Global Health Sciences

Surgical Workforce

Bellagio Essential Surgery Group

Surgical intervention has recently come to be viewed as an important public health strategy. Historically dismissed as irrelevant to improving the health of the public due to perceptions of being too costly and technology driven, recent work published in the second edition of Disease Control Priorities in Developing Countries challenges those assumptions. Over the last three years, UCSF and GHS have initiated or facilitated projects aimed at improving services on the ground in Uganda as well as taking a broader look at the issue with an international conference at the Bellagio Conference Center.

A conference sponsored by GHS, the Karolinska Institute, and WHO at the Bellagio Conference Center in Italy in June 2007 brought together leaders in surgery, anesthesia, obstetrics, health policy and health economics from Eritrea, Kenya, Malawi, Mozambique, Southern Sudan, Tanzania, Uganda, Sweden and the USA, to examine the situation and to decide what steps would be necessary to increase access to surgical services particularly in rural sub-Saharan Africa. The meeting formed the Bellagio Essential Surgery Group as a platform to raise awareness of the need to increase access by poor communities to surgical technologies. The group also agreed to build some demonstration projects to strengthen district hospitals to provide essential surgical and obstetrical services, and to gather much needed evidence about the incidence and prevalence of surgical conditions and the gap in service provision, and about cost effective strategies to introduce surgical technologies into first referral facilities. Pending funding, some of the planned follow-up activities will be implemented and a long-term multi-country program established.

Bellagio Conference 2007 Report

Leaders in surgery and public health from 11 African countries, Europe and the United States came together in Kampala, July 22-24, 2008, to develop collaborative strategies to increase access to surgical services across sub-Saharan Africa. The meeting was hosted by the Department of Surgery at the University of Makerere and co-organized by Global Health Sciences at the University of California San Francisco on behalf of the Bellagio Essential Surgery Group.

The meeting drew up an urgent call for national and international action to achieve universal access to essential surgical care to address the crisis in surgical services in sub-Saharan Africa. The group recommends:

• Commissioning a careful analyses of country needs and implementing realistic options and innovations that will help to reduce surgical mortality and morbidity
• Improving the competence and motivation of doctors and other staff in peripheral hospitals and health centers
• Expanding the surgical competency base to other health care personnel in order to address the capacity issues, human resource shortages and increased access
• Encouraging educational reforms that inculcate practical surgical skills training as integral parts of basic medical training
• Investing in improvements and expansion of infrastructure and equipment in order to strengthen health care delivery overall
• Implementation of effective strategies to attract and to retain skilled health workers at district levels in order to curb the human resource crisis

See the attached report below for more details.

Bellagio Conference 2008 Report

Contact: Sarah Macfarlane

UCSF-Makerere University (MU) Collaboration

Surgical diseases such as trauma from road traffic crashes and other injuries, malignancies and infections, congenital anomalies, and complications of childbirth are among some of the most common surgical problems in Uganda and impose a huge disease burden for the population. This partnership has evolved over the last four years and encompasses training, clinical care, and research.

UCSF surgery residents and UCSF surgical faculty have visited MU and Mulago Hospital - the national referral hospital - and surrounding hospitals, for weeks to months at a time. The first Ugandan Visiting Surgical Scholar completed a two month visit to UCSF in March-April, 2007. The visit comprised collaborative activities in training and research, including an in-depth evaluation of the San Francisco trauma system through observation at San Francisco General Hospital as part of the trauma service and through time spent in the emergency room and the intensive care unit. In addition, she met with staff of the Injury Center and with health personnel of the San Francisco Department of Public Health to learn more about organization of the Emergency Medical System. While in Uganda, UCSF surgical trainees and faculty have worked with subspecialty surgical services at Mulago Hospital, attended clinical conferences, outpatient clinics, and assisted in elective and emergency operations. UCSF trainees derive many educational benefits from these experiences including the opportunity to see varied surgical pathology often with advanced disease, greater reliance upon clinical examination rather than advanced technology, and adaptability, economy, and creativity in patient care.

The UCSF-MU program includes several collaborative research projects. One ongoing project studies the use of ultrasound in the care of injured patients at Mulago Hospital, a technology that is routine in the US, but absent in Uganda. The project has involved training of Ugandan house officers and faculty in the use of ultrasound with donated machines. A one week training course led by UCSF faculty was conducted in November, 2006. Project PI is Dr. Margaret Knudson

Contacts:
Surgery: Doruk Ozgediz, MD
Anesthesia: Gerald Dubowitz, MD
Orthopaedic Surgery: Richard Coughlin, MD