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Good morning. Welcome. Today. One of the guests talk International Conference 2022. Thank you. All for an early morning today and come coming in nice and early. Um, my name is Jean. I'm the conference lead. Uh, and this is the best stock committee who brought you this amazing show for the next two day. So just a few housekeeping things First, there is no fire drills today. So if the fire alarm does go off, that is probably real. Head towards the fire exits at the back, and then we'll gather outside the main entrance of city Hall so we'll have people usher. So don't Don't worry too much. Um, next up is, um we will have pictures and videos taken throughout this whole conference for gas or publicity purposes. If you have any strong feelings about your image is being used, please approach any of the guests committee members, and we'll sort that out for you. So without further ado, uh, it's my great pleasure to introduce to you. Um I guess the president 2020 to who's going to give you an opening speech. So, Mr William Bolton, please, everyone. Thank you, Gene. I would like to start by welcoming you all to the gas Stock International Conference 2022. And it's great to be here with so many of you face to face. And of course, all of our delegates from around the world virtually for those of you who have not met yet, my name is Will Bolton, and I'm a new surgery trainee in leads not far from here. And I'm also a scientist with the research interest in global surgery and med tech. I've also had the immense privilege of being the gas stock president for 2022. As I said, there are hundreds of you joining us virtually and in person from all over the world, representing anesthesia, obstetrics and every surgical specialty. I hope that those of you in person enjoy the amazing facilities and venue that we have here in the Sheffield City Hall. I'd like to thank everyone from the City Hall for helping us put put on today. And for those of you that are joining us virtually, I hope that you find are virtual platform partner medal engaging, convenient and interactive. Please do make sure that you log onto the medal platform even if you are in the room so that we can register your attendance and you can engage with the posters and people from a lower middle income countries who are joining us and giving up their time to be here. Today, the WiFi is around the room on various things and it was behind me on the screen here. The conference theme for this year is sustainable Global Surgery and those calls for international action to address the global environmental and energy supply crisis strengthen. Now is a perfect time for an event like this. Today, the health of our planet and environment directly correlate with the health of the humans that inhabit it. And as doctors, we have a duty of care to limit the impact that surgical delivery has on the environment for the people that are alive today and for future generations. But as you were here over the course of the next two days, sustainability is about more than just environmental stewardship. It's about overcoming barriers to affordable access for safe surgical care, and it requires healthcare, workforce training initiatives that are sustainable, sustainable economic development, sustainable partnerships, innovation, technology and research, and the interdisciplinary speakers and workshop faculty have a wealth of experience in these areas and from this conference, I hope you take away a range of ideas to implement sustainability concepts into your training and working lives wherever they may be. Since its founding in 2015, gasoline has continued to grow from strength to strength, both in terms of our global membership base and in terms of the range of activities and opportunities delivered for trainees from the specialties that we represent. It has been an incredible experience acting as president with this amazing Gastaut committee over the last year and the true multidisciplinary representation of trainees from surgery, anesthesia and obstetrics is the founding purpose of gas stock as an organization and advocating for better global health training for these specialties is a core objective because we believe that better training equals better care. We have continued to provide guidance on the ethical and responsible engagement in global surgery to our membership base of over 1500 trainees from all over the world. The Phenomenal Gastaut Committee have delivered monthly journal clubs, virtual reality training courses, developed curriculum inclusion, strategies for global health for UK trainees and conducted a range of research, innovation and advocacy projects. Some of the highlights to mention include a new partnership with the Virtual Reality in Medicine and Surgery Group that aims to ensure free and open access to a library of ER modules for trainees in the UK and in l. M. I. C s. We also secured a generous grant from the Royal College of Surgeons of Edinburgh to deliver a free, frugal innovation skills. Course the trainees all over the world, and we'll be launching this in January 2023. The gas. That committee worked tirelessly to advocate for trainees at a huge number of regional, national and international meetings throughout the year. And they compile practical guidance documents and position statements designed to help you advocate and engage more effectively in global surgery. And finally, gastric have provided a number of travel grants funded by the Incredible Keith Thompson to support trainees to actually go and engage in global health activities as well as the incredible range of international speakers and workshops on offer. At the conference this year, I was delighted to see so much high quality trainee delivered research on display in our virtual post hole and on stage, including submissions to R s, a competition that's this year kindly sponsored by the Friends of Nepal Ambulance Service. Thank you to everyone who took the time to submit your abstracts and your and your research to our conference. Um and I hope that you're amazing. Work inspires new research and new quality improvement projects for people who see this all over the world. And congratulations to all the prize winners. Please do check out the post as I as I said on the T V, stands at the back of the room at the break, and you can provide comments and ask questions to the authors so hopefully it will be interactive for you. A true hybrid international event like this would not be possible without the generosity of our conference sponsors. And I want to extend a huge thank you to all of them for helping gas up to provide low cost, high quality experiences for trainees, including sponsoring free access to this event for trainees from L. M. I. C s A special thanks goes to our diamond sponsor, RCs Edinburgh are platinum sponsor Striker Gold, sponsored by America and Silver Sponsor Med aid. Please be sure to check out all of our sponsors, amazing products and organizations in the exhibition Haul over to your, uh to your right during the brakes and throughout The breakout session is over lunch today, despite the seemingly overwhelming challenges that we face is trainees from public health emergency such as the coated pandemic conflicts, environmental and political crisis. What inspires me the most is the equally unwavering individual desire to make training better. Better for ourselves, for our colleagues and, of course, for our patients. Gastaut exists to help you in this endeavour. Thank you to everyone, for all of you, for all you do for training and care delivery wherever you work. Please Do you consider joining the amazing Gastric family by signing up as a member on our website? If you haven't already But I hope you will have and you can even join us as a committee member. We have periodic applications and I would love to work with you on a number of projects that we have on you at the moment. I would like to specifically thank the gas that committee for all their efforts in putting on this conference and so much goes on behind the scenes and on the day, uh, normally comprising of months of late nights, uh, and preparations. And they do this all along side full time training as volunteers because they think it's a good thing to do. Hopefully, I also want to give a special mention to this year's conference lead organizer and gas stock Secretary Gene on for leading to the team and going above and beyond to deliver this wonderful event. I hope that you have an amazing conference 2022. Please do engage with the speakers and workshops, posters and exhibitors and try to take away as much as you can. When you come to things like this, you may find inspiration for a new idea or project. It might be a better understanding of an important topic, or you might find a new contact to extend your network. Or better yet, maybe even a new friend. Whether you would consider yourself a seasoned global surgical veteran or whether this is your first venture into a brand new world of global surgery, I hope you'll find something that fulfills you and engages you throughout this conference. I look forward to speaking to you all over the weekend, including at our evening drinks reception, also sponsored by ourselves. Edinburgh. Thank you, a picture and piano, which is just around the corner. It's literally opposite this building, so there's no excuses to stumble in their later and all the gas. That committee can be identified because we're wearing special gases badges, so please do feel free to reach out to them if you've got any questions throughout the day. So now is my great pleasure to introduce our first keynote speaker talking about global surgery, the state of play doctor Keep Park, who is director of policy and advocacy at the program in global surgery and social change at Harvard Medical School. And as a neurosurgical training. It's great that we're opening with a neurosurgeon, and, uh, he is an absolute global surgery influencer and a personal here of mine. So thank you so much, Doctor Park for being with us today, thanks especially to Will Bolton and, uh, and Gene Gene on, uh, for putting together an amazing conference. I've looked through the program and it's outstanding, and I'm sorry I can't be there in person. There's some benefits to be able to, uh, connect remotely. But one thing I will miss is the interpersonal connections that you get in person. Uh, so, yeah, um, let me see if I can set the stage. The title of the talk is global surgery and state of the state of play. And I'm going to start off with this slide in 2008. Uh, Paul Farmer and Jim Kim published a paper, uh, in world surgery. Surgery is the neglected step child of global health. And, you know, this is probably, in my opinion, sort of the the defining, um, statement that that described the state of play back in 2008. That's 14 years ago. Um, you know, as a as a surgeon, when when you get a statement like that. I mean, for me, the immediate reaction was I'm going to change that, right. And, um, I'm sure I'm not alone, uh, in that sentiment. So I think I could sum up this talk with the next slide. This is a tweet from, uh, newer Hisham Abdullah. He's the director general for health for the Malaysian Ministry of Health. And this was tweeted out in May 29th of this year. Now, of course, you can argue his Twitter a fair way to assess where things are and globally. But I think it's one way. And I will tell you this tweet came out after the World Health Assembly and he tweeted global surgery has become a force to be reckoned with. And more than half the Twitter data from the 75th World Health Assembly, uh, is from the global surgery fraternity. It's about time to push forward and address global surgery in the next assembly this. So if you look at the hashtag wh a 75 and then global surgery they were over four billion impressions, which I don't know how to calculate all these things out. And then, uh, in terms of, well, it was actually wh a hashtag not just global surgery, but wh A had over half the world, you know, apparently seen it, uh, 67,000 tweets. But what's really important here is that, uh, who is actually representing the top 10 influencers of the Twitter tweets that that occurred during that time. And more than six out of the 10 were people from the global surgery community. Uh, Dominique Mervat Global Surgery Foundation to go one day Me, uh, and then Harvard, p gs CS see where I belong and then the GI for lions. So I think we can maybe end the presentation right here, right? We've come a long way, but this is not exactly the full story that there's more to it, but I I love this slide. So I'm going to try to give you the high level overview of where global surgery is in terms of the policy engagement, the advocacy activities, research. And I saw that some of my colleagues are going to be on, uh, there on the program. Michelle Joseph will be speaking about surgery, uh, research. And then there's financing, which is probably the number one challenge in terms of where where we're going with global surgery and then a global surgery. Uh, as a field of study, you know what's changing from our profession and any institutional changes that are happening. And I would say there, there, there are so, uh, in terms of policy, I think one of the, uh, the flagship and, uh, let me just qualify this talk. This is a global surgery state of play according to keep Park. This is just one person's opinion, and I don't want to speak for the entire global surgery community, but it is just one person's opinion. So national surgical planning. If you see that as a very significant policy, uh, engagement this these are, you know, plans that are developed, uh, by ministries of health And this map. Uh, and it's actually it should be. Additional country should be added to this, but the countries and blue are the ones that are currently either developing have developed nation wide plans to expand surgical care. It's at least, uh, more than 50% of all the l m I. C s around the world. So this is a another indicator that you know, the global surgery, um, is really a movement. Uh, that's taking hold. So how did that start? Right, So, you know, we go back to the 2015 the Lancet Commission on global surgery. Really? Uh, quantified the magnitude of the unmet surgical needs around the world. Uh, there was a huge, uh, achievement. That's really what propelled me go to go from really training neurosurgeons. I'm a neurosurgeon. I was actually in Cambodia at the time and to actually switch to now global public health. Uh, so that was a defining moment for me. And, of course, the disease control priorities that was published in 2015. The third edition devoted the entire first volume on essential surgery, and that led to a groundswell that ultimately, uh uh had a double the World Health Assembly passing a resolution calling for strengthening emergency and essential surgical care anesthesia as a component of universal health coverage. And to this day, a lot of our activities, at least at the P G s S C and for the policy team goes back to this document, you know, What does it mean in terms of W H O headquarters? Regional office is, uh, and implementing this this this roadmap, this resolution, what does it mean for health ministries? It was very important that this resolution actually happened. I would like to acknowledge Doctor Mario Mukasa, who had a very, uh, key role in the drafting this resolution and was really the, uh, practicing, uh, superb global health diplomacy when he was to help the attache in Geneva for Zambia. So a couple of things happened as a result of this, the programming Global Surgery published a monograph, uh, showing some case examples case studies of countries that are starting to, uh, scale up surgical, uh, services nationwide. And this was published in 2016 2017. These are just simple case studies. But now, uh, there is a manual national surgical, obstetrics and anesthesia planning manual that were able to, uh, work with the unit. Our, uh, and published through Unit are. And so the website is there, and you can go and look at it, but it really gives a very specific how to for countries to develop national surgical plans. And and this has been also now translated into a number of other languages. And we've held a number of workshops in conjunction with the wh. Oh, so the programming global surgery and social change is an official wh collaborating center on the surgical system strengthening. And this was actually in Dubai. Uh, we've had a number of workshops with ministries of health, Walter Johnson, who's no longer at the w h. O. But he was hired in 2015 to lead the global surgery, The emergency essential surgical care program at W H. o. Uh, and he was instrumental in in moving, uh, the policy engagement with a number of ministries. And then since the pandemic, we have not been able to meet, But maybe they will change shortly. But we've shifted to a virtual platform, Uh, and also focusing on regional offices and holding a number of workshops at that level. Our partners, uh, this one happened to be in the Asia Pacific in the Southeast Asia regions, and we collaborated with the racks World College. Uh, rural Australasian College of Surgeons. So what does the national surgical plan look like here? A number of documents. Uh, Ethiopian plan. There's a Tanzania plan. Zambia, Rwanda and Nigeria. A number of these plans are being written up and their their official government policy documents, and some of them have been adopted, uh, as part of the, uh, an integrated into the part of their, uh, national health plans and international development plans. And that's critical. I think it's These plans should always be integrated into these overall large scale plans. Otherwise it runs the risk of being, um, not implemented. So I just want to say a little bit about what the national surgical plan it is, and it's not. It's really a blueprint, right? And a blueprint of a of a building. Uh, it's not the building, so this isn't critical distinction. It's also cost it, and it lays out a road map and how to do it. But having a plan versus having a health system with strength strengthen surgical subsystems to be able to deliver care for the last mile for the patients that are currently neglected is a totally different thing. And that's what we need to really push. Now. Is these plans to be implemented, uh, at the at the ground level? And that's a huge challenge. Couple of other policy, uh, related achievements is the inclusion of the national surgical, uh, surgical indicators, uh, as part of, for instance, here W H O s 100 or indicators things like peri operative mortality, uh, to our access financial risk protection. These are all now embedded in it requires countries to collect them, and that's another challenge. But having it included as part of the core indicate health indicator is a is a huge, uh, progress. Same thing with the World Bank. We worked with the data collection team at the World Bank, and they've not included within the world development indicators. Uh, some of the last indicators. So the POSTOP, the peri operative mortality, access so on and so forth. But once again, this requires countries to go ahead and collect them. And that's, uh that's very challenging. All right, so now I'm going to switch over to another topic within this, uh, talk about advocacy. Uh, so what is advocacy? It's activity that aims to influence decisions within the political domain. This works. This is, uh, governments, ministries of health, uh, OD a donor countries, but also economic domain. So who are financing some of these large scale, uh, plans? And who's able to do that? Ministry of Finance, Uh, development finance institutions. But just as important, our social institutions where I belong, right, Academia, uh, some of the foundations and professional organization's so trainees organizations. Uh, things like that I think are just as important to put global surgery on on their agenda. So what types of activities constitute advocacy? I think research is incredibly important. It all begins with data generation, and and I mean, I'm sorry, evidence generation from data, uh, and then these need to be published. Uh, but more importantly, what? Not only do you publish in the medical journals, I think it's important to also published in, uh, traditional media. And that's what sort of sort of media campaign you know, op EDS. Uh, and things that are maybe not what we we consider, uh, outlets that we normally consider and and and in in medical publishing, um, social media is incredibly important. As I mentioned before, Twitter, um, that's a It's a very powerful tool. I would encourage everyone of you to if you haven't already create a Twitter account and then start tagging right there just or, you know, repeat retweeting or, you know, just quoting, uh, these things and you can tag people. You can tag your, uh, you know, members of Parliament, you can tag your new prime minister. You know, uh, you know people that you think I need to see what's going on in the global surgery field. Uh, these are very powerful tools, and people sometimes reply back and re tweet back. So this is, uh hardly encourage you all do that. But then there's also more directed activity face to face meetings, briefings where you meet with members of Parliament, uh, and then let them know what's happening globally and why it's important to for for Let's say, in the UK to further invest in global surgery. I do know that they have been investing in global surgery research, and I think this is N I h R. But maybe the DHEA component could could could be increased. And then, of course, there's the in person convening. And I'll get to that a little bit, Uh, in the next couple of slides. So, uh, in terms of, you know, uh, elevating global surgery or surgical care as part of global health governance, which W H O is the, you know, the main organisation. We have the resolution 68 15 that was passed in 2015. But, uh, wh, uh, has a regional structure which is somewhat autonomous in many ways because they have their own governance with ministries of health. So it's important for regional office is to also put surgical care as one of their top priorities. And so this is, uh, from 2019 in a row, is there, um and then So this was a an attempt by the number of health ministries to put safe and affordable surgical care and on one of their, you know, priority items for the region and and ultimately lead to a regional framework for action for safe and affordable surgical care. And now what that means is that the Western Pacific Regional Office is actually hiring people technical people to support member states and carrying out these, uh, regional framework for action. I would point out that their number of people in this picture that I think are critical, uh, for the building of the global surgery movement. One is Minister Wonka, third from the left. He is a surgeon, and he's the health minister of Fiji. And he has been incredibly, uh, supportive, actively supporting global surgery movement. And I'm not surprised because he's a surgeon. Uh, the other person is his, um uh who who was the one that tweeted, uh, after After the World Health Assembly? He's standing in the middle, and I don't know if I mentioned, but he's an endocrine surgeon. Uh, so So, once again, you've got the surgeon policy makers really seeing this is an opportunity to make a difference that ties their own professional interest with with public service. This was, uh, an event that was held in, uh, May of this year at the sidelines of the World Health Assembly in Geneva. And this was actually, uh, led by the Ecuador mission, and and they invited wh, Oh, a number of other international organizations, along with, uh, the health ministers of the Latin America and the Caribbeans. And this was, uh, this was led by Ecuador because the vice president of Ecuador is a neurosurgeon. He's a gentleman standing from the U. N. Flag. His name is Alfredo Barredo, and and he still maintains this position and and and championing, uh, global surgery globally, regionally and also in his country and the programming Global surgery at Harvard. We're working directly with the Ministry of Health, and they they have undertaken a national surgical planning process, and we're happy to be working with them. But as you can see, what here's what. These kinds of activities have a way of getting attention from from, uh, governments, uh, international organizations, development finance institutions, and this We should continue these kinds of activities to try to elevate surgical care to the top of the global health agenda and we shouldn't stop at the ministries of health. So we have here at the U. N. General Assembly, which is attended by the heads of state rather than health ministers and, uh, a number of global health advocates. Whole events along the side lines of the, um, General Assembly and the global surgery Community did that This was it was an event, uh, partnership with number of organizations. But Small Train was the lead sponsor, and I noticed that your conference, the key word is sustainable global surgery. And and that's the the tagline that we used a sustainable surgical systems. And then we tied it to something that was beyond what I would consider. You know, what we think of is within surgical ecosystem. We tied into planetary health. And so, uh, what? What's important to do is when you advocate you bring in other communities to partner with these things. And we had the prime minister of Fiji. Uh, it's a small development island state for them. The climate change issues are existential. And he gave the keynote speech at this event talking about his own personal experience with heart surgery. He had open heart surgery recently and then also talking about the importance of planetary health and and sustainable, uh, surgical systems. So this is quite important to engage beyond the health ecosystem and don't stop there, right? And and then so with global health, their number of, uh I don't want to do things that actually rise to the surface, uh, due to multiple factors. And so, you know, right now, right now, women's health is become a very hot topic within global health. And that's great. And we love that. And so, uh, we partnered with a couple of other organizations, Global Center for Global Health and Development and National Cancer Institute. And we held an event at the the sidelines of U. N G. A, uh, within this network called Women's Health and Empowerment Network and talking about an end to end sustainable solution for women's health, specifically women's cancers. And it's it doesn't, uh, you know, we get supported by people like Leah today is, you know, she is the health minister of Ethiopia, and not just because she's a woman. But, you know, this is an important issue, and we have other Health Ministry supporting that, um so Yeah, that the key here is, you know, within, uh, not just within. We're not just talking about global surgery, women's health, and we tie global surgery into women's health. And these are the kinds of things that need to happen to further the global surgery advocacy activities movement. Okay, so going back to that event in Geneva, Uh, this year's wh Oh, the World Health Assembly, the Global Surgery Foundation. Uh, and I need to give you a little bit of background on this. This was started about two years ago, uh, in Geneva. Um, and now it's become really the entity that is being perceived by the international community as to sort of the global fund for surgery. So I think most of you may know about the Global Fund for HIV AIDS, TB and malaria, and it's a $4 billion a year granting organization based in Switzerland. And so we believe that the surgical system strengthening is a unique enough activity that requires a dedicated funding and and it requires technical assistance in implementing so, uh, Global Surgery Foundation, in my opinion, make sense. And, uh, not only is it set up to be a sort of a pulling of funding and the allocation channeling that type of mechanism. But it's also a very powerful advocacy organizations based in Geneva. So they held an event, uh, at the W H A. Uh, because where they're at, they're able to, uh, liaise with number of health ministries. And, uh, I would say that the side event they held in Geneva this year was one of the largest events, Uh, during the week. And so, uh, you know, you can see what's happening right? It's it's no longer being neglected. And then, you know, there's people coming and saying, Well, what's what's going on with surgical care and global health? The gentleman on the right here is Jean Bookman, and he is the, uh, the commissioner for the Lancet commission on Global N. C. D. S for the poorest one billion. So, you know, we look surgical care is an intervention, but we need a partner within global health which is powerful and large enough, and it's really the n c d. Uh, One of them is the n C T community, uh, things like stroke cancer care, right for for lower middle income countries, cancer care. Uh, requires, uh, surgical care for diagnosis and and treatment. And then there's the whole injury section. So for us, it's their natural partners. There are others, but n C T community is really a huge partner. Okay, so I just want to say a little plug, give a little plug for the G four alliance. If God's sake is not a member, I don't think they are, but I would encourage, you know, the gas like to consider joining and maybe any other. You know, people that are in the audience that represent organizations. Uh, the GI for Alliance is really an advocacy organization that brings together all stakeholders that have shared a common interest in seeing stronger surgical system. So they're academia there. N g o s professional societies. Um, they all come together and and then an advocate for a surgical care for all. And then and then they have come a long way. Um, PG s S C is a member. I'm a neurosurgeon, and the World Federation of neurosurgical Society is also a member, and they're very active both in social media. Uh, they also have behind the scenes diplomacy that they're working on, and they also have, you know, a large scale events as well. Um, so G four Alliances is doing a really great job. Um, so one of the things I think I would have to give credit to the G four alliances there. US Resource Mobilization Committee. I'm part of that committee. I'm based in Boston. Uh, so, uh, if we look at, uh, global overall global health, uh, funding external global health funding you s a i d is the largest funder, uh, in terms of a government source. So So we we went ahead and said, How do we get us a idea to help focus on surgical care? Um, and it took a number of years. Sustained effort, key members of the GI for alliance us. Uh, resources mobilization team. People like, um, Michael never occur. And Lismore, networker from Mobile Surgery International, along with a bunch of other people having literally make meeting face to face with staffers and congressmen and senators and and and and and and and actively advocating for inclusion of language that the US budget has for USA I d. So that in the U. S. Congress, uh, is the, uh you know, sets the budget. It's past, ultimately by the White House and then within the last budget. Bill, uh, this language is now part of us, Bill. It says U S A. I D. Administrator shall support efforts to strengthen surgical health capacity and names a number of conditions like traumatic injuries. But there's a language about health and the national surgical planning assisting ministries of health to develop and implement national surgical obstetrics trauma and anesthesia plans. This is huge, because USA i d. Has to have initially these directives to allocate the resources. And then to make things even more interesting, the Biden administration has nominated. And the Congress, you know, Senate has confirmed to go. And as the assistant administrator on global health, the bureau, and as you know, uh, most of you may know he's a He's an endocrine surgeon and and a strong champion of global surgery. So, you know, the stars are lining up. Uh, this is something that I don't think anyone actually expected. Uh, but it's, you know, we take serendipity, we take luck and we take hard work and put it all together and then continue to build on the global surgery movement. we're going to shift gears a little bit to this area of research. And I went ahead and went to public yet and searched the terms global surgery. And, uh, here's, you know, sort of the number of articles that are identifiable with in the pub med search. And and, uh, I went to 2008, and there were 791 articles back that time that fit that category. But as you can see, there's been an explosion of of research that use the term global, uh, surgery. Uh, it's almost a tenfold increase over the last, you know, 12 years or so. So this is really heartwarming to see, uh, and the research really is generated by people like you. You know, people like us at academic institutions. Uh, and then, uh, you know, this is a testament to the contribution. I think academic academic institutions are making resident students, uh, faculty, uh, into the global surgery movement and this I think we'll continue to grow so in terms. And I know Michelle is going to talk about there's a workshop on research, but I just want to point out sort of broadly how we think of researching global health. So there's the why, right? And I think the Lancet commission on global surgery really pointed out the why. Because over half of half the world do not have access to a safe, affordable and tiny surgical care. But there's the what of, uh, you know, the global surgery. Um, you know, how do we finance these national surgical plans? Right? How many, uh, teams are really looking at that issue, but that's critical. And we need a lot more people who are familiar with surgical systems, global health delivery and financing. Right. Um, you know, what is the best way to implement? Uh, these national surgical plans? How do you bring in and two and surgical care into a district level hospital? And what is the framework that we should be? You know, you're applying, uh, when we think about systems level interventions, not just a, uh, a specific, you know, let's say training type of thing. So I think What is it just as important as why and then I think lately we've all been wrestling with this question of how what is? What does equitable research look like in global health? What are the, uh, the underpinnings of global health? Power structure. Right. Who controls want? Uh, so, you know, questioning these kinds of structural issues within not just global surgery, but global health, I think is really important at this point. Uh, and as we move forward to more, much more equitable, uh, partnerships with actors within the lower middle income countries. So, uh, one of the things that I think the research should do And I think that the massive gap and the type of papers that could inform policy in global surgery and I would just make a pitch to To to start thinking about doing research in this this area, Not so much clinical guidelines, you know, When is it appropriate to transfuse a patient or you know, those kinds of questions, But really, What is it? What is what is Health ministries are looking. What are they looking for? Right, So if if, uh, you know, Pakistan says we want to prioritize head and spine injury within our next health plan. Well, they have some questions then, and these are very specific. How many? You know, there's the question of burden, right? I think that should be done. The gap analysis. But things like, Well, how many, uh, neurosurgeons do we need for the population in Pakistan? Where should we put these, uh, neurosurgical centers? How far should they be? You know, those kinds of questions. So once again, you know, policy, relevant research that would inform, uh, number one planning. But once again, there's the whole idea of, uh, you know how effective of these policies. So that's sort of feedback mechanism. Uh, and then maybe some modifications needed, But research is incredibly important in the overall global surgery movement, and I mentioned briefly about this challenge of financing. This is the area that I think that will either make or break global surgery because we the plans are their political will is there. But money is not there. And we really have to match money. And there's, you know, the traditional, uh, domestic resources taxation. You know, micro levies, whatever. You know, you you have you, but and those things should be explored and additional advocacy effort maybe needed to convince ministries of finance that investing in surgical care is critical. But I would also suggest that there may be non traditional ways of financing surgical care, things like, uh, innovative financing and then, uh, impact investing. And this is the area that I think we need to bring in people from private equity. Uh, venture capital, Uh, you know, to this this the meeting that we had at the, um, general Assembly around the end to end cancer care and developing countries. There was a number. There were a number of female operated venture capital and private equity companies. And they want to invest in some of these projects because they they have a social, uh, mandated or or they driven by their own, you know, compass. But we have yet to bridge the gap between the plans to an investable project that, you know, these, uh, private equity can deploy. So if there are people sitting in the audience who are able to sort of make that link, please let me know, because this is I'm not a finance person, but I see that there is a huge gap in it, and we need to fill that gap. Okay, so now a little bit of a pitch for the subspecialties, because I'm a neurosurgeon, and I'm sure there are people out there who are plastic surgeons. Your nose and throat Neurology, What have you and you know, neuro The subspecialties are also undergoing significant changes. Uh, so within the neurosurgery community, we have the World Federation of Neurosurgical Societies. They have actually started a global neurosurgery committee. And, uh, that has, uh that is a result of, uh, some key research. That was, uh, you know, that was published in 2015 2016. It's pretty much the last commission story. And then you can replicate that within your own, uh, subspecialty. I have not seen it not working any other specialties. They're all It's almost universal, you know, because most of specialties have yet to really embrace the global public health health systems approach to, uh, unmet needs in their their particular specialty. So when you talk about a holistic approach, it changes everything. So within global neurosurgery, we've also had an explosion of articles that and use the words global neurosurgery within our own literature. And there's been a global There's a global neurosurgery action plan that's been implemented with by the Global Neurosurgery Committee of the W FNS, with five broad objectives amplifying access, aligning global neurosurgical activity, advancing relevant research specifically from L. M I. C. S integrating, uh, neurosurgical activity within the global surgery framework in individual countries and then lastly, advocating for universal health coverage. So these are specific targets within each one of those objectives. Things like we should map research, output by region and themes. So themes. There's the there's the health system themes and then more of the clinical guidelines type of themes, and you need to distinguish those too. So I think dramatic analysis is critical. Establishing a global neurosurgery research grant an award, right? So how do we sort of pull incentivize L M I c researchers and to conducting global neurosurgery type of research, And we actually now have that There's a There's a There's a research awards for that, uh, generous donation from the global I'm sorry, the Neurosurgical Outreach Foundation, but you can see, uh, so the other one is advocating for global neurosurgery category and sections in major neurosurgery journals, so you can see how this will apply for some of the other specialties, right? Are their global plastic surgery, Uh, section's within the plastic surgery journals. We have been successful in establishing sections in every major International Neurosurgery Journal. They have not had a global neurosurgery section. I'm really delighted to see that, but there's other targets here. As you can see, I'm also proud of the fact that within the global neurosurgery community, we recognize that the publications have significant problems, which is that their commercial publishers. And there's a need to, you know, generate revenues. Which means there's PE walls and also article processing fees. We see this as a significant barrier to the global surgery movement and, of course, global neurosurgery. So there's now a new journal of global neurosurgery. Know it's open access, no article processing fees. Nope, A wall. And there's a preference given to lower middle income country researchers. So I think the last the next couple of slides are sort of my own personal reflections. And where we're going in terms of global surgery, Uh, I think surgeons in general are operative, You know, where we pride ourselves on being operative masters, Right. Well, that that that person is really awesome surgeon. Yeah, I think we should continue to maintain that kind of, uh, you know, uh, reputation within other, Not just among physicians, but also, um uh, lay public. We should also be We also still do enjoy the reputation of being superb scientists and innovators, and we should also maintain that role and reputation. But we're now adding a third component to our profession, which is the reputation I hope will be. You know, we'll be respected for us for being guardians of health, equity, right, global public health practice and that I think fills our profession in a way that I think has not in the past, you know, been been the case. And I think that's what's happening now and then. You know, the other way to look at it is philosophically. We're moving from the charity mindset where we had, you know, trainings and missions and, you know, we're giving, you know, the the the sort of donor recipient type of relationship. And there's been a shift now, and I think this is is long time coming to a solidarity type of mindset where the partners that we have in these countries are that's exactly what they are, were there to support them, their their country owned initiatives and projects, and we see ourselves as supporters rather than donors. It's a different mindset and It's a self health systems approach rather than, um, you know, very isolated training type of, you know, skills transfer, but really helping them build robust health systems that involved that includes surgical care. So that's the end of my talk. I think what we are is we made tremendous progress. We have a long way to go, but I'm just, you know, as a person who went from a clinical practice of neurosurgery to global public health, the transformation that I'm seeing within the, uh, you know, our profession and also within global health is has been incredibly rewarding professionally and also at a very personal level. Thank you. Thank you very much, Doctor. Part for that amazing and inspiring keynote. It was absolutely brilliant to see it's such a comprehensive summary of the state of play. Um, I've got a number of questions on the chat function on our on our med A lap here. And if you guys have any pleased log in and do, I'll try and get through as many as I can. And I also have one myself as well. I'm going to use the chairs rights and ask you a question. But first of all, I've got one from Helen, please. She says, thank you for your excellent talk. Of all the initiatives that are currently happening in the field of global surgery, which endeavors are you most excited about? And what significant changes do you anticipate in the future of this field, please? No young people, Because the every time I meet, uh, students and residents and junior faculty, they are thinking in ways that I've never even imagined, You know, they're they and and the energy that we see, um, I can tell you within the neurosurgical field, um, you know, in the US, at least I've had a conversation with program directors. And, you know, the conversation was something like, you know, are there like, uh, resident applicants who are looking for global neurosurgery types of opportunities in your program. And they all looked at each other and said, Yeah, I said, Well, you know what percentage was? 10% said 30%. 1 in three applicants are asking neurosurgical residency programs, at least in the US, You know, What do you have for me in terms of, you know, my my passion, which is global global neurosurgery, So yeah, That's one, you know. And then every time I talk to you know, the students that just have this incredible energy, uh, and they're very, very well informed. And so I think the future is amazing, incredibly bright, and I get encouraged and then strengthened in many ways from our future leaders. Great. Thank you so much, Doctor Park. Um, just following on from that and one of the things that I'm kind of really curious about as well to get your take on as trainees. Um, as we go through our surgical anesthetic, obstetric training or any kind of health care training, it can be really full on in the centers that we're in. How do you think trainees should or could integrate global health experiences in into their training? How has it done in in your centers? Are there any integrated training? Pathways are options for your residents and trainees. Question Great question. So one of the things I think that I was involved in a couple of papers, but there are others that have published in the same exact topic, which is what is the current, uh, status of of teaching concepts of global health, global surgery within surgical anesthesia, obstetrics, residency programs, medical schools and the results were pretty, uh, across the board. It's sub par, right? I'm being very kind. Uh, it's almost non existent in some ways. So, uh, I think it's important to, uh, advocate and and especially the senior surgeons, right. Senior faculty members within their own profession. Uh, number one to start integrating educational opportunities. Uh, formalized curricula, Uh, global health, Uh, as part of the training, the core competencies. Uh, but I I tell you what happened here and at Harvard, we have medical students, uh, organized. And then they went to the dean of Harvard Medical School and said, We want you to create a course for us. Uh, global neurosurgery. I mean, they're not just global surgery. So here's another, and they're going to do it, and I'm betting they will. This is like the conversations went pretty far. And, you know, the initial verbal response was yes, we'll make it happen. So once again, the students and the young people, it's not just the seniors. Seniors have the the network to start talking about it as a need, uh, to change at the top level. But it's also from the ground up. The students have to make yourself hurt and demand demand These, uh, these things. Thanks, Doctor. Part. That was really interesting. It's something that gas it feels really passionate about, as well as trying to provide educational, um, and practical opportunities to get more involved in global health people who are in training in the in the NHS. Um, one question and the final question, if I may from Gerard McKnight. Um, he asks, The coated pandemic has exposed weaknesses in both low and high income country surgical systems. Should high income countries follow L M I C a lead and develop their own national surgical plans? Oh, should the high income countries develop national surgical plans? I don't know how to answer that. Um, the high income countries have a whole new layer of issues, I think, uh, specifically, in my opinion, um, what I would consider the commercial, uh, interests and also the whole dimension of politics. You know, the sort of individual rights versus public rights there's, there's It's a complicated question, But in terms of the pandemic, uh, I think what's what we've noticed, uh, is the value of having existing surgical care capacity because that could rapidly be pivoted in terms of times of, you know, the surge of coated patients, right? They were overwhelming. The hospital and hospitals responded. I think you know UK is no different by by cancelling elective surgery. Uh, and just having critical, you know, emergencies only. And then using the extra excess personnel space and stuff, uh, to manage, you know, the surge of patients. And we've used this argument. We've used this argument, uh, to to to help, you know, to to for, uh, you know, places like USA I d. And saying you are Now you have this budget for pandemic preparedness and response. You know the support for, uh, l m I C s. You might want to consider investing in surgical capacity as, uh, we think it's one of the best buys because one it's super useful in terms of, uh, during pandemic, you know, surges. But it's also, uh, practical in the sense that the space is used to reduce you know, the unmet surgical burdens and improve, uh, surgical equity. Thank you so much, Doctor Park for your amazing talk and really nice discussions and questions. And thank you for everyone who did ask questions so you couldn't get through them all. But we will draw this session too close.