participants of the course and some believe that um global surgery is helping others. And uh so we had a good mixture of uh H ICM ICL M IC, people in the participant group and the faculty. Uh in fact, about 75% of the attendees were from LM I CS and we gave about 50% of them bursaries. Uh and the faculty was also almost 60% LM IC. And so when one group of people feel that OK, we need to help others, our LM IC group people said, oh, that's very patronizing uh some things that uh global surges about teaching abroad. Some believe in missions like mercy. Um Some believe in parachuting, like operating teams going out there doing something and then returning. Uh there are issues about who are the givers and who are the recipients. And can't we be working on a, on a global stage rather than calling ourselves givers and recipients? Um Many people very young early in their medical school level would think that we want to do some good to the world, we want to contribute. And those are all very interesting and uh very uh noble thought processes. But I think we need to work through this to see what is the right thing to do. So in 2019 and the same um definition has been reverberated in the B MJ uh about a, a month ago in this year which uh shows that global surgery or we believe that global surgery is the term adopted to describe a rapidly developing multidisciplinary field involving uh surgeons, anesthetists, nurses, allied health professionals, working together with non clinicians, including policymakers and so forth. But when we ask our colleagues in LM IC and a very uh champion surgery in LM IC. Emmanuel Makassar, who is um by trade or orthopedic surgeon, but has become a global advocate working with the government in Zambia and who had his internship at WH O level in Geneva. And he said after coming back and experiencing uh interests because now global surgery has become quite fashionable and looking at interest from large number of university institutions. And he came back very strongly saying that global surgery should not only be about research publications and data mining after having mined our gold and silver and copper and presently our cult, our people also want service delivery and support for service delivery. And neither should it be about using our fortunate unfortunate situations to raise money for yourself and your young programs uh in, in the western world. And think about this, it, it does sound true. He tweeted this in 2019 and he was at uh the course where I ran last week and he, he said this the same thing in that he, it hasn't changed uh despite five years of having tweeted this. So in our group in Oxford Sur uh Oxford University Global Surgery Group, uh we are group made up of um the Department of Surgery Department of uh uh women's and reproductive health Departments of Anesthesia as well as uh orthopedics. And we as a four department group have been working towards equity in surgery worldwide. And we believe that, you know, there shouldn't be any borders within our world. And when we mean equity just to give you a little bit of um a picture as example of what we think equality is. So equality is when equal accommodations and access is given. So if you look at these three young people watching a football match and they were given an equal opportunity to watch the match. But the little one in the purple shirt has shirt has started at such a low level that he will never ever be able to get to watch and cross the fans. If you provide equity, then you support providers to achieve their goal. And in this way, those that have a lot shouldn't get much and those that have a little bit should be given a little more and those who have nothing should be given a, a bit more so that there's form of form of equity so that the barrier then comes off and justice is there where people can watch their favorite sport without any barriers. I like the slide though. It's an old one from 2010. But when you are wanting to get involved in global work or in human, in medicine, there were, there are seven sins that was published and it's so true to this day that when you are involved with your colleagues in, in the low or middle income country or in a high income country, you shouldn't be leaving a mass behind. Uh The Second CS is failing to match technology to local needs and abilities, failings of NGO S to compete with each other or, you know, rather than cooperate with each other and not reinvent the work or world or work in silos. Uh failing to have follow up plan, allowing politics and, and the likes to uh distract or trump your goals to the service that you need to provide rather than uh going with what will put you on a stage, uh forcing yourself to go somewhere you are not wanted or needed or being poor guests by not respecting uh you know, the uh your host and doing the right thing for the wrong reasons. So to explain how I have uh worked through the global uh surgery is to tell a story because I think a story is very powerful and it it sends a message. So let's start off with um a high income country. Uh baby who was born with a uh lesion in on the floor of the uh mouth in the mandible. Uh It's, it's a tumor, it's called a teratoma and it's pretty mobile and you can feel it and it's in a submandibular region. So this diagnosis is made even before the baby is born. What happens next is that because we know the diagnosis that this baby has got a lesion which is gonna require tertiary care. So the baby uh is transferred in tro to be born in a tertiary center in the tertiary center. Everyone is prepared for the baby. Once the baby is born, there's work up, appropriate surgery is done with the appropriate team. Uh and then you have regular follow up. So if you look at the POSTOP picture the baby a little older has had its surgery and can lead a normal life because everything is under control and the correct treatment is provided. So let's take the same example in uh LM IC and this is a true story. So the home birth, uh the lesion is identified, but it's regarded as something that will go away. So in three months time, the lesion increases in size and it affects the baby's breathing. The traditional healer is consulted because that's the person they trust and that's the person they can afford. And that's the person that's in the community. And the traditional healer has some ceremony and he marks the area that he is affected toward of evil. The baby's condition worsens. The mother absconds to reach a medical care by walking 12 kilometers because she realizes the baby is not gonna survive. She reaches the primary health care facility, but the baby is too ill to be managed at that facility and the ambulance is a day away. So something has to be done for the mother to get to the appropriate level of uh care to help her baby. She takes a taxi 770 kilometers to the tertiary center. All the savings she's put together for lifelong savings are all gone because the taxi cost a package for her. The older two siblings who go to school um have to stop going to school and uh because they have to uh work on the farm and find a job because the one of the breadwinners which is the mother is now attending to the baby and uh the family needs income. Sorry, my screen has. Mhm. Um I think just click on the screen with your pointer. Oh, there we go. Ok. All right. So the child reaches the tertiary center and has died because of respiratory distress. So it gets worse. The mother takes her life because she can't go back to her village because she absconded. She didn't listen to the elders and sought help for a baby elsewhere. And so the family is in crisis. Now, there's only one breadwinner. There are two siblings without a parent, there's no maternal care for the young ones. And you know, there's catastrophic uh expenditures in the family and the family is in poverty. And this was the story 20 years ago uh in in the country that I have links with. So let's start off with the first box where the child arrives at the tertiary center and um doesn't have the uh facility at the tertiary center as well, I think, right. So if we take this journey, a journey undertaken by family to access surgical care. So what we did is um if we go there, ok. So in the first box, I've worked with my colleagues in Tanzania over 20 years to develop pediatric surgery uh by taking general surgeons who were there fully trained surgeons and sort of uh, giving them a flavor of what pediatric surgery is because they do do a lot of pediatric surgery but not the complex one. And 20 years ago, uh, all the Children in Tanzania, newborn babies or complex Children were being flown out by the government to India or South Africa for the tertiary care. And, uh, over 20 years by changing the paradigm and supporting adult surgeons to then take on a career in pediatric surgery. We now have 15 pediatric surgeons in uh Tanzania and they are now um uh bona fide pediatric surgeons. We have a pediatric surgery centers. Now, we've got seven centers. We're hoping for 10 centers and pediatric surgeries alive and well in Tanzania. So that's where we have, uh we've put in a lot of effort in developing the tertiary centers where there is now also training uh centers. So Tanzania no longer sends their pediatric surgery trainees abroad to be trained or to adjacent countries. They are training them in their own countries uh in three centers. Now, if we look at um the, the second red box where there's difficulty in families from getting to where they need to be so access to care. So the, the first box, we talked about uh seeking uh receiving care, so they get to the receiving center and there isn't enough. So we've worked on that, the, the second grade box that you see now is about uh reaching care where how do these families in rural areas, reach access care that they need. And what we did in Tanzania is we did a, a study of um all the patients that came to the tertiary centers. We plotted, where did they come from? And uh what we did is we then worked out that uh how much it cost for them to reach a tertiary center for care. So the government in Tanzania, all Children under 12 would pay for their medical care if they reach a uh a facility, a health facility run by the government. So under 12 years of age, the treatment is free. Whereas if you take um beyond that, the the treatment is free, but the uh families need to travel to get to the center and also they need to um provide uh sustenance for themselves. Because how do you feed yourself? And one of the rules in Tanzania is that if a child is admitted, a family member must be, must stay with the child in the health facility. So no child is left alone and we worked out that uh the government was giving $67 per child, but the expenses for the families were $90. So we took this publication in our results and took it to the government to say that look, this is where the gap is, this is where the hole is. And uh they've upped the insurance for Children to $90. Uh I think they went up to $100. Now looking at uh reaching primary healthcare facility. Uh So sometimes it is very uh as you said, difficult to get there because of the distances. So what we've done is if you look at the, the um uh squares on the map on, can you see the arrow? Yeah. So what we've done is that we've mapped out that for each child to get to a tertiary level center where they will receive uh adequate pediatric surgical care, they need to be two hours within reach. And this is the wo statement to say that any person needing health care of their particular problem should not be traveling more than two hours. So we mapped out uh where health facilities should be tertiary level health facilities for pediatric surgery so that um patients can reach the facility within two hours. And of the 10 centers we've already got tertiary care facilities in seven. The ones that are still to be developed is there already, the surgeons, two surgeons have uh started work there, but we are sure of a pediatric anesthetist who will be reaching them. Uh By the end of this year, this facility has already got a pediatric anesthetist and surgeon. So that one is fine and Dodoma which is has got all the facility of all the workforce facility but are waiting for infrastructure like a pediatric theater and a pediatric ward and so forth. Further to that what we've done is to cover that aspect of reaching a district hospital where they can get eas easily. Uh some basic pediatric surgical care. We have formed a a uh training module where the tertiary center, which is Dar Es Salaam. In this uh particular map, Tanz Tanzania's economic capital and we identified five district general hospitals where the adult surgeons are doing some pediatrics. But we're training up teams. So we're taking an adult anesthetist, a surgeon, a ward nurse, a theater nurse. Uh They come for a training module over three days to Dar Es Salaam and then go back to the regional hospital so that they are able to do uh resuscitate babies. They're able to work with a local pediatrician, uh cannulation, uh airway management, uh emergency things like how to uh resuscitate a child with trauma. If the child's got uh bleeding spleen, then they have to go to theater uh do uh basic uh uh generality of childhood procedures like circumcisions, hernias, hydrocele, umbilical hernias, lumps and bumps. Uh that doesn't require complex treatment. And then what we also did in this training module is that uh develop the skills whereby the District General Hospital have a whatsapp link with their particular speciality. So safe, a surgeon uh has this child who's got urinary retention and the on and there's trauma. So you can't go through the urethra, but you have to do suprapubic. If they've not done one, they found the tertiary center and they link up with their pediatric surgical colleague. So surgeon to surgeon anesthetist, to anesthetist, nurses, to nurses. So instead of going through a switchboard and asking for all the details of, you know, you know what switchboards are like your phone switchboard and then it takes about half an hour for them to connect you to a person and that is the wrong person. So in this way, within two minutes, they directly connect with who they want to and people will talk through the suprapubic procedure. If the child can't be moved, or if the child needs to be moved, when there's uh multitrauma, they are talk through how to resuscitate the child and then transfer them in a good condition. Uh Also feedback, follow ups, uh burns, dressings, burns, change of dressings, uh doing uh kind of uh first level burns rather than uh tertiary level burns and so forth. So it's basically uh firstly getting your hubs ready, which is the tertiary centers and training pediatric surgical facilities there and then training up district level hospitals so that the tertiary center is not clogged up with uh with patients that the district hospital is able to manage. So, improving care safely on a step by step manner and slowly uh looking at how do we then provide facilities within the community so that uh the referral is appropriate and there is help in these villages. So what we've done in Tanzania is that we've taken the um UNICEF child from India adopted it and added all the surgical conditions. And we've asked um uh the healthcare visitors to who are doing vaccinations. So when babies come for vaccination or Children come for vaccinations, the parents are asked that in your home or in your village, are there anybody with these type of conditions? And if they point out that yes, there is a child of this condition, the health visiting team will go and then support the family in getting the appropriate treatment at either the secondary level hospital, which is the district level or a tertiary level hospital. What Bangladesh has done is they've used the opportunity of uh uh census. So they come did a census in 2023. And together with my colleague uh from Bangladesh, we approached the government to add a box on the census which tells you whether there is any form of um uh abnormality in a child. And I hope I've got that. Yeah. So what we've done is um the, the next page which is on the flip side has got um a drawing of a, a stick man. And then the parents who are being interviewed for the census because some of them cannot read or write, but those that can will read up and then mark across on the census paperwork as to where they think their child has a problem. So in that way, basically creating a birth defects registry. And uh we analyzing them this year to see how effective this is. This. I this is and how we'll be able to then identify the birth defects and uh arrange for appropriate care. We've done uh quite a lot of birth defects projects. Now, knowing that that's one of our big problems in Tanzania. So um I've got a student, Doctor Massawa who's Tanzanian, who's doing uh birth defects, regis recognition focus on uh one of the birth defects, but using it as a case study to then develop birth defect registry in Tanzania. So his phd is jointly done in South Africa because it's cheaper to do a phd in South Africa in terms of funding, not the, the quality of the work, but funding uh compared to Oxford. Uh similarly, we have uh one of our uh MSC students who lives in the most uh poor, poorest county in South Africa. And uh she's also looking at uh developing registry through one of the birth defects, which is called gastroschisis where you have guts hanging out. Uh The babies are born with guts hanging out from the near the umbilicus. Uh We have a Namibian who's also trying to do a birth defect registry again and looking at neural tube defects. And then uh we have Doctor Contrast who's looking at uh what form of um data collection tools they have in Tanzania and how can we put this all together? And Doctor Contrast is doing her phd in Oxford with us. Uh we know that trauma kills more Children than H I VTB and malaria combined. So we've taken that on board and uh I have three students who are doing their P hds or M SE with us highlighting this so that we can get some answers regarding what the burden is, uh how we can prevent this burning and what type of interventions we're going to use to cause a prevention of uh child trauma. And with those studies, uh which are already 50% through. And Dr Far has completed hers, uh I got a N hr grant of 5 million now. And we going to look at trauma prevention in Zimbabwe and Tanzania after having done some groundwork with the above three studies. So in Tanzania, having worked with my colleagues, we also have research output where I have a public health worker called doctor Sa, who's my research counterpart there. And Doctor Zz BKA, who's my clinical counterpart there. Uh Over the years, we've had um uh multiple publications and um uh about 20 for 2003, we have seven that are in the lancet or B MJ was first authorship uh and uh corresponding authorship from Tanzania. And all these publications are part of some of the work that I've shown you in my story that are making impact uh with the Tanzanians colleagues. We have completed one book. Um 90% 92% is online and complete and uh 12% is online. And just we, we've added more chapters because that has been the need and requirement from our LM IC colleagues. Uh So, uh with our work, uh William Wong was my medical student here in Oxford. And to together with um the group of people where we did a multicentre international study on cancer during in cancer in Children, during COVID. Uh 10 other studies came out of it from uh colleagues that were working in different parts of the world. And the team from uh Jordan and our team actually uh got the best study protocol of the year for the work that they were doing. So. Coming back, we can't uh have saving the planet talk. Uh This is to show you that how our colleagues and our counterparts in LM I CS work much better than what we think we know. So on the left hand side, this is a health worker, this is a newborn baby, but she's trying to reach uh people in Peru. So Peru is very mo sorry, it was Nicaragua. Nicaragua is very mountainous and it's very hard to reach uh the uh for people to reach health facilities. So the health workers go up there to do vaccination and screen them for surgical conditions. With the chart that I showed you. And the best access is as this mother and health worker knows that you take um uh a horse and that gives you access to this community. Unlike uh when one of the um uh uh university projects had uh money uh to do their studies and they had a whole lot of vehicles that they were using to access Nicaragua. And you can, the picture tells the story, what their journey was like. If you take Bangladesh, they're also, you know, we think we're doing climate change and we're gonna save this and we're going to save this. Our LC colleagues are doing it for years and years and years. So if you look at uh stoma care, uh we've been using plastic and rubberized material to save the skin around the stoma. And sometimes we don't even have the right size for, for babies and Children in Bangladesh, they use betel leaf which is accessible and free from the trees and make little holes and put it around the sto and that protects the skin. The other innovative thing they do in Bangladesh is they don't have contrast studies to look at um barium and or contrast animals or contrast loopogram. So when we have stomas and we want to then join the bulb, you need to know whether the distal aspect of the colon doesn't have a stricture. So what we do in the western world is we put contrast up to see that, that part of the colon is fine. Whereas in Bangladesh, they take a condom and they fill it with um uh ripe bananas and they push it through one of the stoma ends or they push it from the bottom and then they look at the other end. So if they push it through the stoma, and if it comes out like a normal, uh, kind of like a sausage, then they know there's no obstruction. If it comes out like toothpaste, then they know that there's a stricture in that bit of the colon. And if it doesn't come out at all, then there's a complete stricture. A lot of neonatal surgery in Bangladesh is done under local anesthesia because they don't have the ventilators and the equipment to anesthetize or nor do they have pediatric anesthetized to anesthetize these babies. And um we have learned from this group where in Oxford now we are doing our neonatal hernias under caudal and spinal anesthesia. Uh unlike the heavy equipment that you see uh on the right hand side of the side in Tanzania, uh every hospital has a garden and this hospital is based on the northern part of the country. And uh the the patients that are long term help families help uh with the gardening and the patients are fed in the hospital with food that is grown in the local garden. Uh The picture on the right top hand is a homemade incubator in Tanzania, uh which costs 10 lbs compared to 5000 lbs of a super duper in incubator that you see uh in our environment. Uh they do have some of those for those very specialized babies. But all the premature babies, the extreme prams that need a bit of support are all in this homemade incubator, which is a box and where you see the um it's divided into two. The bottom part has a um heater and on this uh sheet of um wood, uh there is um uh a blanket, the baby is on there covered. Uh This is a purse pax piece. So you can observe the baby through that. And there's a temperature probe vac which looks after the um which monitors the baby's temperature. So you don't need one or two nurses per incubator. One nurse can look after 10 incubators because she can quickly check the temperatures and have a view of how the baby is doing on the left bottom picture. What they've done is all surgical gloves that are used are washed and then these gloves are used by the cleaning staff to do some of the heavy cleaning on the wards and in the corridors. And if you look at the um slide in the right lower quadrant, you have families that take part in the cleaning process and clean the bed for their family so that they have clean sheets and um the clean water and the ward is hygienic probably a much higher standard than some of the wards we have in our own environments. So, thank you for the attention and I'm happy to take any questions. Thank you very much professor. That was um an amazing talk, very, very insightful and I liked that there were things that we could learn from doing this, um, as well from like, as like from both ways. Um I think the idea about reusing gloves, um for the cleaners and other members of stuff is very, is, is very good in the fact that it's good for the planet and it's also um reusing resources that we don't waste. Um I'm going to open the floor um, for any questions as well. Um If I think you guys should be able to speak up as well, um, if you can or you can, um, put it in the Q and A if you want to remain anonymous or you could, uh put it in the mass messages, chat as well. I can also get started with um, a question if that's ok. Sure. Um Professor. Um, so in terms of, um, you said that Oxford had adapted, um, the approach you're using, um, of doing some procedures under um, cordal and spinal anesthesia. How did that sort of, how did that transition happen? Like seeing an experience from a foreign country and learning from it and then adapting it to some uh to something that was like, you know, in like general anesthetic and like, but like then toning it down. So how did that, how did that come about? I was just a bit curious to know So, um, I'm South African trained and, uh, any new anesthetist had come for two years to come and spend some time in Oxford also from South Africa. And we do all these procedures on the local. We use a lot of catamine, uh, for burns for some of the general surgical procedures. So it's quite adaptable. And then we saw it used in Tanzania, we use it in Bangladesh. And, uh, we knew that uh a group in Glasgow was doing something similar uh by, but they were heavily sedating the Children. So what we did is we um put our heads together. It, it's more in anesthetic line than a surgical line. And I was very keen. So I sat down with the group of enthusiastic anesthetist and we looked at the results from different parts of the world. And uh two of our any is also went to Glasgow to see what they were doing. So they use some of the ideas from the, most of the ideas from our LM IC colleagues. And we drafted a protocol where uh we sedated the babies and we uh we got permission that uh this isn't something first time done, first time done in Oxford, but it does exist around the world. And it is uh we, when we, when we put the bid in to the hospital, we said that it's energy saving because we're not using gasses, anesthetic gasses. So, environmentally, it's gonna be a green theater we're not using a lot of equipment. So the plastic is gone. So we calculated uh the lack of energy wastage. Then we showed that anesthetist are very used to giving codal. So the technique is not needed to be learned. They know the technique they are used to giving spinal. So it's not a new technique. Um And then how are we going to give it on the baby? So we used, we learned from our colleagues that uh around the back where you're gonna give the spinal uh if you put in uh some Emla cream to numb that area at a certain time, uh You give the baby some sedation and a bit of um a steroid to calm the respiratory team and you give them sucrose to suck. So they're very happy and calm and uh most of the time they don't like, I think the bit that irritates these babies is when you're holding them down, they don't like to be held down. So we found a way of creating like a cradle. So they feel comfy. Uh And then we started uh we've done now about 50 f yeah, about 50. And we started doing them as spinals. And if the spinal fails, we started doing them as cordal. And our an anesthetic colleagues are far more used to doing corals than spinals. So in by 25 we realize that it's, it's better to give the cordal because it lasts longer. Uh And also, it's a technique that uh they're not uh unhappy with. So that's how it emerged. You just need enthusiast to go and then they will uh you always find critics and you'll always find people that's gonna say it will never work and you just have to prove it and you get a team of people around you that will want to do this. We had a scrub team that was very happy. We have the uh O DPS who were the last to come on board because it's, it's very strange that um everyone was enthusiastic, especially the nurses on the ward because the babies then are not ventilated. So they don't have to stay overnight, they can go home the same day. So lots of advantages, green theater uh day case no longer overnight stay, respiratory status is good safer for the baby. So the team on the ward loved it. The scup team loved it. The anesthetists loved it. The surgeons loved it because fast. It was no different. We just pretended that, you know, the baby doesn't move, the legs don't move. But the but the uh pushback came from the O DPS because they are not used to babies coming in awake and crying. So they says, oh, we can operate on crying babies and he said they're not crying, they have to cry when they are coming in a different environment. So we decided to send our pediatric O DPS onto the ward to see how much we do on Children that are crying. So that was quite a lesson for me. That one group of people are only used to seeing babies with general anesthetic, they've never seen Children uh in hospital that are not asleep. So that was a revelation for me. Yeah, thank you. No, that's really, really insightful. It was, it's really interesting to see how that would like an idea and how that would come to fruition especially um from like, because normally we see this happening the other way around, we see it from like west to east to like from like s to other ices, like going the other way. It's really interesting to see how that happens as well. Yeah. And then we have um Anushka who's um said that she feels really inspired after this talk and is um thanking you greatly. She's wondering if there are any opportunities for an aspiring pediatric surgeon to be involved in any way um to, to be a part of this kind of global impact. Yes, there's lots of opportunities. So wherever you're working, you know, the group of people that you're working with, like, say you're working at Kings, then I would put you in touch with my colleague uh uh ne who's got uh uh collaborations in Sierra Leone and Nigeria. Uh I have a colleague in Leicester who's ha who's got uh collaborations in Sudan uh and Morocco. Um So each, each place has some. So if you get in touch with me and whichever area, uh uh the geographical area you're working in, I can, I can put you in touch with people and a lot of people are kind of, you know, I've got uh a glas region student, a medical student and I've got a FY two in Newcastle who's doing work with me and now has got a, a FP, I think it's a different name now, you know, a academic fund. So they are now uh enrolled as academic foundation with a, with a clear project with my research team. So, you know, it's, we're not exclusive to, as I said, we work with our boards. Thank you. Um That was a really good talk again, people if you have any questions, um Please put them on the chart. This is a really good opportunity to just ask about anything if, if you find it a bit difficult to think about things. And I just like, feel free to, you know, collect those questions and send them to me by email and I'll be very happy to answer them. I think I just have a final question if that's ok with you. Sure. Um So I know you've been very involved within pediatric surgery and global surgery on the whole, what sort of inspired you to first make that step into it because I know there's a lot of, um you know, advocacy about these topics online and everywhere. But actually taking that first step and getting involved is quite challenging, I think for most because they think where do we get started? And they don't really have that. I think mentor that has done that before. So what, what first inspired you to do that? I think. Um it was, I mean, I grew up in South Africa, I grew up under apartheid rule. I grew up under the were setups and South Africa is a country of contrast, you know, where we've got pockets of LM IC, we've got pockets of M IC, we've got pockets of H IC. So I and I grew up uh came from a very needy community. I grew up in a, in a, in a Hamlet uh where we, my grandmother was the health visitor or health worker. She was not trained as a doctor but uh she was trained by the because people can't afford to go to doctors. So she was trained to be a birth uh attender uh community health worker. She knew how to uh look after sprains, you know, identify fractures, treat basic burns, first aiding. She did a lot of first aiding and things like that. So um that was one inspiration for me to do medicine. Uh But um A as I grew up, I have always been involved in communities that are needy but looking at it from a H IC perspective, I got uh uh II was very short term in Oxford and I got invited by a um vice chancellor from Tanzania who was opening a second medical school. So the De Salaam was one place. And then up north, they were deciding to open a second medical school and develop specialism because the country was emerging out of colonialism. And uh he was quite a vi visionary vice chancellor. And he said, look, if we could train our doctors, we have enough uh doctors that can do obstetrics, basic obstetrics, they can do surgery, they can fix bones, but we need specialist, we need specialists so that we don't have to send our complex patients to India and South Africa. So he asked me to come and help with pediatric surgery. And then, you know, I told the story where I worked with my general surgery colleagues and just developed them into pediatric surgery. I think the, the thought process in your head is uh what inspired me and what came to my mind is I saw I worked in L IC and I worked in H IC. And I thought here is the world with Children and some are getting too much and you know, over the top and some have nothing. And why can't we have a world where health care is easily and equally accessible to whoever you are, wherever you are in the world. And I think using that motto. So if a child is born in Tanzania and goes to the health facility, it might be a heart, but the kind of treatment they get is the same as the person coming to the John Radcliffe hospital in an A&E. Right. But it might be a fancy A&E with lots of light, but the kind of treatment you get is the same. You know, it's like um delivering a baby uh in a healthcare facility on the floor, which is comfortable because it's safer and you put a blanket and it's a warm country and the hut doesn't have light but has got kind of ventilation and it's, it's that roof. So it's ecofriendly and it's safe as long as it's clean, you know. So even if you have this five-star Maternity unit with all the Gizmos, you can still get, you can get the worst kind of infection in that kind of setting, you know. So the aim is to, I mean, it's not gonna happen in my lifetime. But if the seed is planted in your generation, within a few generations will achieve that in that uh poorer countries will be able to provide uh the health service that everybody needs, have access to it without going into poverty. And it is realistic. I mean, nothing is impossible till you do it. Thank you. That was very inspiring. And I hope that does actually happen in the future as well. I think we have the final question. Um So sure is just us if there are any possibilities for doctors currently overseas So I think, um, the aim is to look around you. Yeah. Um, I think if you want to go overseas, like, say, if you're doing an elective then in Oxford, I've developed, uh, a group called PL but any medical student who's going on an elective can get in touch with them. And, uh, what I've done is created like a pen pal exchange program where if you're going to say Sri Lanka, then you make contact with a medical student in Sri Lanka. And then I give you a topic of a project which I used to. Now, my LM IC students are saying no, this is what we want to look at. So it's emerged, it's already nine years in the running. Uh I think uh you know, uh like they say charity begins at home. So if you just take Oxford and you take a mile going up north from, from uh town um into Blackwood Leeds, one in eight out of nine Children are living below the poverty line. Um Eight out of nine Children are going to school hungry. This is Oxford, a very rich county. Yeah. So start there, start doing something there. I mean, it took a footballer to push Boris Johnson to provide free meals for these kids because he grew up in that area and that makes a huge change. Uh People living in Blackwood Leighs will die will have a lifespan 10 years less than somebody living in hiding So it's, it's there in front of you. We start making changes locally. Yeah, thank you. Ok, I hope this is helpful and this is what you wanted and uh there are lots of things happening. Please get in touch with me and I will direct you. Ok? Ok. Thank you very much, everybody. Um Again, if you have any other questions that you've not, you've thought of later, you can email us that incision and then we can forward them on to Professor Lao as well. Um But thank you very much for joining us today and thank you very much, Professor Ao. Again, amazing talk as usual take care. Thank you. Thank you so much. I'm gonna end the call everybody. Thank you.