Rwanda Hub Hosts Conference on Enhancing Surgical Care through Community Engagement

On the 18th of May 2024, the NIHR GSU Rwanda Hub, supported by the Rwanda Ministry of Health, Rwanda Surgical Society (RSS), Operation Smile, Medical Military Insurance Rwanda, Pyramid Pharma, Ejo Heza Surgical Center, and Lifebox, held a pivotal Scientific Conference at Lemigo Hotel, Kigali. This event marked the culmination of a week-long surgical outreach program and was centred around the theme: “Community Engagement and Involvement: A Walk Towards Sustainable Surgical Ecosystem.”

The conference opened with an address by Professor Faustin Ntirenganya, the Hub Director, who provided an overview of the surgical outreach activities conducted in honour of Kwibuka 30, commemorating the Rwandan Genocide of 1994. This initiative was a significant community engagement effort by the RSS to bridge the gaps in surgical care across Rwanda. He then introduced Dr. Corneille Ntihabose, the Head of Clinical and Public Health Services at the Ministry of Health, who officially inaugurated the conference.

Dr Ntihabose commended the RSS for their remarkable efforts and emphasised the critical need for enhanced surgical care in Rwanda. He outlined the Ministry's recent reforms, which included the expansion of public hospitals with surgical theatres, procurement of advanced medical equipment, and the improvement of surgical procedures' valuation by various medical insurance schemes. He reaffirmed the Ministry's commitment to ongoing collaboration with the RSS to facilitate nationwide surgical outreach initiatives.

Mr. Emmanuel Munyaneza, the National Coordinator for Community Engagement and Involvement (CEI), emphasised the crucial role of community involvement in healthcare initiatives. He explained that CEI ensures patients and the broader community are active participants in healthcare research, not just data sources. Munyaneza highlighted successful CEI projects, including Project REACH (REsources for surgical cAre training of Community Health workers), which trains community health workers on post-surgical care and surgical site monitoring using locally developed teaching materials. He introduced the Rwanda National CEI steering committee, composed of selected community members from various GSU Rwanda research sites. This committee oversees and advises the research team on best practices for engaging with the community in their research.

A series of panel discussions followed, focusing on collaboration with professional bodies. Dr Ntihabose noted the positive impact of surgical outreaches on reducing surgical case backlogs but stressed the need for better organisation. Prof. Ntirenganya emphasised the empowerment of professional bodies and the establishment of a coordination system for efficient collaboration. Mrs. Viviane Umutesi- a community member and co-chair of the National CEI steering committee, underscored the importance of a unified understanding among stakeholders and the decentralisation of surgical care to the grassroots.

Mr Munyaneza concluded the discussions by highlighting the distinctions between participation, engagement, and involvement, stressing the need for genuine involvement in surgical decision-making processes. "Community members should always be present at the table where decisions are being made," he insisted.

GSU-Pulmonary Score - a new model published in The Lancet Digital Health

A new model has been published in The Lancet Digital Health: A prognostic model for use before elective surgery to estimate the risk of postoperative pulmonary complications (GSU-Pulmonary Score): a development and validation study in three international cohorts

The publication can be read here: The Lancet Digital Health, Volume 6, Issue 7, 2024,

The GSU-Pulmonary Score is a novel prognostic risk score that aims to estimate the risk of postoperative pulmonary complications in adults undergoing elective surgery, based on ten preoperative variables routinely accessible in preoperative settings. It was developed as a collaboration between the NIHR Global Surgery Unit, STARSurg Collaboration and HDRUK, the UK's foremost health data science research network.

The model was derived from a prospective international dataset of 86 231 patients from the SURG-Week study, and discrimination and calibration were explored in two external prospective datasets of 37 281 patients in total (STARSurg: RECON, and CovidSurg-Cancer). It can now be implemented in individual risk assessment for patient prioritisation and resource management during the ongoing COVID-19 recovery period. It will support front-line clinicians and policy makers to safely scale capacity for elective surgery to address growing waiting lists around the world.

The live model is available at:

We would like to thanks all collaborators involved in this project, and we hope this tool is useful to you in the future!

Vibrant May in Veracruz: Mexico Hub Community Engagement Highlights

The NIHR Global Surgery Unit Mexico Hub reached out to communities by holding three engagement events in May 2024.

On the 14th of the month, the Hub visited Grupo Reto, a support group for women battling breast and cervical cancer. There, they tackled the crucial topic of breast cancer and nutrition. The informative session explored how a balanced diet can bolster the immune system, enhance the quality of life for patients, and even mitigate side effects from treatment. The Hub debunked common myths surrounding cancer and nutrition, providing evidence-based information.

Shifting focus on the 15th, the Hub delivered a talk at Tec Milenio University, addressing a crucial public health issue – the impact of e-cigarettes on health. Engaging with 30 students aged 17-18, the Hub discussed the risks associated with these devices. Through open dialogue, they explored the detrimental effects of e-cigarettes on the lungs, heart, and other vital organs.  To emphasise the urgency, they conducted a live experiment – performing electrocardiograms on 10 professors before and after using e-cigarettes. The revealing results were a stark reminder of the immediate impact on the cardiovascular system. The interactive session fostered an open discussion environment, with students actively questioning and engaging with the presented information. 

Finally, on the 17th, the Hub celebrated Mother's Day at Lomas Residencial- a housing development in Veracruz. Here, they empowered 20 women with vital knowledge about breast cancer awareness. The session highlighted the importance of early detection and noting early warning signs of the condition. Recommended screening tests like mammograms and ultrasounds were also discussed.

A crucial aspect of the session involved teaching participants how to perform self-examinations. The Hub ensured attendees felt confident conducting these examinations at home through detailed instructions and demonstrations. The interactive format allowed for questions and clarifications, promoting understanding and accessibility of the information.

GSU Mexico Shares Expertise, Wins Hearts at Mexican Childhood Cancer Association

Staff from the GSU Mexico Hub recently visited the Mexican Childhood Cancer Association (AMANC) in Veracruz on 27 March 2024 to deliver a wound care workshop for families battling childhood cancer.

The session, aimed at 15 paediatric patients and their parents plus 5 members of staff, focused on identifying common causes of household wounds.  This was especially important as many of the attendees were children with cancer who face wound care challenges daily.

Following the theoretical discussion, the workshop transitioned into a practical demonstration with attendees learning proper wound treatment techniques.  The event's highlight was a raffle for five first-aid kits, with the young people actively participating and demonstrating their understanding of wound care practices.

The session concluded with information on the care of chemotherapy catheters to recognise warning signs for seeking immediate medical attention.  The rapt attention from both children and parents underscored the importance of such knowledge for navigating the daily realities of childhood cancer. It was touching to see everyone paying attention to these important aspects, aware of the reality that children and parents of children with cancer face.

The success of the event has led to an invitation for the GSU Mexico Hub to return for future sessions to focus on topics like diabetes and hypertension. It is envisioned that these sessions will offer valuable health information to paediatric cancer parents who are selflessly dedicated to their children's well-being, often at the expense of their own health.

Mexico Hub Community Event Educates on Wound Care

In a bid to empower patients, the GSU Mexico Hub held a community engagement event at the DIF Ruiz Cortines Community Centre, Veracruz on wound care and infection prevention on 22nd February. Dr. Carolina, a dedicated research physician, spearheaded the informative session aimed primarily at the elderly demographic within the community.

The event, attended by 70 people, commenced with an insightful inquiry into the common remedies employed by attendees for wound healing at home. Many disclosed the use of potentially harmful substances like laundry detergent, eggs, and even urine. Such practices, though prevalent, were underscored as detrimental to skin health.

Dr Carolina delved into essential aspects of wound management, highlighting crucial warning signs indicative of infection. Through a meticulous step-by-step demonstration, attendees were equipped with practical skills for effective wound care.

As part of the interactive segment, eight wound care kits were raffled off to attendees. The session culminated in a vibrant Q&A segment, fostering an open dialogue on wound management strategies. Participants also expressed a desire for future sessions covering topics such as diabetes management and pressure ulcer care. Such feedback underscores the pressing need to further educate this demographic on preventive healthcare measures.

EAGLE 2 has launched!

Following on from publication of the EAGLE study last year, we are pleased to announce the launch of EAGLE 2.

Register your hospital

EAGLE 2 will be a snapshot audit of patients undergoing right sided bowel anastomosis, but restricted to units who undertake the EAGLE online training. This training may have already been done (as part of the first EAGLE study), or surgeons in your team may complete it between now and May 2024. A key finding from the EAGLE study was that in centres where most surgeons undertook the training, the anastomotic leak rate fell by almost 50%. We need your help to grow engagement across as many hospitals as possible, so we can validate this finding. EAGLE 2 will be open to hospitals who participated in the original EAGLE study as well as new hospitals.

Units who undertake the EAGLE online training (either as part of ’EAGLE’ or between now and May 2024) prior to data collection can take part. The anticipated audit period will be May/June 2024. Results will be presented at ESCP 2024 in September, and published later this year.

View the training platform

You can find out more about the EAGLE study in the below video:

If you have any questions, please contact the team.

GSU awarded additional funding for Community Engagement activities

The Global Surgery Unit was recently awarded additional Official Development Assistance (ODA) funding from the University of Birmingham and UK Research and Innovation to increase already existing community engagement activities across its Indian and Rwandan research Hubs.

The funding for the India Hub will be used to expand training for local ASHA community health workers (CHWs) on surgical wound management, stoma care and early cancer detection. According to the World Health Organisation, CHWs are healthcare providers who live in the community they serve and receive lower levels of formal education and training than professional healthcare workers such as nurses and doctors. They are key players in addressing the health needs of remote and marginalised low-to-middle-income (LMIC) country settings but traditionally have yet to have a role in post-surgical care. The funding will also be used to disseminate the recently co-developed patient education toolkit co-developed. Since last year, the India Hub has been engaging with ASHA workers and registered medical practitioners in different cities such as Ludhiana, Kolkata and Vellore which garnered the attention of the Punjab Civil Surgeon who tasked the Hub to train an additional 2,000 ASHAs.

On the other hand, the Rwanda Hub will be using its additional funding to expand on PIGEON (ImProving surgIcal care outcomes throuGh the active involvEment of cOmmunity in RwaNda)- a mixed method study that will initially scope CHW’s knowledge of surgical care and co-develop with them an intervention focused on improving surgical care outcomes through the active involvement of CHWs in both rural and urban regions of the country.

ODA is UK government aid that promotes and specifically targets the economic development and welfare of LMICs. Funding is provided through the International Science Partnerships Fund (ISPF) Institutional Support Grant (ODA), funded by Research England, Grant Reference: RE-CL-2023-09.

Community Talks Address SSIs and Smoking Cessation in Kolkata and Vellore

In a bid to promote healthcare awareness and foster essential knowledge among healthcare professionals, a community engagement talk organised by the GSU India Hub, attended by 40 paramedic trainees was held at the School for Skills in Allied Health Sciences, Sonarpur, Kolkata, India on October 31, 2023. 

The talk encompassed an array of crucial topics, including the awareness of surgical site infections (SSIs), wound care at home, recognizing the signs and symptoms of SSI, and the proper management of wound care in a home setting. Furthermore, it highlighted the significance of hand hygiene and the timely change of gloves during wound care procedures.

The interactive session provided a platform for the paramedic trainees to raise queries and concerns regarding the correct use of gloves while handling patients in both hospital and community settings. Questions such as the duration for which gloves can be worn and when to change gloves were addressed, ensuring that these future healthcare professionals are well-prepared to maintain rigorous hygiene standards.

Another event was previously held at the Christian Medical College & Hospital in Vellore on October 27, 2023, catering to 35 patients and their caregivers. The event aimed to create awareness about carcinogens in tobacco products and the importance of smoking cessation.

The talk, delivered in English, Tamil and Hindi, covered various aspects of smoking, including its effects, withdrawals, triggers, risk factors, addictive nature, and the toxic components ingested while smoking. Furthermore, it delved into methods to quit smoking and discussed challenges encountered during cessation, such as withdrawals and triggers.

The outcomes of the session were highly positive, with attendees gaining a deeper understanding of the adverse effects of smoking and the significance of quitting the habit. Many patients were previously unaware of carcinogenic smoking and cessation, highlighting the importance of such community engagement talks.

WOLVERINE Unleashed!

The launch webinar for the latest ESCP audit and cohort study ‘WOLVERINE’ took place on 07th November. The aim of this study is to conduct a prospective cohort study and audit in wound closure and SSI prevention following abdominal surgery.


Panel Discussion

Amongst the panellists were GSU hub representatives from Ghana (Prof. Stephen Tabiri, Dr Napoleon Bellua Sam) and India (Dr Parvez David Haque).

WOLVERINE has 2 recruitment periods;

  • Period 1: 01st November 2023 to 15th December 2023 (audit only)
  • Period 2: 02nd January 2024 to 31st March 2024 (audit + elective cohort study)

Patient recruitment for the period 1 audit is now underway and you can register your centre to join here. More than 160 centres have already registered to participate.

If you have any questions please contact

Project Lion Cost Analysis

New Publication: A Prospective, Observational Cost Comparison of Laparoscopic and Open Appendicectomy in Three Tertiary Hospitals in Nigeria

We are pleased to share our latest publication in the World Journal of Surgery from Project LION, which was led by Dr Adewale Adisa at the NIHR Hub in Nigeria.

This study compared the outcome and cost of conventional open and laparoscopic appendectomy for clinically confirmed, uncomplicated, acute appendicitis in a low resource setting. Although the cost effectiveness of laparoscopic surgery has been investigated previously in high human development index (HDI) countries, similar studies are lacking in low and middle HDI countries.

The publication can be found on the following link:

Studies- GSU - Lion