Academic global surgery has gained significant traction over the last decade, in part due to the Lancet Commission on Global Surgery’s seminal report in 2015 (Meara et al., 2015). This increase in interest has led to many initiatives, and subsequent publications, focusing on providing much-needed surgical care to low- and middle-income countries (LMICs). Pediatric surgery, with organizations such as the Global Initiative for Children’s Surgery, has been one of the most represented specialties (Fowler et al., 2022). But how does a busy pediatric surgeon become an academic global pediatric surgeon?
This question has long been something I have struggled with. As an immigrant with strong ties to my home country, I have always wanted to bring the decades-worth of surgical training far beyond the reach of my American medical institutions. But as I began the search for my first attending position three years ago, my dreams of being able to split my time with the hospital and abroad were quickly discouraged. The COVID pandemic was still straining hospital systems, making administrators unwilling to support a surgeon who would not be fully operating within their system. Not to mention, COVID outbreaks made planning such trips difficult. At the end of my search, I happily landed in a position closest to my dream job, a pediatric colorectal surgeon in an academic hospital.
The itch to pursue academic global surgery, however, never dissipated. While using my vacation time, I embarked on a pediatric colorectal surgery mission trip to Mwanza, Tanzania with my mentors from Cincinnati Children’s Hospital Medical Center which was supported by the non-profit Mending Kids. During this trip, I performed multiple colorectal procedures alongside surgical trainees in Mwanza, and the experience was nothing like I imagined. While we, the surgeons, were in the operating room, our team of nurses were directing bowel management for patients who had received their definitive colorectal procedure during a prior mission but required assistance with stooling. Some of these patients were among those whom our team encountered during their first mission 8 years ago, and while they were certainly improved from a surgical standpoint, they still needed continued surveillance and management for proper stooling. It is precisely this long-term relationship with these pediatric colorectal patients that drew me to the subspecialty in the first place.
Bowel management is a unique and necessary component of the care of pediatric colorectal patients. These are children with Hirschsprung’s disease, anorectal malformation, and spinal differences who, despite surgical correction, require continued modifications for stooling. Often, bowel management involves the titration of laxatives, and enemas, or offering surgical procedures to foster independence in growing children. So much of our practice as surgeons is focused on how to provide, and train how to do, the surgery, but my recent trip reminded me how much we also need to figure out how to care for patients after the surgery. In cases like my patients, post-surgical care is lifelong, particularly during transitions in childhood that affect stooling, such as potty training and school attendance. While time-intensive, bowel management requires tools that are accessible in LMICs such as x-rays and foley catheters. In one of the few ways that the COVID pandemic has changed medicine, telehealth programs are now more universally accepted. Bowel management can be formatted on a telemedicine platform and has been proven to be effective(Lopez et al., 2022). In fact, I already use telehealth in my practice for patients who live too far from our center.
While I continue to work on garnering institutional funding for my academic global surgery pursuits, I have been able to find other avenues towards this goal that do not necessarily involve multiple months away from my home institution. For example, our group has embarked on surveying current bowel management practices in LMICs. The study will not only be informative but will also serve as the stepping stone towards building a telehealth platform for bowel management, such that children everywhere can be helped to stool better through a network of pediatric colorectal surgeons. These efforts do not require prolonged time away from clinical practice but do demand creativity and collaboration with our surgical partners around the world. It is precisely this kind of partnership that fuels successful academic global surgery efforts.
References
Fowler, Z., Dutta, R., Kilgallon, J. L., Wobenjo, A., Bandyopadhyay, S., Shah, P., Jain, S., Raykar, N. P., & Roy, N. (2022). Academic Output in Global Surgery after the Lancet Commission on Global Surgery: A Scoping Review. World J Surg, 46(10), 2317-2325. https://doi.org/10.1007/s00268-022-06640-8
Lopez, J. J., Svetanoff, W. J., Rosen, J. M., Carrasco, A., Rentea, R. M., & Comprehensive Colorectal Center of Children’s Mercy Hospital, K. C. M. O. (2022). Leveraging Collaboration in Pediatric Multidisciplinary Colorectal Care Using a Telehealth Platform. Am Surg, 88(9), 2320-2326. https://doi.org/10.1177/00031348211023428
Meara, J. G., Leather, A. J., Hagander, L., Alkire, B. C., Alonso, N., Ameh, E. A., Bickler, S. W., Conteh, L., Dare, A. J., Davies, J., Merisier, E. D., El-Halabi, S., Farmer, P. E., Gawande, A., Gillies, R., Greenberg, S. L., Grimes, C. E., Gruen, R. L., Ismail, E. A., . . . Yip, W. (2015). Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet, 386(9993), 569-624. https://doi.org/10.1016/S0140-6736(15)60160-X
Irene Isabel P. Lim-Beutel, MD, MPH
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