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Chelsea & Westminster Postgraduate Medical Education, Hot Topics in Global Health Presents...

  • Q&A session with Dr Keerti Gedela, Tim Law, and Miss Elizabeth Tissingh

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

Thank you so much for your thoughts and both. Excellent. And we've got lots of questions coming in and we've got lots of time for questions. So that's brilliant. Um About the stage. Oh, I'm Doctor Bdella as well, please, cause I got some questions for you coming in as well. Um Sorry. Um Our first question um is for me to you. Um What level of female do you need to be to get involved in your project for school? Um I, I mean, I think it's gonna take anybody and everybody and it's definitely gonna take young people. Um So I think get involved in some way at whatever level you're at. I think, think really carefully about how you get involved, depending on the level you're at. So I'm not in any way advocating that a medical student hops on a plane and starts operating. Uh What I am advocating for is that a medical student gets involved? Does advocacy, trains themselves, makes friends, does some admin stuff, you know, just get involved, learn, educate yourself, teach yourself. So I, from my point of view, there's nobody too young and there's nobody too old. Um There's just Right. Motivation. Right. Intentions and well, well prepared, I think for all these, they get involved in your project. Yeah. Whereas it's a bit different, different for us actually because if you're gonna have credibility teaching people in war zones and particularly as those people become more efficient themselves because of the experiences that they've had, you need to have that degree of, um, the credibility in front of that, that audience. So up till now, the um the principle, you know, the currency that they have not found to be a consultant level. Um And you need to have had some humanitarian experience. That's the next situation, isn't it? Because how you get that humanitarian experience without those opportunities? Um Obviously, we've heard of some that are available here through Kings College partnerships, but also several others across the NHS. Uh Recently, we had a discussion with MSF UK. Um I think whether or not um our sort of systems lend themselves ideally um such that maybe when you're younger, you have more time to be able to give to um MSF type work, which might be two or three months in duration or, or longer in some cases. And then subsequently, when you're somewhat older, perhaps you have home um uh responsibilities or something like that, you can come on a daily foundation mission which typically lasts for five days. Um So there'll be a dangerous side for travel. Um But that might make it somewhat easier for someone who do something or whatever, to be able to release themselves from a senior in a, in a, in a medical practice. So, um that's really where we are. But I have to say that we also have an surgeon training of the not foundation and if you haven't heard of them, put them up on social media, um, it's run by a, a registrar, um surgeon called, um, but with a, with a committee and they run events that, you know, help people sort of understand what it is to be like going into the humanitarian surgeon, anesthetist. Um or um and we are creating a nursing course which is gonna be different. So, um yeah, there are options. Thank you very much and we'll do a couple more questions if that's OK. And so he says, thank you for, how do you build trust to be able to work in some of the stable and divided communities that you work in? I'll, I'll answer that question with the story of, I mean, um the first trip that picture saw the gentleman in the red hat, the Congolese ophthalmologist. Um They sort of set up lots of meetings, people that they knew universities, hospitals, the Minister of Health Minister of Health. At the time, there was a picture of her. We rocked up and our g got deposited. We were supposed to have, you know, there's a delegation from the UK has come to meet this woman. Anyway, we, we and she just looks at us uh and she speaks in French so I can hear what she's saying. But my colleague Andy who doesn't speak French, it goes over his head. Listen to him here. Are these people, what are they doing in my country? Why are they in my city? This one doesn't even speak French. Why am I spending my time with these people? Which completely endeared her to me because I know that is 100% the normal response to have to a bunch of strangers who walk up on your doorstep wanting to do something. You know how, I don't know. Um, anyway, we had a, we had like one, we sat around the table discussion back and forth. She was sort of a bit more amenable by the end when we said, you know, we just come to visit, explore partnership and all that kind of stuff. Anyway, it wasn't until the following year. I went back on my own. Uh, and I knocked on her door again and she looked up and she's like you came back. Uh, and I think it was then that started the relationship for us. It was, it was, it needed that it needed like hell, no. And then, oh, you came back. Maybe there's something we can do here. Um, and so she's now part of our steering group committee and she's no longer the virtual Minister of Health. Um, but that relationship, you know, that was 1010 years. Um, and it didn't start happy, which I think is, I mean, her response entirely normal to what we were doing but it opened the door for a relationship. You can do a case in HIV. M due to what the future challenges would be in. Lower. Yes. II think, um, you know, about the innovation for the R team. You've got better now in two patients a little bit earlier compared to say 3035 years ago. But that's still a challenge and that's it very much into. Mhm. Capitalism. You need extreme capitalism, commercial partnerships that, that we, that we absolutely need. Um, and, um, we have conversation and he was asking about health equity when you might not call it health equity, call something else and you speak more of the language of, um, the set that you're in and what they need and what, how they, how they see things, those cases. I think so. Definitely in the HIV space though. So HIV drug innovation is lifting off in terms of different delivery systems, um, new agents and it can, um, prevent, you know, people having necessarily a daily pill even though that's revolutionary. But they can even, you know, every six months how that gets translated, translated to the low income world is a big gap. But, but, and that's often not only related to what we might think about is also related to how those innovations are developed and that kind of leans in a bit into my role as EI Nr chart. When you develop, develop drugs for clinical trials, we need to think about how we do those and sometimes they require a high income infrastructure to do it. Do you need viral load testing? Do you need VRT? Does it need to exclude on this basis? You can't translate that to a lung because you feel that it from the outset um prep um prevention of HIV. There are, you know, incredible innovations again in that space, looking at injectables and different drug delivery innovations. I mean, in some ways, the, the sadness is, you know, comparative, I think to what our two thoughts is in the HIV space. Like I said, you have the tools, tools are there, scientific tools are there and you know, we still have a situation and that your point about we don't live in a very nice world. Sometimes it, it, it's, it's, it's challenges in the social behavioral space, the political space, the how they could be. I often uh find that I sometimes think the language I speak is not the language I need to speak. I need, need to speak a different one. I have to. Yeah. Well, so I I'm definitely prep innovation and prep drug delivery, novel diagnostics, getting people, you know, um diagnosed quicker onto treatment sooner. Um That's certainly where the, the United Kingdom, the Netherlands and other places are really um how we do that in other settings is very much related to the social behavior context, the complex health system. All right. So um so those who were hands up in here as well, you put your hands up now and who's your appetite? OK. Give me one second. I'm not asking you to use a microphone to give me one second. Yes, to start off more than just a few days, especially um most consult family. I need something else. You just gonna repeat that for the benefit of those online. Um The question was, do you have special needs or how do you um allow to go to the family? So, II wonder do you want to May, may I can say. Um So when I was, I started this poor surgical training, um I had a couple of times where the job let me take this study leave. So where I had somebody who was particularly sympathetic, let me go away for two weeks of study leave. I did a lot of the other work in my own time. Um You know, prepping stuff, prepping, training materials, meetings, all of that kind of stuff. Now on my consultant job plan, I have a day a week and built into my job plan allocated to what I do uh with King's Global Health Partnerships. Um So I have a, a separate contract with KJ HP, but that's built into my job plan. Um I haven't got any private practice. So, um from my job plan that works well. Um But the trips I'm still taking as part of my own as annual leave at the moment. Um I'd love to work towards an annualized job plan, but actually my trusts have been really supportive and I three amazing colleagues um within our memory construction department at Stanmore who are really supportive of. Um I think as a group, we're supportive of whatever anybody else wants to do. So it's my thing is that I need a trip to D RC. Then they, they're 100% behind me on that. So I think working in a team, you know, that where that works and II know that's not easy for everybody. So good question. So I'm a consultant that that's my job. I've been put on full time but up and down with et cetera to s but as we all know, that's also a thing to navigate um related to your team and the service need for the first grant. So um a lot of my time before I go to a consulting job and during my consulting job, I have worked overseas and there is a um it was always much more, I was able to do that more as a registrar. And Ch in Westminster is a good trust. I think I would say arguably in that space to allow that through et cetera. But how I managed it as a consultant was the M RCI grant I got which I was fortunate to get and to be fair, me getting that first MRC Grant was probably not, you know, the ones were against me to get it paid for 80% of my salary. Actually, it paid for 100% of my salary. But because of the F EC, so this is an important question to be because of the fact that a grant only give you 80% of the full economic cost. And because she in Westminster are not an academic institution, they couldn't bridge that gap. So 80% was fine, but it didn't mean that everything else was cut at 80%. Um So there was lots, there was lots of, I think learning from and, and so that meant that I had my salary paid by the MRC grant and then it was up to the, to my team enabling me to, to um to have a lo and so we got a local to cover me over two years. I then came back and she became a consultant. So it worked in that sense because I was paid by MRC. There was no way I could have done that unless my salary was paid. Um And then since that the next grant we have, it gives me in proportion. So I get a research pa from the next MRC grant that we have. However, the, the I think some of the discussions are about whether you lean into a academic organization. So if you become honorary, who trust and um paid by the academic institution for something like imperial or vice versa, I think where there is, there is research grants, that's always a possibility that when it might work for different partnerships or it doesn't come from research grants, I think it's a trickier thing. But if you get the money since the August, I know I'm not a doctor so II can't speak um for them. But um we've got 80 people on our teaching faculty, about 45 surgeons, they're global. Actually, some of them, you come from other um countries between the USA and mainland Europe. Um and we also um have about 25 nn nurses and obstetricians and the rest of them, some people are selected permission, we give them eight weeks notice. So it allows them to get a week's leave, which I think is very standard in the NHS. Reasonable for most people to be able to achieve that. I think it largely becomes a study for people and that I think is paid in the NHS generally. And so um it came as a bit of a surprise to me actually, when I joined the foundation, but we actually pay, uh I wouldn't say pay rates for people that we send um on trips overseas and we also immun our local factory. Um But we do that in a way that is not gonna break the uh it's gonna be as equitable as possible, but without changing the market dynamics in the places where we operate as well. So, I was quite surprised by that because actually, um, when I was coming back from Libya a few weeks ago I was sitting on a, an airplane and like, I know nowadays you don't really talk to people on airplanes and nowadays, probably about the last 20 years, but I actually happened to start chatting to the person next to me and she was a registrar based in Bristol now, had just come back from a quite long with mercy ships in, in Sierra Leone and Liberia, West Africa. Um And um she said that she was totally unpaid for that period, but she got really great accommodation. She had to pay her own flights there and back. And actually our American factory um who are also members of Med Global, which is a Chicago based NGO. Um they can get their flights paid but they have to pay for their hotels and their assistance when they're overseas and they don't get paid. So, you know, there's quite a big yeah variety in the, in the um community and then I guess it's worth finding out before you sign up for that. That's one other thing there is the acknowledgement of a privilege in this. I think that's the other thing. So there was a lot of money we paid out of that because of COVID going back and forth global health insurance or whatever it is that you do, you have the privilege of doing. I think it is important. What I often think about is who, you know, who we get into research, who we get to do this work. Um I've often navigated my role in different countries as a brown woman. Like sometimes it's actually been to my advantage and other times it hasn't been and you try and figure that out. But there is a, there is certainly a privilege related to what you can afford and what you can't, how much time, you know, we, we know that and there is a, there is definitely a space that we, we must talk about that. We wouldn't discussed about leveraging people from that country to do this work and to be like to be even in our own country who gets the chance to do this type of work, even if junior doctors guys have debt that I didn't have, you know, et cetera, et cetera, et cetera. How do you manage that? Um The other goals of dreams that you have? It's not an easy one. It's not an easy one, but I think we need to acknowledge that. So, you know, I have a husband who works. He's a GP, he's a, he's like that. So he was like, yeah, you can do that for two years. If he didn't allow that, he couldn't do it, you know. So there is we've got time to have one more question. So, um I II guess this is uh a question for the uh the trauma uh trauma group. II just want to get a better sense of my mind of uh how a, a kind of a trauma service functions in a low resource setting. So for example, that they, I imagine they can't do much of like a prehospital trauma care. And then also just wondering how, uh like um damage control surgery occurs and whether there can be any semblance of like a trauma network you can create. And then I guess a, an another slightly different question, um for, I guess more for the not foundations work in Northwest Syria when uh like healthcare has been so specifically targeted when running a, a trauma service in that se setting, whether it's feasible to or, or how one runs a, a more decentralized service and how, um the, the feasibility of, for example, some shifting different aspects of I start on the last one before I forget, forget the question. Um We actually work with partners in Northwest Syria, um in particular, um s and actually for Humanity, Humanity, you know, the Syrian Relief. Um And those are the people who deliver healthcare services, you know, in concert with actual healthcare providers that are, you know, when I say, I mean, not state of Syria but Syrian Authority. Um with currently funding uh someone to do a phd in London at King's College to um talk about emergency medicine in healthcare settings. This person was a trained doctor but um became a sort of manager. One of the men were in the um crisis and um his wife was a document made and made the documentary for which was um yeah, it really amazing um insight into what it looks like from the perspective of people trying to be good in a, in a crisis. Like I really recommend watching, it's actually on um 43 on, on uh channel four. So you can look it up. Um And um we have asked him to as part of that sort of payback for him being a phd to provide us with a module on hospital management and emergencies actually. And it's about things like, have you organized an emergency department when there is activity in the area? Have you checked our hospital from the sort of fragmentation that and blasts that occurs with um conventional weapons? Um And um have you negotiate to transfer patients across front lines in very challenging situations? Those things are really, really important. We'll be incorporating those into our programs as we go forward. Um What was the first question? Um I think it was just about how a trauma system works. So I think the question is how, how does the trauma system function in a low and middle income setting? So I think the first things to unpick on that is number one, you know, Africa is not a country. And so, uh, it's just vastly vastly different. The other thing to really unpick also. And I would urge all of you to do a bit of reading about the term LM IC because it lumps together really, really desperate groups. So if you go onto the World Bank website and you pick out and, and you look up LM IC, it'll tell you what a low income country is, what a low and middle income country is, what a middle income country is and then what country is and they are vastly vastly different. So as a, as a term, it's probably not actually that helpful because there is so much variation because if you're a low income country, there is no semblance to even a middle income country, they're just vastly different. Um And the other caveat I suppose is that there are some countries that have never had a functioning health system and that have never had a functioning trauma system. So D RCI would argue has never really had a health system that was fully able to care for its population to care for its patients. Maybe for a brief period in that kind of towards the tail end of a kind of colonial period where there were some Congolese doctors trained. But you know, at independence, there was one university trained physician in the whole of the D RC and everybody else up and left so has never had a health system that knows what it's like to treat a trauma patient. So, if you then try and develop a trauma system, it's very difficult because people haven't got a memory of what working looked like. I think in Syria, Gaza, you know, many countries, regions currently in conflict have a recollection of what it's functioning looked like. It maybe wasn't perfect and there was a way to go, but they have a recollection of what a trauma wall is. They have a recollection of what it is to deliver surgery in a timely manner. Other places have no idea, they've never experienced it. So, um, I mean, it's a, it's a really complex question. The other thing is funding, right? So some funding, uh, models in healthcare systems allow for treatment of trauma. So if you pitch up in an A&E department, somebody deposits you into hospital, however you get there and you've got some bowel hanging out, you'll get a laparotomy and somebody will look after you in the D RC, particularly where we are. If you show up and your bowel is hanging out, nobody will touch you. They will first find out where your family is. Uh, and then once they've established that you have some family, then they might consider giving you a dose of antibiotics and putting up a drip. But even that dose of antibiotics, somebody's gonna pay for that. That's a dollar to somebody somewhere in the hospital has gotta find a dollar for your antibiotics. Then somebody has to find another dollar to pay for your cannula. You get one cannula. So there's no missing, you know, you've got one shot of that thing cos it's one cannula and one bag of fluids and then they've gotta go and find the money that it takes to get your laparotomy, which is probably about $50 maybe 100. When you think that people have got a dollar to live on for that day, they're not gonna have $50. So, uh, unless you fix the funding issue, you know, it's kind of academic job that way, trauma system website so nobody can pay for it. Um, which again, and it's just about to be different depending on where you are. So, it's a, it's a really complex question. Sorry, I know. But, um, just mention Ukraine, um, Ukraine is not low income country, it's middle income country, obviously. Um, and the sur that we've taught has, um, come from what was, in essence, the Soviet system where the opinion of the senior person president was the prevailing opinion of group. And I don't know what it's like in the NHS because I've never a doctor. Maybe it's the same. I don't know. But, um, when it, um, it came to some of the things that we were teaching that actually we switched on light in some of the, um, we keep the damage control and there was one who'd been working in the civilian sector. So in the military casualties, because you can imagine then come to a war where your nation was entire at war. Everything is sort of some left and said that had, he realized the sort of impact of damage control procedures. Um He would have been able to save many, many more lives and the, the work that we have done to put his eyes to that have been quite subs in changing the way he now there are also some people that come to us and say, I don't know how we're gonna get this past the senior surgeons and senior in the place where we work. But we do also do a with the governments that we work with to try to help the assists in general. It's not just about being better surgeons, it's having a better surgical assistant. Thank you all so much. We are out of time. Um So thank you all again.