Defining Optimal Resources for Children’s Surgery through International Collaboration
Etienne St-Louis
Left to Right: Prof. Emmanuel Ameh (Nigeria), Dr. Dan Poenaru (Canada), Dr. Keith Oldham (USA), Prof. Benno Ure (Germany), Prof. David Sigalet (Canada), Dr. Stephen Bickler (USA)
In the two days preceding the launch of the 5th Congress of the World Federation of Associations of Pediatric Surgeons (WOFAPS), a unique and novel model of international collaboration in pediatric surgical care took place in Washington DC. The Global Initiative for Children’s Surgery (GICS), a multi-specialty and multi-disciplinary coalition of providers of children’s surgical care from 39 countries representing a variety of differently-resourced environments, convened for its second meeting. In 2015, the Lancet Commission of Global Surgery (LCoGS) shed light on the critical importance of improving access to essential surgical and anesthesia care in low- and middle-income countries (LMICs). This redefined the global health perspective on surgery as a valuable and cost-effective priority, rather than a cost-draining and unrealistic luxury. However, the LCoGS failed to address the specific needs of children suffering from surgically correctable conditions. Indeed, children are not small adults, and while the demographic proportion of children in LMICs usually ranges from 40-60%, the expertise and conditions required to treat the immense burden of unmet pediatric surgical needs are undeniably scarce. GICS was launched as a result of this observation, and adopted a unique grassroots model that places the experience and needs of LMIC healthcare providers at the center by integrating them at the outset.
Left to Right: Dr. Naomi Wright (United Kingdom), Dr. Robin Petroze (USA/Canada), Dr. Keith Oldham (USA), Prof. Kokila Lakhoo (United Kingdom), Dr. Laura Goodman (USA/Mongolia), Dr. Neema Kaseje (USA/Kenya/Switzerland), Dr. Doruk Ozgediz (USA), Dr. Diana Farmer (USA)
During the inaugural meeting of GICS, which was hosted by the British Association of Paediatric Surgeons and the Royal College of Surgeons of England in May 2016, the focus was directed at bringing together providers from low-resource settings to generate a consensus document detailing minimal standards for safe surgery in children. The “Optimal Resources for Children’s Surgery (OReCS)” document was thereby created; the first edition of which was presented for review at the second meeting in DC. This second meeting also welcomed the participation of funders and implementers by bringing humanitarian and other non-governmental organizations to the table. Together, they tackled the thought-provoking challenges of implementation and sustainability. Indeed, OReCS stands as an aspirational set of standards, and as such, often stands in stark contrast to what many perceive as achievable or realistic. Nevertheless, the fact remains that children’s surgical disease is not a minor threat to the health of communities and, in fact, forms a critical priority for improving the well-being of billions of people across the world. Therefore, it is vital to devise a carefully crafted roadmap to the implementation of these standards, and advocate strongly for support from local governments, the international community as well as altruistic funders.
As a general surgery resident with an interest in global pediatric surgery, it was a privilege for me to participate in this meeting. I was brought on board the Core Operations and Logistics Team with the help of my PhD supervisor, Dr. Dan Poenaru. Dr. Poenaru is a pediatric surgeon working in Africa and Canada. His areas of interest are global burden of surgical disease, chronic pediatric surgical disabilities in Africa, faith issues in clinical practice, and global surgical education. Dr. Poenaru is a founding member of the GICS Executive Leadership Council and has been instrumental in promoting the initiative among his colleagues worldwide.
Left to Right: Dr. Bertille Ki (Burkina Faso), Dr. Romeo Ignacio (USA), Dr. Jonathan Lord (United Kingdom), Dr. Luis Zea-Salazar (Ecuador), Dr. Diana Farmer (USA), Unknown, Prof. Tahmina Banu (Bengladesh), Mrs. Edna Adan Ismail (Somaliland), Dr. Dahir Shukri (Somaliland), Prof. Kokila Lakhoo (United Kingdom), Dr. Zipporah Gathuya (Kenya), Dr. Luc Malemo (Democratic Republic of Congo), Prof. William Harkness (United Kingdom), Dr. Rashmi Kumar (Kenya), Dr. Jason B. Brill (USA)
In addition to conducting his own research, Dr. Poenaru is a supervisor to Master’s student, Dr. Yasmine Yousef, and acts as a mentor to many medical students through the Faculty of Medicine’s Osler Fellowship Program and other research projects. In addition to his activities within the Centre for Global Surgery, Dr. Poenaru has endeavored to nurture the global pediatric surgery expertise at McGill University by advocating for the creation of the new Jean-Martin Laberge Research Fellowship in Global Pediatric Surgery through generous support of the Department of Pediatric Surgery. As inaugural fellows, Dr. Yousef and I have the opportunity to develop our research by drawing on the knowledge and experience of Dr. Poenaru and his colleagues, Dr. Jean-Martin Laberge, Dr. Sherif Emil, and Dr. Robert Baird, who have all served the overseas in various pediatric global surgery missions.
There has been a strong interest from GICS participants to create new partnerships and develop ongoing collaborative research. In light of this attention, multiple opportunities shall become available to undertake pediatric global surgery research within the Department of Pediatric Surgery at the Montreal Children’s Hospital. Given the existing strong representation of McGill University at the GICS table, we are hopeful that the new Jean-Martin Laberge Fellowship in Global Pediatric Surgery will enable a growing number of students and trainees to assist in addressing some of the most pressing research needs with regards to global pediatric surgery. In particular, our group conducts research regarding optimal capacity assessment tools for goal-oriented partnership establishment between high-income countries and LMICs. Furthermore, we are conducting research on the benchmarking of pediatric trauma outcomes using simple point-of-care variables in resource-limited settings. In collaboration with the Centre for Global Surgery, we are also interested in development and deployment of a pediatric trauma registry that satisfies the needs of LMIC users. The field of global pediatric surgery is still nascent and rapidly gaining recognition among the scientific community. Research in this field will surely have a tremendous impact on the safe surgical care of children all over the world. It provides opportunities for exchange and travel that are unparalleled among other surgical research disciplines.
Etienne St-Louis is a General Surgery resident at McGill University who has an interest in Global Surgery and Paediatric Surgery. He is interested in teaching and has been involved as an instructor for the Rural Trauma Team Development Course in Latin America. Furthermore, he is presently re-editing the Trauma Team Training course in collaboration with partners from the Centre for Global Surgery and Canadian Network for International Surgery. His research interests are in the field of Paediatric Trauma in under-resourced settings, a significant cause of preventable morbidity and mortality. Specifically, he is developing a new paediatric trauma and injury score that can be incorporated into trauma registries for benchmarking and quality of care assessments for injured children in low-resource environments.
For more information about the Jean-Martin Laberge Research Fellowship in Pediatric Global Surgery, visit the link below.
For more information regarding the Global Initiative for Children’s Surgery, visit the link below.