Injury and surgical research
In partnership with local universities and health care leadership, we have deployed and instituted trauma registries in Tanzania and have recently piloted these registries in the Ukraine and Haiti. The registry is a minimal dataset collecting the most essential, high yield data regarding injury epidemiology. The importance of simplified tools cannot be over-emphasized as they are the most reliable for data collection in the clinically overwhelming and strained environments characteristic of resource limited settings.
The registry is divided into four components:
The most recent innovation was the piloting of an electronic tablet application which allows for real time data entry at the patient bedside and significantly facilitates data entry and analysis. In addition, we have been actively involved at assessing the burden of surgical disease in Rwanda evaluating operating room caseloads, patient demographics, and diagnosis.
- Patient demographics
- Mechanism of injury
- Anatomic injury and severity scoring
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.
Trauma training in resource limited settings is an area that only in recent years is gaining attention. The Trauma Team Training (TTT) course was administered first in Tanzania in 2006 by Drs. Razek and Deckelbaum in close collaboration with the Canadian Network for International Surgery (CNIS).This has been a successful intervention and the course has been independently administered at the Muhimibili Orthopedic Institute and now surrounding smaller hospitals every three months since that time.
More recently, the TTT course was administered in Rwanda (2011) with ongoing course administration by Rwandan leadership and in the Ukraine (2012). This model of “train the trainer” and identifying local leadership to implement the course independently is ideal for efficient knowledge dissemination in the field of Trauma in resource limited settings. This interactive course focuses on multidisciplinary teams working together and gaining the necessary knowledge to improve outcomes of the injured patient. . Each course is administered to an average of 24 health care professionals.
In addition, since 2010, the CGS-MUHC has been engaged in the Center for Global Surgery-National University of Rwanda partnership for surgical education. This program focuses on augmenting the postgraduate surgical education at the National University of Rwanda. While previously the program was mostly service based, since the inception of the partnership, there has been a significant academic component added to the post-graduate surgical training including the implementation of an academic day with lectures, conferences, case presentations and morbidity and mortality rounds. Since the program implementation in 2011, there have been approximately twenty 2-week modules focusing on surgical education in Kigali. These modules are supported by local Canadian surgeons from the MUHC.
Mentorship and career advancement
Students today are the leaders tomorrow. We have developed a significant research and global health mentorship program at the Center for Global Surgery. The demand for active participation in global health related activities by students, residents and faculty has been tremendous. In fact, in a recent survey, over 50% of medical students at McGill University have an active interest in Global health and seek structured opportunities to build on their educational experiences in the field. In the last three years alone, at the Center for Global Surgery, we have mentored and funded over ten residents and twenty students here in Montreal and others in resource limited settings (Tanzania and Rwanda) in global surgical endeavors.
These range from research here 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 aforementioned gaps in injury and surgical care.
Humanitarian disaster 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) such as the International Committee of the Red Cross (ICRC), the African Medical Research Foundation (AMREF), AMREF’s branch the Flying Doctor Service, as well as local government hospitals in countries such as Sudan, Kenya, Rwanda, Somalia, Uganda, Tanzania, Ethiopia, and most recently Haiti.
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.