Surgery

Program in Global Surgery and Social Change

John G. Meara, MD, DMD, MBA, Program Director

Background

Historically, global public health discourse has largely omitted surgical care from its list of priorities. However, conditions amenable to surgical treatment such as injuries, cancer, congenital anomalies, and complications from childbirth comprise a significant and growing proportion of global death and disability. In addition, research done over the last several decades has highlighted the essential role of surgical care in horizontal health systems strengthening and health augmentation in resource-poor settings. Despite these findings, however, the provision of surgical services remains unequally distributed around the world: the poorest third of the population receive less than 4% of the world’s available surgical services, while the richest third receive nearly 75%. The effects of lack of surgical care can extend far beyond health status, crippling advances in development, and economic enhancement. Given the significant burden of surgical disease and the devastating impact lack of treatment can cause, surgery can no longer be considered a privilege for the few. The Program in Global Surgery and Social Change (PGSSC) aims to address this disparity, creating excellence and parity in global surgery and anesthesia care delivery to people in resource-limited settings around the world.

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Program Objectives

The mission of the PGSSC is to achieve excellence and equity in global surgical and anesthesia care through leadership and innovation in education, training, research, clinical care and advocacy. Projects undertaken by the PGSSC consist of sustainable efforts to improve delivery of quality surgery and anesthesia in low- and middle-income countries in the Americas, Africa, and the Caribbean. Program objectives include:

  • Creating and enhancing research and clinical endeavors that define the burden of surgical disease, elucidate barriers to care and allow for optimized surgical and anesthesia care delivery to the most vulnerable populations around the globe
  • Training medical students, residents and fellows in global surgery through creation and maintenance of collaborative educational opportunities pertaining to global surgical and anesthesia care delivery
  • Supporting and augmenting the work and careers of faculty from around the world who are committed to addressing issues associated with inadequate and inequitable global surgical and anesthesia care
  • Increasing advocacy efforts that expand resources and efforts directed toward global surgery research, education and care delivery
  • Improving global surgical and anesthesia care delivery in low-resource settings through collaborations with NGOs, ministries of health and local healthcare providers to provide and strengthen provision of surgical and anesthesia care in low-resource settings

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Paul Farmer Global Surgery Fellowship

Surgeons associated with Harvard teaching hospitals, in conjunction with Boston Children’s Hospital (BCH), Partners In Health (PIH), and the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School are addressing the need for a surgical role in global health through the Paul Farmer Global Surgery Fellowship. In this fellowship, dedicated surgeons and surgeons-in-training are able to obtain the medical and non-medical skills they need to improve the health of some of the world's most impoverished people. The Paul Farmer Global Surgery Fellowship is a one or two year program designed for medical professionals who have either already completed their surgical residency or are taking a scheduled break from formal training to conduct research. Please click on the links below for additional information about the two available tracks within the Fellowship:

Paul Farmer Global Surgery Clinical Fellowship

Paul Farmer Global Surgery Research Fellowship

Interested fellows in either track may incorporate a Masters of Public Health degree during their fellowship, but this option is not compulsory. The MPH degree can be started through the Summer Program in Clinical Effectiveness at the Harvard School of Public Health. Obtaining an MPH will require a separate application to the Harvard School of Public Health (see Application Instructions). Tuition and fees associated with matriculation in the MPH program will be the responsibility of the Fellow unless otherwise specified. For more information on the Paul Farmer Global Surgery Fellowship please visit the Fellowship’s primary website. Any questions regarding the Fellowship should be directed to:

.(JavaScript must be enabled to view this email address) Partners In Health 888 Commonwealth Avenue Boston, MA 02215 .(JavaScript must be enabled to view this email address)

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Featured Initiatives

Hôpital Universitaire de Mirebalais

Partners In Health is constructing a 205,000-square foot, 300-bed facility, with 6 operating theatres in central Haiti that will fill a huge void locally and nationally for people who previously had limited access to quality health care. The hospital will provide primary care services to about 185,000 people in Mirebalais and two nearby communities. However, patients from a much wider area—all of central Haiti and areas in and around Port-au-Prince—also will be able to receive secondary and tertiary care. Clinical and Research Fellows and Associates are involved in technically supporting the Zanmi Lasante team for surgical service structuring and operating procedures. This collaboration is implemented within a framework set by the principles of accompaniment and development of local capacity.

Global Anesthesia Fellowship

The Boston Children's Hospital Department of Anesthesiology, Perioperative and Pain Medicine has started the first Global Pediatric Anesthesiology Fellowship. The program is designed for individuals who have completed their clinical training in pediatric anesthesiology who have a strong interest in becoming academic leaders in global pediatric anesthesiology. The fellowship isfor 12 months with at least 6 months spent on the faculty at Boston Children's Hospital and the remainder engaged in an academic project in a lower resourced country to be determined mutually between the fellow and the fellowship director. The current fellow, Dr. Denise Chan, will be spending six months in Rwanda as of July 2013 as part of the Human Resources for Health program. Interested parties should contact Craig McClain at .(JavaScript must be enabled to view this email address).

MGH-Mbarara Anesthesia Collaboration

The academic collaboration between the Anesthesia Departments at the Massachusetts General Hospital and Mbarara Regional Referral Hospital aims to find innovative ways to build capacity and improve surgical and anesthetic outcomes in low income settings. We are building an electronic surgical database at Mbarara to establish quality improvement initiatives. Education initiatives include a weekly Skype lecture series linking residents and the MGH and Mbarara, and a program to introduce ultrasound guided regional anesthesia to Uganda.

Rwanda Human Resources for Health (HRH) Program

The Rwanda HRH program is an ambitious 7-year long, US Federally-funded, collaborative program of the Rwanda Ministry of Health and thirteen US Academic Medical Centers and Universities that seeks to expand and improve Rwanda’s health care workforce via strengthening national training programs of specialized physicians, nurses, oral health providers, and hospital managers by recruiting US faculty educators to join the National University of Rwanda (NUR) training faculty. In year 1 of the program (August 2012–July 2103), Brigham and Women's Hospital / Harvard Medical School contributed the largest number of physician educators to the program, recruiting 40% of the US HRH physician faculty, including 6 surgeons. These surgeons have worked closely with their Rwandan faculty counterparts to restructure and organize the NUR surgery residency program including development of curriculum, organizing didactic and clinical teaching, and greatly strengthening resident supervision and mentorship.

Orthopaedic Training in Haiti

Haiti’s devastating earthquake in January 2010 created an unprecedented orthopaedic catastrophe, with hundreds of thousands of serious skeletal injuries occurring at once, even as the infrastructure for caring for them was simultaneously wiped away. In response, in 2011, we established an Orthopaedic Training initiative, operated in conjunction with Partners In Health (PIH) and sponsored by a generous grant from the American Academy of Orthopaedic Surgeons. Our objective has been to provide support to Haitian orthopaedic trainees, attending surgeons, and allied health professionals. We have organized a rotating faculty of foreign surgeons who work and mentor surgeons in three sites in Haiti. The academic aspects of the program have been coordinated through the PGSSC.

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The Program in Global Surgery and Social Change is dedicated to developing strong ties with institutions that share its goals. Current affiliations include Children’s Hospital Boston, Brigham and Women’s Hospital, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Massachusetts Eye and Ear Infirmary, Harvard School of Public Health, Partners In Health, Operation Smile, American College of Surgeons, and World Health Organization.

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