Global Scalpels: A Global Surgery Podcast

What happens when a scalpel meets the unexpected? In this episode, we journey into the heart of global orthopedic surgery, where late-presenting cases, resource scarcity, and cultural nuances redefine the art of healing. We are joined by none other than Dr. David Spiegel as he discusses the challenges and triumphs of treating complex musculoskeletal conditions in austere settings over the last several decades - emphasizing the importance of adaptability and collaboration. From crafting a practical textbook for surgeons in the field to navigating the intricacies of low-resource environments, this conversation offers a behind-the-scenes look at orthopaedic care in various settings. From pioneering new surgical techniques to fostering research and education, Dr. Spiegel’s work continues to inspire the next generation of surgeons and advocates for equitable care.

In this episode of Global Scalpels, we dive into the complexities of delivering surgical care across different healthcare systems. We explore what it truly means to be a surgeon in a world where protocols, resources, and even antibiotics are far from universal. From Malawi to the UK and beyond, our expert guests share eye-opening stories on resourcefulness, teamwork, and cultural adaptation in global surgery. Discover why a Foley catheter is never just a Foley catheter, how surgical hierarchies can hinder progress, why being open-minded is the key to sustainable impact and why the best surgeons aren’t just skilled with their hands—but with their ability to learn, unlearn, and adapt. This episode is packed with insights, humor, and lessons that transcend borders. Tune in now!

Each surgical subspecialty has unique sets of challenges when performing their specific procedures. In plastic surgery, procedures for complex burns, hand injuries, and congenital deformities can require tissue/skin graft preparation and microscopic reapproximation. These challenges are only exacerbated when resources are limited - both in terms of personnel and materials. Meet Dr. Metasebia Abebe, the first female plastic surgeon in Ethiopia and one of only a few specialists in her country where there are more than 1 million people per plastic surgeon! Join us as we discuss the complex care involved in treating hyena bites, the effects of climate change, and international fellowships for LMIC surgeons. This is one episode to remember!

Leaving behind everything to escape war, persecution, or even natural disaster poses its own unique challenges. Forced relocation is difficult, creating a unique set of problems including housing, food, finances, and importantly, healthcare. Accessing these resources as a refugee is extremely difficult and uniquely convoluted. Refugee camps seek to be a safe haven for these underserved populations but pose their own unique challenges as well. With limited resources, experts like Dr Zachary Enumah are fighting to help provide essential healthcare in these settings, most recently in Tanzania. With over 500 live births per month, OBGYN services are vital to life, including c-sections and other emergency surgical services. Strategies to allocate funding, work with public health officials, and coordinate with medical boards to expand care are difficult but essential. Join us in this exciting episode with guest host Ashwin Reddy as we discuss the medical ethics behind care delivery in the camp, e-health to facilitate access, referral systems, and preventative strategies currently being deployed by Dr Enumah and his team!

Delivery of surgical services in low-resource settings is extremely difficult. Supply chain issues, funding, shortages of supplies, and even lack of healthcare professionals are each enormous hurdles in and of themselves. What about when civil conflict arises and a war begins? Increases in different types of injuries start to plague the already fragile system. How does one get life-saving supplies via the already scarce supply chain when roads have been taken out by bombs or blocked by military personnel? Doctors, nurses, and support staff, all risking their lives each day just to show up and provide care. Join us with guest host Ala Magzoub as we talk with Dr. Shahrzad Joharifard about her work in the Democratic Republic of the Congo during civil conflict and the unique challenges inherent to surgical delivery in this space. In this robust episode, we also learn about anti-racism and helping people to self-identify racist, sexist, or homophobic actions and comments. As a healthcare team, safe and conscientious spaces are vital to the delivery of surgical services and each of us can do our part to encourage these practices from ourselves and others.

When we discuss global surgery, we often focus on the physical workforce that it takes to support a patient through their surgical needs. The other side of this process is the digital or mechanical support that makes surgery all possible. It is easy to take for granted the countless computers, x-ray machines, ventilators, and more. We often don’t recognize the biomedical engineering that takes place to make all those tools function - we just know it works (but often not how it works). Acquiring these machines in low-resource settings is important, however, understanding how the machine works and how to maintain it is equally as important for its longevity as a surgical tool. In an effort to help, there has historically been a flow of second-hand or cheaper machines from high-resource environments to low-resource environments however often without the needed tech support, product manuals, or training to upkeep them. End-of-life equipment can be common and its utility is limited. Donations are vital to the progression of surgery in these settings but can sometimes create more of a burden than a support. Join us as we speak with Tom Monahan, the prior director of Biomedical Engineering at Health Equity International and previous Master Biomedical Technician at Massachusetts General Hospital about the engineering challenges of surgical equipment and strategies for tackling this problem at the grassroots through apprenticeship and training models.

In commemoration of Pride month this month, we wanted to highlight a population within society, but particularly in the field of global surgery, that is often left behind. The LGBTQ+ community has experienced high rates of discrimination and ostracization resulting in higher rates of mental illness, suicide, and even drug use. Further, LGBTQ+ patients encounter a very unique set of barriers within healthcare globally. For example, in many countries, significant others/partners of LGBTQ+ are not recognized as legal unions. This lack of legally legitimate status can pose issues when healthcare proxy decisions need to be made. Further, LGBTQ+ may have decreased number of children due to society and logistical pressures not experienced by heterosexual counterparts. This leads to a lack of access to needed elder care in regions where children and offspring predominantly handle elder care. Lastly, access to “luxury treatments” such as hormone therapy and gender-affirming surgery is extremely limited around the world leaving many transgender patients without access to potentially life-saving medications and surgeries. It is the job of clinicians to treat all patients fairly and with respect. Fair, does not necessarily mean the same, however. Recognizing how to interact with, respect, and support people of all backgrounds is essential as human beings. Putting ourselves in the shoes of other people brings new perspectives and insights. Join us in this special episode with Dr. Steven Orr as we highlight implicit bias within the surgical realm, the promotion of diversity and inclusion in surgery, and how to encourage the health and safety of all patients - regardless of sexual orientation or gender.

The beautiful thing about surgery is that it has the power to change lives in ways that no other field can. Surgery is often used to correct physical deformation. Whether that is a fractured femur from a motorcycle accident, a craniotomy to relieve pressure on the brain, or an appendectomy to remove a ruptured appendix, each of these procedures helps to restore a person back to “whole”. What we don’t often talk about is when these procedures are needed to help bring a person back to whole when many places in the world do not acknowledge that this person has a deficit or even needs to be fixed. They fail to recognize the dissonance between the person’s soul and body. As one of the most vulnerable citizens in society, transgender individuals have staggering rates of harassment, discrimination, and violence. Although their fight is not seen as a medical issue by some, our guest today is helping to tackle this issue to provide safe access to gender-affirming surgery. Join us as explore these sensitive and important issues including the personal, legal, medical, and surgical process of gender affirmation surgery, female genital mutilation, and clitoral restoration surgery. This is an episode you won’t want to miss!

Imagine if you arrived at your house and there were dozens of Amazon boxes at your door. None of which you had ordered. You open them only to find random items – a hairbrush, t-shirts that are way too big for anyone in your household, a toaster, and ice cream that is now all melted since you didn’t know it was there and should be refrigerated. Further, this doesn’t happen just once. It happens over and over again. Each time with a new set of items, all of which you didn’t order and may or may not even need. The items start piling up and boxes are everywhere. Despite your best efforts to keep up, stuff just accumulates and clutters your house. The items are unusable to you and impeding your access to your own space and effectively just becoming trash. Now imagine if you got a knock at your door. It’s a random person unknown to you, claiming to be a contractor. They let themselves in and start accessing your home and telling you they need to tear down this wall, re-route a pipe, change light fixtures, etc. They may even start doing these things without consulting you first or getting your permission. They never present any type of license or ask your opinion “because they are the expert and know best”. This is how it can feel in some global health situations. While people are trying to help, external aid can often be misdirected and create new, additional problems. The sending of supplies to resource-poor settings is often ill-informed and becomes like the Amazon analogy – trash. Incredible resources that are donated but unusable in their setting, incomplete material sets, not sorted, or frankly, not needed. The receiving institution may not be equipped to deal with the influx of these donations, and they become a burden rather than a help. This is compounded by physicians and surgeons offering their services regardless of the stated needs of the area, often leaving the local physicians to clean up the aftermath of post-operative checks, new medication management, and physical therapy needs. Join us as we talk with Dr. George Dyer, an orthopedic surgeon/professor at Harvard Medical School and orthopaedic advisor for Partners in health, about trash (disguised as donations) and the need for need-directed donations, education, and effective surgical support. You won’t want to miss this!

Our episode today covers a debilitating and life-threatening condition that disproportionately affects those in developing countries around the world. Affecting more than 150,000 people annually, Noma is a fatal infection of the face and mouth with the mortality rate approaching more than 90 percent and the morbidity/sequelae are permanently debilitating. Noma is a result of acute necrotizing ulcerative gingivitis (infection of the gums) which can rapidly spread and destroy other facial tissues. This can lead to struggles with eating, talking, and even breathing for affected individuals - if they even survive. Not only does this affect their activities of daily living, but it also affects their social interactions; often becoming shunned or excluded from societies and families due to the severely disfiguring and unpleasant aftermath. Further, the social and economic deprivation and political insecurity are staggering. A simple internet search before this episode will put the condition in context. Despite the high fatality rate and crippling aftermath, noma is a sorely neglected disease that can be prevented with multidisciplinary treatment. Join us in this episode as we speak with Dr. Bukola Oluyide and Charity Kamau as we discuss Noma as a condition, efforts that are being done to tackle it, and the sociological/anthropological aspects that remain following disease in its many forms.

Findings from studies published in The Journal of the American Medical Association (JAMA) report that more than 45% of resident physicians experience burnout and the numbers are continuing to climb. If that number didn’t surprise you, then you are well aware of the psychological stress and struggles that doctors and other healthcare workers experience on a daily basis - particularly during this recent pandemic. As a result, more than 1 in 10 physicians said they had suicidal thoughts. Unfortunately these thoughts often become action with suicide deaths among physicians is 250-400% higher than similar counterparts in other occupations. These suicides lead to more than 1 million patients losing their medical expert in the US alone - leaving a substantial number of underserved and vulnerable populations without healthcare services. As these statistics show, mental health is a major issue among physicians and our speaker today is attempting to help alleviate that. Join us as we talk with Dr Paola Fata about protected spaces (including protected nap spaces!), increasing positive feedback and value, community ties, and helping to bring ourselves back to center in safe environments.

Humans are inherently social creatures. For centuries we’ve learnt to survive, adapt and overcome through collaboration and unity. Medicine, in particular, highlights the value of taking input from multiple specialities and healthcare professionals to optimise patient care. However, with the power of modern technology, does this collaboration need to be confined to a single hospital? Why shouldn’t we collaborate with experts from around the world? Intersurgeon.org aims to establish a new paradigm to ensure the standard of clinical care is high no matter the setting. By harnessing the knowledge of over 600 specialities worldwide, this free service drives the pursuit of equitable and safe surgery. Join us as we dive deeper into the work of Paediatric Neurosurgeon Dr James “Jim” Johnston, co-founder of Intersurgeon with Guest Host Daniel Lowe a passionate Medical Student from Australia as we discuss how to facilitate regional LMIC collaboration and the value of ‘coral reef’ networking.