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Is the world of Global Surgery too exclusive?

Updated: May 15, 2019

One of the five key messages delivered by the Lancet Commission on Global Surgery is that to reach a minimum operative volume of 5000 surgical procedures per 100 000 population by 2030, urgent and accelerated investment in human and physical resources is required. As the future consultants and surgical leaders, it is widely agreed that trainee involvement is crucial in order to reach this target.

The ethics of how best to support and encourage trainees to do this was discussed at the GASOC Journal Club meeting in February (click here for a link to the highlights!). One of the featured papers was Mohan et al’s “Engagement and role of surgical trainees in global surgery:

Consensus statement and recommendations from the Association of Surgeons in Training”. It was felt by the journal club attendees that while the methods of reaching such a consensus may have been dubious, there were some excellent points raised…Consensus statement and recommendations from the Association of Surgeons in Training”. It was felt by the journal club attendees that while the methods of reaching such a consensus may have been dubious, there were some excellent points raised…

One of the paper’s recommendations was for the creation of low-cost, trainee-focused courses dedicated to preparing individuals for overseas placements. A few google searches reveals the cost of courses currently available:

• The London School of Hygiene & Tropical Medicine offers the Professional Diploma in Tropical Medicine & Hygiene (DTM&H); an intensive, three-month, full-time course in tropical medicine and public health for physicians. It costs £6,600, or £7,575 if you want to do it in East Africa

• The Liverpool School of tropical medicine three-month diploma costs £6000

• The university of Glasgow offers a diploma in tropical medicine and Hygiene which consists of a distance learning course set over 7 months with two full time teaching weeks. It costs £2400, with an additional £229 required for the exam

• The Royal College of Surgeons of England runs a course entitled “Surgical Training for Austere Environments”. It is a five-day course run partly in Manchester and partly in London. Although there is no date advertised currently, you can register your interest. .The cost is not advertised but considering a two-day practical course with the college such as the Damage Control Orthopaedic Trauma Surgery (DCOTS) costs £1199, it is perhaps unlikely to be easily-affordable.

• The five-day Global Surgery course at the University of Oxford costs £1200.

Of course venues need to be hired, administrative staff need to be paid and the upkeep of relevant learning resources requires funding. Some courses also use the fees from students of high-income settings to pay for scholarships for students from low- and middle-income countries (LMICs).

These courses therefore do not end up being low-cost and although they are undoubtedly worth every penny, this will not help surgical trainees who might not have a penny to spare. Anaesthetic, Surgical and Obs&Gynae trainees are undoubtedly used to spending a proportion of their income on training, but trainees who are preparing to work in LMICs may feel particularly short of cash if they are in anticipation of giving up a paid job to do so.

With some digging and considerable effort filling in application forms, there are bursaries available. But there is clearly an ongoing requirement for financially accessible training. Liverpool is in the process of creating a one-day primary trauma care pre-deployment course for only £150, but it is currently only available for those already undertaking their tropical medicine diploma. Hopefully this will change soon… and we will keep an eye out for when this might be.

GASOC strives to promote the sharing of medical knowledge and experience to improve surgical equity in LMICs. Let’s not forget that whilst overseas placements may be useful in reaching our goals, plenty can be done from here in the UK. We can promote global surgery research and advocacy without getting on a plane.

As an aside, it might not just be money that jeopardises the collaborative, inclusive nature of Global Surgery. Check out the latest BMJ Global Health blog post by Bentounsi and colleagues: “Global Surgery doesn’t belong to the English Language”. It is a thought-provoking look at how the knowledge synthesised by the global surgery community can exclude policy makers, researchers and research participants who do not speak English. It offers some excellent, straight-forward solutions.

As the next generation of healthcare leaders, creating affordable, accessible training should be something we advocate for, or arrange ourselves. If a course or qualification eventually becomes a pre-requisite for trainees to attain before travelling to LMIC settings, we need to do our best to ensure it is not prohibitively expensive.

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