Research for Greener Surgery Conference 2024
What better way to wrap up 2024 than an inspiring conference?
In December, we hosted our Research for Greener Surgery Conference at the University of Birmingham, inspiring 400+ UK and international clinicians and academics to make surgery more sustainable. It was great to gather and discuss the latest research advancements in the field, from reusable drapes and gowns to, clean energy for healthcare, sustainability across the patient pathway, reducing the environmental impact of anaesthesia and many more.
A prominent theme across the conference was the need to enforce change and the small ways in which we could make a large impact. Research shows positive changes are taking place – however, there is room for improvement as clinicians, academics, and patients, and events like these offer a unique platform for engagement, dialogue and shared learning.
A highlight from the event was the address from Dr Adewale Adisa, Professor of Surgery from our NIHR(National Institute for Health Research) Global Surgery Unit, Nigeria Hub who spoke about the launch of a world-wide campaign to raise $100 million to equip 100 hospitals across the Global South with secure, clean energy that will help them maintain vital health services and save lives. Obafemi Awolowo University Teaching Hospital Complex, Nigeria, have been chosen as a pilot site for the initiative. Adewale expressed his excitement and encouragement to be involved with the project.
It was remarkable to see multiple networks communicating in the same space and sharing their innovative way to make surgery more sustainable. In his final remarks, University of Birmingham Professor Aneel Bhangu said “we are a community with power”. We hope this resonates with all that were in attendance and look forward to continuing to work together to advance sustainability within surgery.
GSU Hosts Webinar on Implementing Community Engagement in the Global South
The Global Surgery Unit (GSU) hosted a webinar on the 5th of November 2024, on delivering Community Engagement and Involvement (CEI) across multiple settings.
During this event, GSU presented three case studies of how it made its research relevant to local communities. The first case study involved patient and carer input in the design of TIGER- an inguinal hernia trial repair that aims to task-shift this procedure to non-surgeon physicians such as GPs in Ghana. You can read more about these findings here and here.
The second case study involved upskilling community health workers on the early signs of cancer in India and surgical site infections in Rwanda. Finally, the third case study involved a discussion on the development and implementation of the GSU patient and community education toolkit.
The event was hosted by the Unit’s funders, the National Institute for Health and Care Research (NIHR), and co-presented by RESPIRE, a global health research group on respiratory health based at the University of Edinburgh.
If you are interested in knowing more about CEI as it relates to global surgical research, you can access our free, self-guided online course HERE.
Community Engagement Focus Shines at Benin Hub Surgical Conference
Community Engagement and Involvement (CEI) took centre stage during the 2nd day of the Second Beninese Surgical Conference, held from August 19-21, 2024 at Millenium Popo Beach Hotel in Agoué. Organised by the GS Benin Hub in partnership with the Beninese Society for Surgery and the Beninese Society of Paediatric Surgery, the session aimed to enhance the capacity of local CEI groups and key stakeholders in promoting effective community participation in health initiatives.
The CEI session focused on training local community representatives on CEI principles, methods, and tools. The goal was to equip them with the skills to mobilise their communities effectively for health studies and projects such as Project REACH (REsources for surgical cAre training of Community Health workers), a program designed to disseminate community and patient educational resources on surgical site infections (SSIs). Additionally, the session sought to establish a National CEI Steering Committee to coordinate and harmonise community mobilisation efforts nationwide
A total of 93 participants from various backgrounds, including surgeons, gynaecologists, medical residents, general physicians, community members and students, attended the session. International attendees from Senegal, Martinique and Mali were also present.
A delegation from Rwanda, comprising the National CEI Lead and the International Patient Representative, enriched the discussions with their valuable insights and experience on community health worker training.
Key outcomes of the CEI session included:
- Enhanced capacity of Local CEI Groups: Members gained a deeper understanding of CEI principles and tools, strengthening their ability to mobilize their communities.
- Clarified roles and responsibilities: The National CEI Committee's functions were clearly defined, ensuring effective coordination of CEI initiatives at the national level.
- Establishment of the National CEI Committee: A representative committee was formed to coordinate and harmonize community mobilization efforts.
- Shared experiences and best practices: Participants benefited from the Rwandan delegation's insights into community mobilization and the REACH project, providing valuable lessons for Benin.
The session was a significant step towards CEI capacity building in the country. By equipping local groups with the necessary skills and establishing a National CEI Steering Committee, the Benin Hub has laid the foundation for more inclusive and effective community involvement in future projects.
Benin Hub Expands CEI Network
The GSU Benin Hub has successfully expanded its Community Engagement and Involvement (CEI) network by establishing groups in two partner hospitals, aiming to strengthen local healthcare capacities and improve patient outcomes through targeted education programs.
The CEI expansion began with visits to Klouékanmè District Hospital on 24 June and Hôpital de zone de Dassa-Zoumè on 26 June. These visits attracted diverse attendees, including hospital staff, qualified community health workers (QCHWs), and patients, totalling 44 participants across both locations.
The initiative's central focus involved training attendees on the fundamentals of CEI in global health research, focusing on preventing surgical site infections, understanding the patient's surgical journey, and managing post-operative wounds. These participatory sessions were conducted in local languages (Fon, Adja, and Idatcha) to ensure comprehensive understanding, particularly among patient representatives.
A pre-training assessment revealed a significant knowledge gap, with 93% of participants initially unaware of the CEI concept. Post-training evaluations showed a dramatic improvement, with 82% of participants indicating a clear understanding of CEI principles and their practical applications in healthcare settings.
At each site, a core CEI group was formed comprising five democratically selected individuals. These groups are tasked with continuing the work of educating and involving the community in health research initiatives, enhancing local healthcare delivery, and fostering a collaborative environment between healthcare providers and the community.
Community sensitisation efforts on wound care and surgical site infections (SSIs) were also done. This included showing participants an animated SSI prevention video in French. Visual aids such as leaflets and posters were also shared with the group. The focus on practical, relatable content helped demystify medical procedures and post-operative care, encouraging better health practices within the community.
The session was received enthusiastically by attendees, who expressed a keen interest in the topics covered and a commitment to future CEI activities. The establishment of local CEI groups is expected to facilitate ongoing education and support such as translation of the SSI animated video in local languages.
Mexico Hub Community Engagement Roundup for June-July 2024
The GSU Mexico Hub has made strides in community engagement through a series of five educational events conducted in June and July 2024. These initiatives, aimed at different groups, focused on critical health topics such as heatstroke, addiction prevention, hepatitis, and surgical wound care, reinforcing the hub’s commitment to public health and safety.
On June 7th, GSU Mexico Hub held its first event at SEMPRA, a leading oil company, addressing the increasing concern of heatstroke, particularly relevant given the recent heatwaves affecting Veracruz. The session, attended by 32 staff members, emphasised the importance of early recognition and intervention to prevent fatalities. Practical demonstrations equipped employees with the skills to handle heatstroke incidents, prompting a follow-up invitation due to positive feedback. A subsequent training on June 27th at SEMPRA delved deeper into heatstroke management, showcasing new equipment acquired by the company, such as ice packs and fans. This session highlighted the significance of immediate action and proper use of the equipment in preventing severe outcomes. The interactive session featured case studies and simulations, fostering a proactive safety culture among the 30 attendees.
On June 19th, the focus shifted to addiction prevention at the Veracruz branch of NUVOIL- another oil company, with 20 staff members participating. The training covered the nature of addiction, risk factors, and prevention strategies. Engaging activities and discussions underscored the importance of early intervention and the availability of support systems, enhancing the company's supportive work environment.
SEMPRA hosted another significant event on July 5th, focusing on hepatitis awareness. This session educated 30 employees on the various types of hepatitis, transmission methods, and preventive measures like vaccination and hygiene practices. The interactive format encouraged participants to adopt healthier lifestyles and reinforced SEMPRA's commitment to employee health.
The final event, held on July 10th at Hospital Español de Veracruz, targeted 15 undergraduate medical interns. The training provided crucial insights into surgical wound care and infection prevention, enhancing the interns' ability to manage postoperative care effectively. This initiative aimed to improve patient outcomes through better-trained healthcare providers.
Benin Hub Community Engagement Immersion Visit to Rwanda
Members of the GSU Benin Hub visited the GSU Rwanda Hub from 8-12th July 2024, to learn about community engagement and involvement (CEI) practices.
The visit focused on Project REACH (REsources for surgical cAre training of Community Health workers), a program designed to disseminate a community and patient education toolkit on surgical site infections (SSIs) in two districts: Kacyiru, located in Kigali, and Rwamagana in the Eastern Province. The Benin team also met with the Rwanda National CEI Steering Committee to discuss strategies for enhancing community involvement in promoting surgical care and research.
Project REACH aims to train community health workers (CHWs) on recognising and managing symptoms of surgical site infections (SSIs). CHWs, often unpaid volunteers trusted by the community, play a critical role in healthcare, especially in remote areas where hospital access is limited. These volunteers typically have basic literacy skills and serve as the first point of contact for health issues in low-to-middle-income countries.
The project involves an initial assessment of CHWs' knowledge about SSIs, followed by a training session led by the local research team. Immediately after the training, another assessment is conducted to gauge understanding. A final assessment occurs 3-6 months later to measure information retention.
As a community-driven research project, CHWs are consented to the study, and assessed by senior CHWs. This process includes Hub-directed training of senior CHWs on the research protocol, guiding them through informed consent forms, addressing participants' questions, and using data collection software for assessments.
The visit concluded with the Benin Hub presenting its observations, recommendations, and future plans to the Rwanda Hub.
New CEI Updates Published in Impact Surgery
Our Community Engagement and Involvement (CEI) teams across our partner countries have recently published updates of their work in the journal Impact Surgery.
The GSU Benin Hub reported on patients’ perceptions of anaemia, pre-operative iron treatment and blood transfusion in preparation for an upcoming trial. You can read the article here.
The GSU Ghana Hub looked into the patient acceptability of a quality-of-life tool for our TIGER trial which aims to task shift inguinal hernia repair to non-surgeon physicians. Patients were also asked to advise researchers on the best participant recruitment strategy. Read the report here.
The GSU India Hub discussed their experience training female community health workers (also called ASHAs) in the Punjab region on various surgical care topics such as surgical site infections (SSIs), early cancer detection and stoma care. Read the report here.
Similarly, the GSU Rwanda Hub write about their work training community workers in representative urban and rural settings on SSI detection and wound care. Read the report here.
Finally, the GSU Mexico Hub based in Veracruz reports on the various community outreach activities conducted in the last few months including talks at health fairs and schools. Read the report here.
Cite these papers:
I Lawani, YI Souaibou, JB Gnele, S Lawani, C Bokossa, C Fadonougbo, et al. Community consultation in a regional hospital in the Republic of Benin to co-develop the PUMA randomised trial. Impact Surgery. 2024;1(3):102-104. Doi: https://doi.org/10.62463/surgery.55
S Tabiri, NB Sam, E Amofa. Co-developing research for inguinal hernia repair in Ghana. Impact Surgery. 2024;1(3):98-99.Doi: https://doi.org/10.62463/surgery.68
Suroy, A., Jain, D., Gulrez, A., Kaur, A., Shukla, P., Mathai, S., Ghosh, D. Transforming Health Advocate Initiatives in Punjab and beyond through surgical community engagement. Impact Surgery. 2024;1(4):158-161. Doi: https://doi.org/10.62463/surgery.7
Munyaneza, E., Umutesi, V., Muhawenayo, E., Mwungura Ngabo, E., Nshumuyiki, J., Imanishimwe, A., ... Ntirenganya, f.. Surgical Site Infection Prevention Training of Community Health workers in Rwanda. Impact Surgery. 2024;1(4):161-162. Doi: https://doi.org/10.62463/surgery.78
LMP Maldonado, NO Borrell, NMF Ortega, CO Brenis, ID Sanchez, APG Duran, et al. Report of Surgical Community Engagement in Veracruz, Mexico. Impact Surgery. 2024;1(3):100-101. Doi: https://doi.org/10.62463/surgery.63
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: https://surgicalrisk.app/
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.