Off The Table: A Global Surgery Podcast

Welcome to our seventh episode, featuring the inspiring husband and wife duo, Dr. Nandakumar Menon and Dr. Shylaja (Shyla) Devi.In this episode we welcome two extraordinary individuals who have made an enormous impact on improving healthcare accessibility and delivery for indigenous populations in rural India. Shyla, a gynecologist, and Nandakumar, a surgeon, selflessly dropped a successful practice and comfortable lifestyle in the United States to follow their dreams of starting a hospital for underprivileged populations in their home country. They landed in Gudalur Valley with dreams of aiding the Adivasi, a historically persecuted tribal indigenous population in India. The Adivasi have suffered from hundreds of years of prejudicial colonial oppression leading to their complete societal isolation. Abandoned by the government and cut off from modern medicine, the Adivasi lived in extremely poor health with debilitatingly high maternal and child mortality, and rampant casualties from treatable health conditions and complications.This egregious neglect inspired the duo to help the Advisasi obtain adequate healthcare, and so, the Association for Health Welfare of the Nilgiri (ASHWINI) was founded in 1990. ASHWINI is a charitable organization with the mission of establishing healthcare facilities to serve the Adivasi. Most importantly, Shyla and Nandakumar knew that if they were to gain the trust of these individuals and truly make a difference, they would have to empower the Adivasi to embrace their own medical autonomy. They decided that these institutions must be both owned and managed by the Adivasi people themselves. Thus, in one of the most pristine examples of capacity building and decolonizing healthcare, the Gudalur Adivasi Hospital was established. This hospital has grown to have 50 beds and 8 community sub-centres. It trains and employs the Adivasi people as nurses and other healthcare personnel and is self-sustaining. They have managed to completely transform health outcomes in the Gudalur Valley, all while generating an impressive revenue stream for the people. Their secret to success: build capacity and trust first. If you can empower someone to take their health into their own hands, and give them the tools to do so, the rest will fall into place. In their eyes, the foundation of global health and surgery is altruism. They emphasize that “Healthcare has no beneficiaries”; if one wishes to truly make a difference, everything you do must be for the greater good of the people you are doing it for. Tune in to hear their incredible story.You can learn more about their mission and accomplishments here: https://ashwini.org/new/ Check out their recently launched platform where health professionals can find job opportunities in rural areas in India and make a difference just like them: https://ruralhospitalnetwork.org/. Contact: instagram: ott_globalsurgerytwitter: OFFTHETABLE_PODemail: offthetablepod21@gmail.compatreon: https://www.patreon.com/offthetablepodcast

We are delighted to be joined by the incredible Dr. Brian Madison, president of South Sudan Orthopaedics and Trauma Society. Dr. Madison is an orthopaedic surgeon with a passion for global surgery. He is a dedicated advocate for the improvement of surgical systems in Africa. Born in Eastern Equatoria, before South Sudan was even recognized as an independent country, he comes from humble beginnings. After medical school in Khartoum, Sudan, Brian returned home to Torit; a no-man’s land of healthcare infrastructures. He loves his country, and describes his province as “paradise”. With passion and drive, he created his own career opportunities. From a surgical residency position in Tanzania to an orthopaedic trauma fellowship in Canada, he acquired the skillset needed to become one of only 11 orthopaedic surgeons in South Sudan.He discusses the geographical, socioeconomic, and political barriers to accessing surgical care in South Sudan and provides insightful commentary regarding their current healthcare environment and how it may improve. We discuss the implications of low resources, brain drain, and conflict hindering the progression of South Sudan as a country. He excitingly announces the recent launching of his country’s Orthopaedic Surgery Society, of which he is the president. Their goal is to build a training program for orthopaedic surgery in their country, and partnerships with high-income countries’ academic institutions can help play a supportive role through clinical exchanges and capacity-building in research. Tune in to hear the astute perspective of Dr. Madison regarding the evolution of global surgery and the importance of establishing infrastructure which supports the sharing of knowledge and training.Dr. Brian Madison on Twitter: @madisonbrian85South Sudan Orthopaedics and Trauma Society: https://ssorthotrauma.com Contact: instagram: ott_globalsurgerytwitter: OFFTHETABLE_PODemail: offthetablepod21@gmail.compatreon: https://www.patreon.com/offthetablepodcast

This week we are ecstatic to be joined by the renowned Dr. Dieudonne Lemfuka, a general surgeon from the Democratic Republic of the Congo. Dr. Lemfuka is passionately involved in surgery, surgical education, global surgery advocacy, and Christian SIM missionary work. Dieudonne received his medical training from the Pan-African Academy of Christian Surgeons (PAACS) out of the Bongolo Hospital program in Gabon. He is a certified Fellow by the College of Surgeons of the East, Central, and Southern Africa (COSECSA). He currently works and resides in Monrovia, Liberia, as a General Surgeon and Surgical Education Coordinator at ELWA Hospital.Tune in to immerse oneself in Dieudonne’s captivating memoir. Together we delve into his humble beginnings and navigate through the series of obstacles he’s conquered throughout his journey. After touching on some of his inspirations for pursuing surgical care, Dieudonne expresses his admiration for the organizations COSECSA and PAACS. He highlights the shared visions between the two, as well as the equitable opportunity for salvation that they provide financially-limited physicians with. Dieudonne articulates his concerns with doctor shortages in Liberia which lead to physician burnout. Fervidly speaking on the critical challenges that surgeons face when working in demanding environments in underdeveloped regions. Nonetheless, he remains optimistic regarding the future of these challenges and is committed to providing and teaching widespread, affordable, and high-quality surgical care. We then shift gears and discuss some of his thought-provoking contributions to academia, as well as his advocacy for equality of surgical care throughout Africa. He touches on his work as a Christian missionary, before providing us with one of the most compelling definitions of global surgery that we’ve received from a guest to date. To hear more from Dr. Dieudonne Lemfuka, watch him present his webinar “Training Christian Surgeons: An Answer to the Surgical Need in Africa” at the Samaritan’s Purse International Health Forum. Contact: instagram: ott_globalsurgerytwitter: OFFTHETABLE_PODemail: offthetablepod21@gmail.compatreon: https://www.patreon.com/offthetablepodcast

Dr. Emmanuel Makasa does not require an introduction, and he tells his story and career path better than anyone else. In short, he is an orthopaedics and trauma surgeon turned global health diplomat with senior management experience at the Zambian Ministry of Health as Deputy Director responsible for Emergency Health Services. He was Secretary General of the Zambia Medical Association (2007-2008) and Secretary General of the Surgical Society of Zambia (2006-2007). He is a counsellor for the UN and an advisor for several global health organizations such as the G4 Alliance and the Global Surgery Foundation.We talk about the Lancet Commission, how he became involved and his perspective on the (lack of) practical applications of the Commission’s recommendations. He speaks passionately on the importance of engaging patients in global surgery initiatives. He highlights the importance of doing research on the social and economic impact of surgery on people’s livelihood and productivity. He encourages surgeons to be better advocates for their patients by leaving the cocoon of their operating rooms and speaking up about the positive impact of surgery and challenges they face. Emmanuel believes that we can help by creating partnerships between high-income countries and low-middle income countries’ academic institutions for graduate programs. When asked to choose a single actionable item he has the simplest and most impactful answer: “put the patient first”.Thank you Dr. Makasa for this phenomenal conversation. We look forward to having you again on the podcast.Recommended links: The Lancet Commission on Global Surgery: https://www.lancetglobalsurgery.org/ The Zambia NSOAP: https://www.pgssc.org/national-surgical-planning The outreach program FlySpec providing free orthopedic care across Zambia: https://www.flyspec.org/ Contact: instagram: ott_globalsurgerytwitter: OFFTHETABLE_PODemail: offthetablepod21@gmail.compatreon: https://www.patreon.com/offthetablepodcast