EPISODE GUIDE

Episode 0: Founders Episode

Welcome to Global Scalpels! Find out a bit of who we are and why we started this podcast.

Episode 1: Dr Rishi Rattan

Have you ever wondered what it would be like to practice surgery in a combat area? Or what about during a mass-casualty event such as the Boston Marathon bombings? Join us as we talk about Kurdish controlled Iraq, medical education, disaster management, and even workforce management in some of the most well-known organizations in the world including the White House, US Army, United Nations, and local governments.

Episode 2: Gerald Mwapasa

“Sent.” “Delivered.” 65 billion messages are sent on WhatsApp every day. That is 29 million messages every minute. Perhaps one of the most used social media platforms around the world, Gerald Mwapasa and his team at SURGAfrica are using WhatsApp for a whole new purpose – to create a network of surgical consultation across Malawi. They are using the app to connect non-physician Clinical Officers in remote areas with surgeons around the country. Malawi currently only has approximately 10 orthopedic surgeons in the whole nation. Using non-physician Clinical Officers significantly increases the country’s ability to provide care. SURGAfrica helps to create a robust network to increase quality of care as well as to create an educational resource for providers (surgeons and otherwise) to refer in future cases. You don’t need to be a clinician to be involved in global surgery or make a difference. This fight needs a whole army with diverse backgrounds. Come explore the world of tech, security, and networks on this exciting episode!

Episode 3: Dr Mahmoud Hariri

 

Practicing surgery is difficult in normal conditions. Even more challenging in resource-constrained situations. But what about when you are actively being targeted by your own government? You have several aliases and multiple SIM cards, but your not a spy, you are just trying to provide medical care to those in your war-torn city. Filling tires with sand to create shock absorbers on the roof of the hospital. Operating in the hospital underground corridors to be protected from missiles. For some this may seem like a movie, for Dr Mahmoud Hariri, this is his daily. Join us as we talk about his experience of surgery during the Syrian conflict, the scholars at-risk program, and his recently published article in JAMA Surgery!

Episode 4: Dr Zineb Bentounsi and Dr Parisa Fallah

Being able to make a difference in global surgery as a trainee can seem difficult. Even unachievable. “What skills do I have to offer?” “Do I have a voice in global surgery – and if so, how can I make it heard?” These questions can be hard to answer but that didn’t stop our two guest on this episode. If you are a global surgery trainee, you will definitely want to tune in as we explore the creating of the two largest student-founded and student-run global surgery student groups around the world! With over 5,000 members and 48 national working groups of InciSioN and more than 2,500 members and 60+ national chapters of GSSA these two organizations have changed the face of trainee involvement in global surgery. Learn about the origins of both of the organizations, their founders, what it takes to start an international platform, and how students can get more involved in global surgery!

Episode 5: Dr Nobhojit Roy and Dr Monali Mohan

110 million people. This is twice the number of the entire population of the United Kingdom, 10 times the population of Greece, and more than 1,000 times the population of Tonga – and that is just one state in India. Welcome to Bihar and the amazing team at CARE India that works here. Join us as we investigate health systems strengthening through the lens of one of the original Lancet Commissioners for Global Surgery representing Southeast Asia as well as from physicians working on the ground in district hospitals to develop ground-level solutions. Both Indian born, foreign-trained, our guests speak about their decision to return back to India in an effort to fight brain drain, tackle international networks, and expand funding for their important mission.

Episode 6: Dr Jacquelyn Corley

Approximately half of the world is female… yet they are often invisible. In fact, only 12% of neurosurgery residents in the United States are female. Although, great strides have been made for women’s rights we still have a long way to go – particularly in global surgery where the conversation is largely absent. A conversation, that our guest today has greatly changed. Listen in as we discuss the power of media and how to harness that power to bring awareness to critical issues such as gender equality. In this episode, we explore behind the scenes of writing for some of the largest media organizations in the world including JAMA, Forbes.com, and the Huffington Post as well as the establishment of key resources in global surgery to better support the Sustainable Development Goals (SDGs) 3 and 5. Advocacy, challenge, and empowerment are key themes in our road toward equitable surgery for all – regardless of the presence of XX or XY chromosomes.

Episode 7: Anant Jani

Diversity is the key to innovation and new solutions. Global surgery is a field that needs people from any and all backgrounds to tackle this issue. So how did a PhD researcher in immunology at Yale become a major force for good in global surgery? What does role does value-based healthcare have when working in low-resource settings where healthcare isn’t even present let alone “value-based” and how do social determinants of health affect access to surgery around the world? The answers to these questions and more are found in today’s episode. Join us as we talk about air conditioners as a social determinant of health – something you may have never considered before. We also look at the power of adapting solutions to local situations to create lasting and meaningful change no matter where you are. Come explore outside the operating room and into the other aspects of global surgery that play an important role in preventing people from needing a scalpel at all.

Episode 8: Walter Ulrich

Hundreds of millions of shipping containers are transported around the world annually. Some of them are filled with cars, toys, or cosmetics. Others are filled with perishable food items or electronics. As the world shut down in the wake of COVID-19, we all saw what happens when supply chains are disrupted. Supermarket shelves full of toilet paper and canned goods disappeared seemingly overnight. Genuine fear arose as resources became restricted. Supply chain is a big issue. In many countries around the world, it isn’t that their medical supply chain is disrupted – it is that it doesn’t exist. You can’t even get the medical device you need. Medical bridges is disrupting this cycle and creating new supply chains to support the needs of hospitals around the world who lack access to important medical devices and surgical supplies. Think x-ray machines, dialysis pumps, and life-saving ultrasound imaging all donated, renewed, serviced, and then shipped in big shipping containers to distant hospitals in need of these technologies. Partnerships with local NGOs for servicing these machines keep them up and running for years to come. Tune in as we talk about ethical issues around serving in developing countries, medical waste, and supply chain channels as we explore entrepreneurship and business principles to create new opportunities in global surgery.

Episode 9: Dr Jean Christophe

Every day 830 women die from pregnancy or childbirth related causes – that is over 330,000 per year. That is 830 mothers. 830 sisters. 830 wives. Lives lost, and families shattered. Sometimes these deaths come as a result of surgical complications, other times due to unsanitary conditions or infection, and still more due to severe bleeding that could easily be prevented if they had adequate access to healthcare. In addition to these 330,000 women, another 5.8 million die due to trauma related causes such as road traffic accidents. This is more than the total number of deaths that result from malaria, tuberculosis, and HIV/AIDS combined!

What do these two major topics have in common? While mortality may seem to be an obvious answer, this is too far down the line. Prevention. Many of these deaths are completely preventable. Join us as we talk about the role of public health in tandem with surgical care and how surgeons and non-surgeons alike can help to advocate for better public health measures to prevent these deaths from occurring, rather than having to work with the ugly aftermath of a traumatic injury in the operating room. In this episode, we challenge the paradigm that surgical care only takes place behind closed doors and sterile drapes. It can also take place on the steps of the legislative government building through advocating for safer traffic laws or funding for family planning education.

Episode 10: Andrew Bonneau

250 degrees Fahrenheit. 121 degrees Celsius. This is the temperature at which surgical equipment is sterilized. Pressured steam envelops each and every instrument cleansing them of impurities and killing microbes. This whole process is vital to the practice of safe surgery and is done in the confines of an autoclave. In order to create these temperatures and the resulting steam, the autoclave machine needs power – and lots of it. So what happens when the power goes out? Or what happens when the generator runs out of gas? No power, no heat. No heat, no surgery. Join us as we talk with Andrew from Noor Medical about their new “Hybriclave” which enables surgeons and technicians to sterilize medical equipment even in areas of unstable electrical supply by harnessing the power of the sun, thermal heat, or traditional electricity.

Episode 11: Dr David Chong

In many regions of the world, clean water, electricity, medical facilities, and medical personnel are limited or nonexistent. Healthcare infrastructure is lacking and access to needed supplies can be highly variable. But what if you could have a state-of-the-art hospital and a whole crew of medical professionals delivered directly to

the areas that most need it? This is where Mercy Ships comes in.

 

The ocean is a vast resource that covers 70% of the earth’s surface. It brings life to many through fishing and other important resources. For this reason, more than 40% of the world’s population live within 100 miles of a coast and 90% of the of the trade between countries happens via sea. Mercy Ships is able to harness the power of the ocean, and the close proximity of communities to the coast, to deliver high quality healthcare around the world. They also train local healthcare providers and seek to improve the medical infrastructure of the areas they visit. They even stock their ships with a supply of vehicles so they can reach remote areas!

 

Join us as we talk with Dr Chong about what it is like to be “stationed” on a medical ship, the concepts of universal citizenship and diagonal development, and how to be “a fibroblast vs a cancer cell”.  You won’t want to miss this episode!

Episode 12: Dr Dominique Vervoort and Dr Nabeel Ashraf

As a country, creating a national long-term strategy to address barriers in your health system is a daunting task. Where do you start? What do you do if you fail? And how to you ensure long-term longevity. It is your responsibility to bring together key stake holders with different backgrounds including: health economics, surgery, business, advocacy, health policy, and so much more! This is where an NSOAP comes in. A National Surgical, Obstetric, and Anesthesia Plan (or NSOAP) is a national strategic plan that uses 6 pillars to strengthen the surgical system as a whole to expand surgical access across the country. The NSOAP is embedded in a national health plan and headed by the Ministry of Health of each country. Join us in this special episode as we talk with two guests about the creation of the NSOAP of Pakistan as well as the power of social media. With more than 500 million Twitter tweets being tweeted daily, how can you raise your voice to bring attention to global surgery? Global Surgery consists of people from different sectors (tech, advocacy, surgeons, and more), different surgical specialities, and different counties, one of the miracles of social media is that there is very minimal barrier to joining and your reach can be much wider than you ever thought possible. The #globalsurgery movement has made huge strides in brining together the global surgery movement. How are you going to leverage your social media to make your mark? And what are the potential changes you could influence? You won’t want to miss this episode!

Episode 13: Jim Ansara (with Guest Host Rolvix Patterson)

You are sitting at your desk with a paper and pencil. You draw a rectangle on the paper and start looking at it from different angles. It represents the layout of an operating room. You draw a larger box around the inner one. This represents the whole perioperative area. What do you put inside these boxes? How many water stations do you need? Hand washing basins? What about oxygen pipes or electrical outlets? Or back-up generators for the unstable electrical system in the low-resource setting? These are all things Jim Ansara and his team and Build Health International (BHI) are trying to tackle – creating low-cost but robust surgical facilities in places like Haiti. Listen in as we discuss the complex planning that is required for the design, construction, and maintenance of surgical facilities, infrastructure within health systems, and creating sustainable teams (both construction teams and surgical teams!). We are sure you will learn a lot about what goes on behind the scenes in the creation of medical structures and things you should think about as part of the surgical workforce using these facilities – we know we did!

Episode 14: Dr Nadine Hachach-Haram

Imagine you are sitting in a medical tent in a combat zone. You are the military surgeon and a soldier is brought to you with injuries from a bomb blast that you have no idea how to treat. This wasn’t in your training. You have no idea what to do. How do you save this soldier’s limb – or even more importantly – this soldier’s life? Now imagine you are in a rural, remote hospital. A new patient is brought to you with a congenital condition you have never seen before. While you are a surgeon and had extensive training, this is beyond your expertise. They are clearly suffering and their daily life impeded. Do you turn them away? Do you let them suffer the rest of their life? Using the power of artificial intelligence (AI), a team of passionate and dedicated individuals headed by Dr Nadine Hachach-Haram are seeking to make these situations a thing of the past. With even just a small tablet strapped to the side of the operating table, with their technology, surgeons can now use intraoperative video calling to get guidance on unfamiliar cases or to get mentorship and training from experts around the world.

Episode 15: Dr William Bolton and Dr Noel Aruparayil

Laparoscopy is a major breakthrough in surgery. By using gas to inflate the abdomen, surgeons are able to drastically increase their visibility and thus can work through very small incisions to do major abdominal surgeries. The benefits are numerous including smaller scars, quicker recovery, and shorter time to return to work (which decreases lost wages). The problem? It requires a constant supply of carbon dioxide gas to be pumped in.

 

While this is usually not a problem in a high-resource setting, how do you do this in a low-resource context where even electricity is often unavailable? No gas, no problem? This was the thought by Noel Aruparyil and William Bolton. Conventional laparoscopy would never reach rural areas, but by designing a system which would work without gas, it could be a bridge to get healthcare workers trained and patients benefitting from this important technology.

 

 Join us as we talk about innovation in this vital procedure and the process of medical technology as a whole!

Episode 16: Dr Mamy Lalatiana Andriamanarivo

Delivering care in rural areas is one of the hardest challenges of global surgery. Access to necessary medications is difficult and limited, but access to surgery is even harder, forcing many to travel hours on muddy roads through public transport to seek care. Even still, these are the lucky ones. Many never even make it out. Today about 15% of people live in rural areas around the world. In Madagascar however, over 60% of the population lives in a rural area, thus creating unique challenges in access to surgery.

 

As the minister of health for Madagascar, our guest today built dozens of new district hospitals, redirected funds, and even utilized helicopters to expand their reach. A physician himself, he understands the rural barriers and was able to advocate for change in health systems from within the government. Join us as we learn more about Madagascar and the importance of clinicians in non-clinical settings and the impact they can make.

Episode 17: Dr Godfrey Sama

There are many ways to make a difference in people’s lives. Some people do that through medicine. Others through technology. And even others through public health. For our speaker this week, he started as a clinician and has transitioned to a public health specialist. Global surgery requires an army – people from every discipline to come together to create change. One cannot be the master of all trades and expect to get the kind of results that a team of specialists would. One is not a surgeon by him or herself. It requires an interdisciplinary team and people committed to interpersonal communication to make miracles happen.

That is exactly what Dr Godfrey Sama is doing through the MUHAS-UCSF Cancer Collaboration. They are defining new care pathways and challenging the difference between advisory versus advocacy work. We also discuss his work within global paediatric surgery, revealing congenital abnormalities are responsible for almost half a million deaths/year, with 97% of those in LMICs. Join us as we talk about ensuring true collaboration including up-skilling and giving local ownership to both research and data analysis.

Episode 18: Marc DuBois

hu·man·i·tar·i·an: (h)yo͞oˌmanəˈterēən/ = concerned with or seeking to promote human welfare.

 

We often put humanitarian aid as an ideal – but what does it truly mean to be a humanitarian? Is it volunteering one’s time or financial resources to another? Is it only during times of crisis or disaster, or is it at any time? What are the ethics behind the aid and how can the fundamental human right of dignity be ensured or at least strived for?

 

As a field of endeavor, humanitarian aid is unique in many ways. Crucially, it is a sector in which the consumers of the aid are not the people paying for the aid. Traditionally a consumer buys a product and then decides whether they want to buy it again based on the price, quality, and availability of other options. The consumer may even choose to return the product if they are unsatisfied. Humanitarian aid recipients hold no such power; no say as to whether the assistance or services being offered meet their most important needs or even helps them. Aid may also arrive with harmful consequences. This is often due to difficult issues such as paternalism and colonialism that has dominated much of the field for decades. In fact, many of the actions that we took 10 years ago, may not sit well with us today. In this episode we discuss some of the legal and ethical issues behind humanitarian work, power dynamics, and accountability to local people. Join us as we talk with Marc DuBois about his two decades of work with Médecins sans Frontières (Doctors Without Borders), maintaining the political neutrality and independence of humanitarian action, and the many challenges to human dignity in the most inhumane places on Earth.

Episode 19: Dr Pierre Marie Woolley

In a matter of seconds, your world can change. When a 7.0 magnitude earthquake ripped through Haiti in 2010, no one was prepared for the aftermath that would occur. Over a quarter-million people dead, and with 52 aftershocks, the country continued to be hit over and over. As the poorest country in the Western Hemisphere at the time, the country’s infrastructure was brought to a halt and the process of rebuilding was painful. Despite the immense amount of aid that was brought in, efforts were often uncoordinated and lacked local partnerships which impeded the impact made. But as our guest today says, we shouldn’t wait for an opportunity for change, we have to create it – and he is doing just that through medical education, virtual technology, and expansion of the trauma surgical workforce through training of future Haitian surgeons leaders. Join us as we speak with Dr. Pierre Marie Woolley, an orthopaedic trauma surgeon who was on the front lines of providing surgical care during one of the worst disasters ever seen in his country and how the lessons learned in 2010 have been applied in 2020 in the disaster of COVID-19.

Episode 20: Dr Kee Park

Home to 25 million people, North Korea is a world of its own. Insights into the country’s healthcare system are scarce at best, let alone surgical care. This is not the case, however, for Dr Kee Park, a neurosurgeon working with Harvard’s Program in Global Surgery and Social Change and the World Health Organization to support local surgeons in their efforts. Tune in as we discuss innovative, cost-effective computed tomography designs unique to North Korea, neurosurgery in Ethiopia and Cambodia, geopolitical healthcare diplomacy, as well impending funding cuts to the largest global health entity in the world – the WHO.

Episode 21+ --> To be Announced! Stay Tuned!

If you or someone you know is doing something in global surgery you feel should be highlighted in Global Scalpels, we would love to hear from you! We welcome guest interviewers and new ideas. Pop over to our contact page, send us an email, or message us on any of our social media platforms. We would love to hear from you!