My research interests have focused largely on my international work. With projects in Latin American, Ethiopia and Madagascar I became accustomed during my training and early career to traveling abroad, meeting new people, operating in different environments while trying to facilitate educational programs with a goal of building capacity. In 2020, I was lucky to find an academic position that supported these efforts and felt like my efforts were gaining momentum and becoming sustainable. And then COVID hit… Travel stopped, research budgets were frozen, and focus shifted to the crisis at hand. Understandably, global surgery work temporarily took a back seat as we tried to control the pandemic.
Almost a year and a half into this new world, many borders remain shut, making it nearly impossible to return to the countries where I have built partnerships with some incredible surgeons. And yet the disparities in care-whether for communicable or non-communicable diseases- have become only more apparent during this time. It is more important than ever that we work to improve access to care for patients in low- and middle-income countries.
So the question becomes “what can we do?” and I would propose that the answer is quite a bit!
During the last year, our global surgery team has placed an emphasis on research education and capacity building. As operative volumes declined across the world, we took advantage of the time allotted to create and implement a virtual research course for faculty surgeons and residents. The course included 4 hours of lectures and small groups sessions each week, taught by a variety of surgeons and researchers here and abroad. The participants started by identifying an area of interest and the course culminated with each presenting their research question, an explanation of its significance, and a proposed study design- all the makings of a strong ethics board proposal. Participants who completed this task were assigned a mentor to ensure that they had the support needed to complete this process. In the end, about 50% of our students completed the final project, meaning that 10 new surgical research projects were initiated in southern Ethiopia.
The physical distance from this project led to some unexpected benefits. First, the initial plan was for a 3-day in-person course. While there are benefits to being face-to-face it would have led to the participants drinking from the proverbial research firehouse with little time to process the information provided and then independently think through how to apply it to their topic. The slower pace gave them time to do this, all while having access to experts to guide their thought process. This distance also forced a degree of independence in the project ideas and design creation, ensuring that the final proposals represented the interests and ideas of the local participants, not the course directors. It was an exercise in true capacity building as we gave our Ethiopian colleagues the skills and knowledge they needed while cheering them on from thousands of miles and many time zones away.
In the following months, we have been able to apply for grant funding for several of these initial projects, ranging in topics from long-term outcomes of pediatric traumatic brain injury to barriers to screening for breast cancer. We have helped build a department of surgeon researchers who are increasingly independent in their study design and implementation with us helping to secure necessary resources to ensure their success.
I am proud of what we have been able to accomplish this year, making the best out of a difficult situation and adapting in ways that will change the way global partnerships work in the future. But don’t get me wrong, the first opportunity I have I’ll be hopping back on a plane and heading back to work to the people and places I love.
Mary Libby Schroeder, MD, FACS
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