The FRRHH Fellowship

Barnabas Alayande is a General Surgeon who serves as the inaugural global surgery fellow with the University of Global Health Equity (UGHE), Rwanda and as a Senior Research Fellow with the Harvard Program in Global Surgery and Social Change. He is passionate about surgical education and research, improvisation, non-technical skills for surgery in variable resource contexts, and contextualised surgery in African settings. He is currently focused on creative curriculum development for Low- and Middle-Income Country surgical education at UGHE.

Project Summary: Barnabas Alayande is leading an effort to comprehensively map the state of access to appropriate surgical care for dwellers in rural Plateau State, North-Central Nigeria. Using various surveys and geospatial analysis, the relationship between rural access to Surgery and the corresponding burden of neglected rural surgical disease will be defined as a baseline for clinical intervention, policy, advocacy, and the location of surgical facilities. Findings from this study will help stakeholders, including governments and communities, understand and take action concerning the relationships between identified untreated surgical disease, geolocation, and access to timely care.

I completed my medical school training from Dow University of Health Sciences and Civil Hospital Karachi in Pakistan. This is the largest public sector hospital in Pakistan mostly serving an underprivileged population travelling long distances from rural and remote areas of Southern Pakistan. My earlier training has given me a very clear insight into challenges faced in accessing healthcare in rural areas, motivating me to work for student run NGO, Patients’ Welfare Association. After completing foundation training, I moved to the U.K. and completed my Urological training in Northern Ireland and I currently work as a Consultant Urological Surgeon in Ninewells Hospital and Medical School, Dundee, specializing in all aspects of management of renal cancers. Teaching and training remain the most important aspect of my career and I have supervised many trainees in the UK in both general and specialist uro-oncology. Over the last 6-7 years, I have been consistently involved in charitable work with The British Association of Urological Surgeons charity, Urolink and have completed several urology workshops in Southern Ethiopia. Over the last 2 years, I have been involved with several institutes in Pakistan where with a combination of simulation courses and hands-on surgeries, I am playing my role to establish laparoscopic urology. I have remained active in the African continent with another laparoscopy campaign in Hospital General Idrissa Pouye, Senegal, which has been accredited by RCSEd. My most recent endeavour planned is at John F Kennedy Medical Centre, Liberia, with huge support from RCSEd. My aim is to facilitate Surgical and Urological training in Liberia. I am a current Masters in Public Health Student and have interest in strengthening primary care setups in low-and middle-income countries and humanitarian work in conflict affected areas.

Project Summary: As a Urological Surgeon, I aspire to improve the standard of surgical care for patients belonging to remote and rural areas in Liberia, achieved with provision of high standard surgical training and international collaborations. Liberia’s healthcare system was affected by a decade long civil war. As a Public Health student, I aim to identify the humanitarian efforts taken with the help of local organisations, and via WHO and World Bank. I have a keen interest in primary healthcare setups in low and middle-income countries and plan to study the primary healthcare structure in Liberia to identify areas of improvement.

I am Dr Richard Miti, I work for the government of the Republic of Zambia as a registrar in the fourth year of general surgery training under COSECSA, at Chipata Central hospital. My current roles are: Acting Head of Department of Surgery, Chief Resident in the Department of Surgery, Deputy in-Charge of internship training at the institution and In-charge of training clinical officers and medical licentiates. I previously worked as Medical Officer in-Charge of 3rd Level hospital. I have a passion to serve those in need and general surgery is one of the many ways I want to remain of value. I am a hard-working young man, a team player and easily teachable. I would be very pleased to do cardiothoracic surgery in the near future.

Project Summary: This project plans to conduct surgical camps in districts located in the region. The camps will focus on resuscitation skills for critical surgical patients, offer technical support on emergency operations for life-threatening conditions and evaluation of the critical-care competencies and referral systems will be done. The project will therefore improve surgical competencies for the local teams in district hospitals on common surgical conditions and most importantly improve surgical care to the patients in the remote areas (the neglected patients or those who have not been able to transfer to the referral hospital). This will also improve my personal surgical experience.

Tracern Mugodo, is a Medical Doctor by profession. She is also the first Zimbabwean trained female orthopedic surgeon and the current Clinical Manager of the Clubfoot Programme. Helping the less privileged is her passion and through working with the Global Orthopedic Foundation, this has really helped to achieve the goal of making a difference as well as improving rural healthcare.

Project Summary: Clubfoot is a common congenital foot deformity with a prevalence of 1 in 1000 live births in Africa. Most of the affected children come from a poor social background. In the course of the management, 80-90% will require a minor surgery called tenotomy to finally correct the deformity. This surgery is performed by doctors but a number of resident doctors in district hospitals are not trained to perform this surgery, resulting in patients being referred to central hospitals. Due to financial problems, most patients cannot afford to travel to central hospitals resulting in delayed treatments and even treatment default. This grant is going to be used to fund travelling costs, accommodation, food, and surgical accessories needed to go around the country and train resident doctors in district hospitals on how to perform tenotomies. This is going to improve the treatment of clubfoot in remote areas, as well as equipping the doctors with great surgical skills.

Dr Mwachiro is a General Surgeon and Interventional Endoscopist based at Tenwek Hospital, Bomet, Kenya.

Project Summary: His FRRHH Fellowship project seeks to provide basic and interventional training in endoscopy for surgical trainees and practising surgeons at COSECSA training sites in Kenya through one day workshops using low fidelity simulators and monthly dedicated discussions on endoscopic management of gastrointestinal pathology. He will also seek to evaluate the endoscopy capacity in these facilities during the period of the fellowship. This project will enhance endoscopy care provided in these rural areas and improve the knowledge of trainees and surgeons practicing endoscopy in these areas

Nigel is a Consultant Trauma and Orthopaedic Surgeon in Basingstoke, UK. His principal areas of surgical practice are in Orthopaedic Trauma, all aspects of knee surgery and soft tissue shoulder surgery. He is Chair of the trustees of the Primary Trauma Care Foundation, and founder of a hospital charity – twinning his hospital with one in Uganda. He sits on the G4 Alliance strategic board advocating for trauma globally with the UN, WHO and other agencies and governments. He is a member of the Oxford University Global Surgery Group, and the Faculty of Remote Rural & Humanitarian Healthcare at the Royal College of Surgeons of Edinburgh.

Project Summary: PTC training will occur in Burundi to enable better initial management of Trauma using globally recognised sequential methods and communication. Aiming to:

• use French speaking PTC faculty instructors to deliver the initial week, funded by the FRRHH Fellowship Fund
• cascade the course in Burundi using the instructors trained in the first week
• qualitative and quantitative educational measures will occur before the course starts, at the end of the course, at 6 months, 1, 2, 5 and 10 years if possible; and report these to FRRHH, publish in journals and present at appropriate meetings / fora.

Namaste and warm regards from Nepal. I am an Experienced Consultant with a demonstrated history of working in the field, skilled in Clinical Research, Medical Education, TMJ Surgery, Orthognathic Surgery, Oral & Maxillofacial Surgery, and Medicine. I am currently an Assistant Professor in the department of Oral and Maxillofacial Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine Nepal. I also volunteer in my free time for a philanthropic organization, Ek Ek Paila as a Dental Consultant. Along with being registered as MOMS RCSED, I also serve as a Regional Dental Ambassador for The Royal College of Surgeons of Edinburgh. My duties entail serving my patients at the Institute of Medicine, TU Teaching Hospital, being a part of medical and dental academics, research, evidence assimilation and dissemination. Being a Nepali, it is my dutiful passion to work for the upliftment of rural and remote healthcare, not only pertaining to oral health but holistically.

Project Summary: Oral health care systems often focus on disease treatment which requires intensive health care resources and personnel that are often in critical shortage in low-middle income countries, while attention on primary prevention could be a better alternative. Nepal has arguably the most remote and rural geosocial structure in the world. The FRRHH Fellowship funding will help us to initiate and sustain this project which will aid to prepare the data and resources required to initiate a nationwide preventive oral health program. Such program is intended to reduce the oral-health disease burden in rural and remote areas of Nepal.