Injury and surgical disease are leading causes of global morbidity and mortality. In fact, there are more annual injury-related deaths than from HIV, malaria and tuberculosis combined. Ninety percent of these deaths occur in low- and middle-income countries and commonly affect the most productive portion of the population. At the Centre for Global Surgery (CGS) McGill University Health Centre (MUHC) we have recognized the impact of injury and have been committed to addressing this major problem. Our ultimate goal is to reduce injury and acute surgical disease-related morbidity and mortality through local capacity building while strengthening the trauma response system. Our program is build around four main pillars
Injury and Surgical Research
It has been demonstrated that people with life-threatening but potentially treatable injuries are up to six times more likely to die in a country with no organized trauma system than in one with an organized, resourced trauma system. Such evidence demonstrates the need for deployment of trauma systems especially in low and middle income countries where the burden of injury is on the rise. Trauma systems require a thorough understanding of the patterns of injury in a geographical area thus the importance of using databases to describe the epidemiology of injury and the access to quality surgical care. Such data can be used for the purposes of performance improvement, injury prevention and further policy measures to reduce the burden on injury and improve access to surgical care. Several registries have now been implemented in resource-limited settings.
In partnership with local universities and health care leadership, the CGS has deployed and instituted such databases in numerous countries around the world. These databases comprise:
- Trauma Registry (TR)
- Operating Room Registry (OR) including the Perioperative Mortality Rate (POMR)
The implementation of registries provides the earliest hospital-based injury epidemiology, which in turn informs future targeted interventions in education and prevention, addressees human and material resource gaps, and drives policy to attend to the challenges of injury.
The CGS’s most recent innovation is the development and introduction of an electronic tablet application called iTrauma™ which allows for real time data entry at the point of care. This app has been implemented in Tanzania , Malawi , Mozambique , Chile and Ukraine with plans to further expand.
iTrauma™ application Local Health leadership introducing the iTrauma™ in Mozambique
Injury and Surgical Education
While research is instrumental in defining the extent of the burden, such work needs to be supported by education to address the burden of surgical disease and injury in resource limited settings. The education component of the CGS program revolves around trauma training and capacity building. At the request of institutions worldwide, the team provides certified training in trauma management and teamwork development through courses such as Trauma Team Training™, the Advanced Trauma Life Support™, the Basic Life support™ , the Rural Trauma Team Development Course ™ and the Trauma and Team Disaster Response™ Course . By identifying local leadership to implement and manage the courses we have ensured continuous knowledge dissemination in resource-limited settings through a train the trainer process. For example, with the CGS support , Tanzania has been offering the TTT™ for the last 10 years, which has helped improve the skills of many providers. We are also actively involved in organizing and offering training in Ukraine in partnership with the World Health Organization and in Nepal at the request of the Canadian Red Cross.
Along with the our international education and training programs , we have recently developed a curriculum for students wanting to get involved in global surgical work and research. This thesis based program is offered at McGill University and allows Canadian and international students from both medical and non medical backgrounds to engage in our international projects and advance our capacity building programs. For more information visit the program's page here.
The CGS has also introduced a pediatric component to their educational programs with the new Jean-Martin Laberge Fellowship in Global Pediatric Surgery. This Fellowship will be under the direct supervision of Dr.Dan Poenaru a pediatric surgeon and professor at McGill with extensive experience working in Africa. To learn more about this fellowship click here.
After completing a 2 days TDTR training in Palestine in collaboration with Juzoor (April 2016) After completing a 3 days BLS and TTT training in Ukraine ( December 2015)
Mentorship and Career Development
The CGS mentorship activities range from research addressing the burden of injury and surgical disease to clinical activities, student exchanges, resident exchanges and opportunities to present at international conferences. As the professionalization of global health and surgery becomes an expected competency of those engaged in the field, we strive to support this demand by providing students, residents and faculty structured opportunities to set a foundation for their future careers in global surgery while simultaneously addressing the gaps in injury and surgical care.
As an example , we recently supported a student led exchange program between McGill student and medical students from Rwanda and Haiti. The exchange involved a rotation in acute care surgery, training at the Arnold and Blema Steinberg Medical Simulation Centre, a dissection program in the McGill anatomy lab and a research project, split between three weeks in Montreal, and three weeks in Kigali, Rwanda.
More recently the CGS welcomed a colleague from Maputo Central Hospital, Mozambique, Dr. Mario Jacobe , who spent 4 months training in the Montreal General Hospital at the McGill University Health Centre. Dr.Jacobe who was supported the implementation of the first trauma registry in Mozmabique alongside the CGS. During his time in Montreal Dr. Jacobe also became certified in Advanced Trauma Life Support®. As a result of this exchange, Dr. Jacobe has now been appointed in charge of Trauma in Mozambique by the MOH.
McGill - Rwanda- Haiti Students exchange program (2015)
Disaster Preparedness and Response
In addition to the academic programs, MUHC faculty have been actively involved in the provision of surgical support in low- and middle-income countries in response to natural disasters, armed conflict, or baseline need of surgical capacity. This has been done through affiliation with Non-Governmental Organizations (NGOs) as well as local government hospitals in countries such as Sudan, Kenya, Rwanda, Somalia, Uganda, Tanzania, Ethiopia, and most recently Haiti and Nepal.
Not only are such contributions part of the global social responsibility recognized by our faculty to support under-resourced and underprivileged populations around the world, but it also enables us to have a ground-level understanding of the issues and needs in those areas. This is an essential component for the proper implementation of longer-lasting, higher-impact, academic programs such as those described above.