InciSe 2023: Rekindle InciSe, Reinspiring Global Surgery

2023

InciSe Rekindle, Reinspiring Global Surgery

P U B L I C A T I O N

Meet the Editorial Team behind InciSe '23...

Law Shen Hong

InciSe Editor-in-Chief Public Relations Director InciSioN Global

McKenna Lauren Schimmel InciSe Editorial Team Member Public Relations Team Member InciSioN Global

Sumeja Ćatić

InciSe Editorial Team Member Public Relations Team Member InciSioN Global

Joanne Philip

InciSe Editorial Team Member Public Relations Team Member InciSioN Global

Seblewengel Kebebew

InciSe Editorial Team Member Public Relations Team Member InciSioN Global

InciSioN, the International Student Surgical Network, is an international non-profit organization for medical and public health students, residents, and young doctors in the field of global surgery. InciSioN started as an informal group of students in 2014 and grew to become the formally established organization "InciSioN" in March 2016. In 2015, in light of the passing of the WHO Resolution WHA68.15 "Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage," InciSioN started celebrating Global Surgery Day on May 25th as a global awareness day on Global Surgery. In 2016, InciSioN played a pivotal central role in the World Development Indicator (WDI) surgical data collection 2016 through a framework of virtual internships for ten selected students around the world to collect data from all Ministries of Health, which was updated in the World Bank database on July, 1st 2017.

In 2017, InciSioN co-organized its first World Health Assembly (WHA) side-event at the 70th WHA on May, 24th 2017, in Geneva, Switzerland, in collaboration with Lifebox Foundation, the World Federation of Societies of Anaesthesiologists (WFSA), the G4 Alliance, and Operation Smile on "What Next for Surgery and Anaesthesia: Civil Society and Global Solutions". In 2018, InciSioN established its independent international conference, the InciSioN Global Surgery Symposium (IGSS), for which the first edition took place in Leuven, Belgium, and attracted 228 people from 50 different countries, including 12 fully-funded Travel Scholars from low- and middle-income countries. In addition, InciSioN established and piloted its formal standardized three-day global surgery advocacy workshop, Training Global Surgery Advocates (TGSA), in order to create a global legion of effective and knowledgeable advocates and future leaders. Moreover, on May 23rd, 2018, InciSioN became the newest (and first trainee) member organization of the G4 Alliance, joining more than 80 professional global surgery societies, institutions, and NGOs from around the world.

Today, InciSioN represents over 5,000 members in over 80 countries and 49 fully established National Working Groups (NWGs) across all world regions. InciSioN’s international work is driven by the International Team (IT), consisting of 53 people from 33 different countries, speaking a total of 28 different languages. The IT 2020 comprises 26 female and 27 male members without preexisting quotas and is distributed evenly across all world regions, with 26 members from low- and middle-income countries and 27 from high-income countries, highlighting the importance and strength of the diversity of the International Team. Accordingly, InciSioN aims to contribute to the development of future generations of global surgeons, anaesthesiologists, and obstetricians around the world and help bring safe surgical care to everyone, everywhere, by 2030.

1. The Theme: Incise Rekindle,

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Reinspiring Global Surgery 2. InciSioN Co-Chairs Message

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3. Flagship Events: Key

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Highlights 4. InciSioN Global Recognition

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5. Themed Articles

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6. Mapping InciSioN

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7. Connect With Us

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The Theme: InciSe Rekindle, Reinspiring Global Surgery InciSe, the newsletter by InciSioN, had fallen silent for far too long. Its pages, once filled with the passion, commitment, and heartbeat of global surgery advocacy, lay dormant. But today, I stand before you with a renewed sense of purpose and excitement as we bring InciSe back to life.

The theme of revival is not one chosen lightly. It signifies the importance of breathing life into something that had, for a while, been eclipsed by the busyness of life and the challenges of our times. The theme encapsulates the essence of what we aim to achieve – not just to resurrect a newsletter but to reignite the spirit of global surgery advocacy.

Reviving InciSe is a call to action. It's a reminder that the world still needs to hear the stories, experiences, and voices that InciSe represents. It's an affirmation of our commitment to the cause and a testament to our belief in the power of knowledge and information.

InciSioN, as the largest global surgery network, stands as a formidable force in advocating for equity in surgical care. It's a community of individuals who have devoted themselves to making the world a better place through their collective efforts. The revival of InciSe aligns perfectly with this mission. It is a platform to amplify the stories and experiences of those who have been part of this journey and a means to inspire others to join us.

As we rekindle InciSe, we rekindle the stories of surgeons and healthcare workers who tirelessly labor to bring healing to those in need. We rekindle the narratives of patients whose lives have been transformed through surgical care. We rekindle the spirit of collaboration, inclusivity, and compassion that are the pillars of InciSioN. This revival is not a mere act of nostalgia. It's an acknowledgment that the world still needs to hear the voices of global surgery advocates. It's an affirmation that the work we do is far from complete and that, by sharing our knowledge and experiences, we can inspire others to take up the mantle and continue this important journey. Together, we can reignite the flames of global surgery advocacy and continue to make a tangible impact in the lives of those who need it the most.

In conclusion, I want to express my gratitude to all those who have contributed to the InciSe 2023. Your dedication and commitment are the driving force behind this endeavor.

Together, let's make InciSe a beacon of hope, knowledge, and inspiration for all those seeking to make a difference in the world of global surgery advocacy.

Law Shen Hong

Editor-in-Chief for InciSe 2023 Director of Public Relations for InciSioN Global

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Co-Chairs' Message InciSioN Global

As this year’s co-chairs, we are both very grateful to have such a dedicated team. We began this year with an incredible Executive Board (EB) and International Team (IT) of 83 members with a balance of genders, ethnicities, religions and countries.

Working together, we have accomplished a lot with the IT as well as our beloved National Working Groups.

InciSioN was present at several high-level meetings and conferences, including the World Health Assembly (WHA) and American College of Surgeons (ACS) Clinical Congress, once again educating and advocating for global surgery with our partners by hosting a hybrid event. Building on the hard work previous teams put in, we were honoured to be granted special consultative status at the United Nations (ECOSOC). This is a hard-fought accomplishment that gives us the privilege to create more positive change in the field of global surgery.

We are proud to see how active our National Working Groups have been, from webinars, discussions, and training, to detailed and well-planned conferences. The collaborative spirit shown is commendable. It is our hope that going forward, our international team will be able to provide greater support to each National Working Group.

Shahnur Shah

Co-Chair for InciSioN Global

Sofia Wagemaker

Co-Chair for InciSioN Global

As always, it truly is an honour for us to be part of such a broad and diverse network full of people we consider friends and colleagues. In such a dynamic time, our members keep pushing towards achieving the goals of global surgery and equality. While we try our best to be apolitical as an organisation and as leaders of such a wide-spanning organisation we can’t help but sympathise with the suffering of people globally and are saddened by the conflicts that we see sustained and emerging globally. Each conflict reminds us of the importance of equitable and safe Surgical Obstetric and Anesthesia Care.

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InciSioN Flagship Event In the past few months, we had a busy agenda coming up to events. InciSioN understands the importance of online events to promote Global Surgery and its aspects, aiming to build a worldwide community among the Global Surgery Enthusiasts. Thinking of this, we planned a series of events trough the last months! If you missed any of these days, here is a summary of what happened.

Global Surgery Day (GSD) 2023 To celebrate Global Surgery Day on May 25th, we made a Global Surgery Week with the theme revolving around "WHA 68.15 Resolution" as guidance for the campaign and events of the week. It is important to remember that this resolution is responsible for signifying the global commitment to strengthen surgical and anaesthesia care as an essential part of universal health coverage. Here is a sneak peek of the most successful events during the week: 22nd May: Introduction of the Campaign and Journal Club on WHA 68.15 Resolution.

23rd May: Instagram Live - Importance of WHA 68.15 in Shaping Global Surgery, with Dr. Katayoun Madani.

25th May: Global Surgery Webinar on "Universal Access to Emergency and Essential Surgical Care: How do we Close the Gap?" with Dr. Barnabas Alayande and Dr. Christopher M. Dodgion.

28th May: Starting with a Round Table on "Challenges of Global Surgery Career by LMICs and HICs Chairs with Dr. Aemon Fissha, Dorine Kaneza and Asadur Rahman.

Then, a webinar on “Global Surgery Across Borders: Research Collaboration in Surgical & Anesthetic Care” with Dr. Beverly Cheserem, Sofia Wagemaker, Gabriela Sansoni, Nebongo R. Bokoe, Cyubahiro K. Verite, Samuel Robinson and Pratyush Kumar.

We had a lot of fun during the week, especially because it was the same week as the 76th World Health Assembly in Geneva, Switzerland. So, we had the chance to highlight Global Surgery as an important piece in promoting health.

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Advocacy Amplified: Speak Up, Stand Out Advocacy is a term that has been used internationally, by different institutions, as a synonym for defending and arguing in favour of a cause. It is a process of claiming rights that aims to influence the formulation and implementation of public policies that meet the needs of the population.

Advocacy is one of the most important pillars of Global Surgery, which is why we dedicated an entire month to this cause.

During the whole month, we had a great chance to understand how Advocacy works and that it is not made by just one, but by countless people. This just showed us, once again, the importance of InciSioN's purpose for Global Surgery.

Check out what was done: 9th July: Fundamentals of Advocacy with Asadur Rahman and Rabbey Raza.

16th July: Diving Deep into Advocacy with Dr. Isobel Marks and Lim Yee Siew.

23rd July: Medical Student Role in Advocacy, with Shahnur Shah, Sofia Wagemaker and Lim Yee Siew.

30th July: Planning an Advocacy Campaign with Dr. Katayoun Madani and Michael Ergayanmen.

Thank you for being part of our events. We hope you gained a lot of knowledge, as well as a passion for Global Surgery. We also suggest you follow our social media to be notified when events like these will happen, and of course, to be tuned on what Global Surgery looks like when made by InciSioN Global.

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RECOGNITION

InciSioN has received the United Nations Economic & Social Council (ECOSOC) special consultative status.

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Theme Articles 1. Important Milestones Of Global Surgery In The Last 10 Years 2. Small Humans, Huge Gaps 3. From Conflict To Collaboration: InciSioN Ukraine Has Had A Remarkable Year 4. The Impact Of War And Armed Conflicts On Global Surgical Care 5. Pioneer in Global Surgery: Philippines 6. Malaysia’s Surgical Renaissance: Bridging Borders and Building Bridges in Global Healthcare 7. CLINICAL ONCOLOGY: HOW IT LOOKS LIKE IN DEVELOPING WORLD? 8. Comparative Analysis of Laser Interstitial Thermal Therapy and Gamma Knife Radiosurgery for Trigeminal Neuralgia: Efficacy in Pain Relief and Complication Mitigation

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IMPORTANT MILESTONES OF GLOBAL SURGERY IN THE LAST 10 YEARS Angel Iriogbe, Abdullah M Satti, Gloria Shani

The development of global surgery has evolved since 1980, when WHO recognized the importance of surgery in primary healthcare (Roa et al., 2019). Global surgery, often overlooked in global health efforts, presents a pressing challenge in low- and middle-income countries. Regarded as a costly option, obstacles to enhancing accessibility are numerous. It's considered a luxury for the wealthy, highlighting the evident and complex barriers to progress (Charlotte, 2018).

InciSioN, the International Student Surgical Network, was established in 2014 to address surgical care iniquities affecting billions globally. From its beginnings as a student group, it grew to an organisation promoting awareness through initiatives that include: Global Surgery Day, data collection efforts, hosting events like International Global Surgery Symposium (IGSS), and events at the World Health Assembly. With over 5,000 members spanning 80 countries, InciSioN aspires to champion efforts towards accessible surgical care by 2030.

InciSioN has contributed significantly to advancing global surgery by collecting primary data on crucial surgical indicators in low and middle-income countries (LMICs).

Collaborating with organisations like LCoGS(Lancet Commission on Global Surgery) and WHO GIEESC (Global Initiative for Emergency and Essential Surgical Care), InciSioN systematically gathered data using various strategies. InciSioN's work has shed light on the global surgical landscape, aiding in identifying areas for improvement and policy formulation. Meticulous data collection has led to a better understanding of global surgical disparities, ultimately driving improvements in surgical outcomes and access to care (Meara et al., 2015).

Other organizations have emerged in the field of global surgery, each making significant contributions to improve surgical care worldwide. These organizations Include but are not limited to Operation Smile, Surgeons OverSeas (SOS) which focuses on building surgical capacity in low-income countries through education and training programs, G4 Alliance (The Global Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care), and Association of Academic Global Surgery (AAGS). These organizations have made significant contributions by addressing critical gaps in global surgery through equipment provision, capacity building and advocacy efforts.

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One of the major advocacy efforts is the contribution to the WHA Resolution 68.15 (2015): Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage, which called for the following actions: 1. Governments should prioritize the integration of emergency and essential surgical care and anesthesia into their national health systems.

2. International organizations should provide technical support, capacity building, and funding to strengthen surgical care and anesthesia services in low- and middleincome countries.

3. Stakeholders should advocate for increased investment in surgical infrastructure, workforce training, equipment, supplies, research, and data collection to improve access to quality surgical care globally.

Over the last decade, a noteworthy progress in global surgery has been the establishment and execution of National Surgical, Obstetric, and Anesthesia Plans (NSOAPs). These plans are a response to the need for robust surgical systems and have proven crucial in fulfilling Sustainable Development Goals (SDGs). NSOAPs offer a comprehensive framework to address surgical needs, bolster healthcare systems, and advance well-being. They tackle gender inequality, poverty, economic growth, and infrastructure development, aligning surgery with broader development aims (Meara et al., 2015).

Several influential figures have made significant contributions towards improving surgical care worldwide. One such figure is Dr. Paul Farmer, cofounder of Partners In Health (PIH), who dedicated his career to providing healthcare access to underserved populations. Through PIH's efforts, Farmer helped establish surgical programs in resource-limited settings, such as Haiti and Rwanda (Farmer et al., 2011).

Another influential figure is Dr. Atul Gawande, a renowned surgeon and writer who has advocated for the implementation of surgical checklists to improve patient safety and outcomes (Gawande et al.,2009).

His work has led to the widespread adoption of checklists in operating rooms globally. Dr.Sherry Wren is another influential figure in global surgery who has focused on building surgical capacity in low-income countries. She has collaborated with organizations like Operation Smile to provide free surgeries for children with cleft lips and palates (Wren et al., 2013)

As global surgery initiatives aim to improve access to safe, affordable, and timely surgical care, it is recommended that policymakers, healthcare organizations, and stakeholders play a crucial role in supporting and promoting these initiatives.

Policymakers should prioritize the integration of surgical services into national healthcare systems by allocating adequate resources and developing policies that address the specific needs of surgical care (Meara et al., 2015). They should collaborate with international organizations to establish standardized guidelines for surgical training and quality improvement programs (Bickler et al., 2015). Lastly, stakeholders such as professional societies and nongovernmental organizations should advocate for increased funding for global surgery initiatives and engage in capacity-building activities through partnerships with local healthcare providers (Meara et al., 2015).

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SMALL HUMANS, HUGE GAPS Advocating for more accessible pediatric surgery.

Gabriela Azevedo Sansoni, Halima Ibrahim Gure, Yee Siew Lim Comprehensive strategies are needed to address these issues, including bolstering the healthcare system, enhancing medical professional education, promoting resource allocation, and boosting public awareness. We can strive towards a future in which all children have equitable access to crucial paediatric surgical treatment by addressing the issue's complexity.

CURRENT ISSUE Children in economically disadvantaged regions are disproportionately affected by the serious worldwide issue of limited accessibility to paediatric surgical treatment. Geographical differences play a large role since rural and distant locations lack the resources and medical skills needed to provide adequate healthcare.

Families are forced to travel long distances as a result, which adds to their financial load and logistical difficulties. Children in rural locations had a two times greater chance than their urban counterparts of surgical treatment being delayed, according to Johnson et al. (2019) [1]. The situation is made worse by the dearth of skilled medical personnel and specialised equipment in these regions [2].

Socioeconomic differences make the problem worse since families with low incomes find it difficult to pay for surgical procedures. Children from households with low incomes are more likely to experience postponed surgical care, according to Smith et al. (2020) [3]. Young patients may have worsened health issues, protracted healing durations, and greater pain as a result of this delay. Delay in interventions is also a result of communities' lack of knowledge regarding the value of paediatric surgical care and accessible treatment alternatives. To address this issue, community education campaigns on the need for early surgical procedures are essential [4].

“1.75 billion children live in countries without access to safe surgery.”

INTRODUCTION Global health encompasses advocacy in both surgical and medical fields, thus far the main focus has been on eradication of communicable disease due to the gap in treatment options and prophylaxis on some neglected tropical diseases. With the advance of vaccination campaigns and accessible treatment for some of these, along with the current advances on new vaccines for diseases such as Malaria which is already on Phase 3 of development, non-communicable disease prevention and treatment also gained space in global health advocacy. Obesity, cardiovascular diseases and diabetes are an increasing burden on Low and Middle Income Countries (LMIC) and efforts have been made to cope with its negative effects on public health. However, few organizations focus on surgery advocacy.

The burden is highly reflected in LMICs, where we can find paucity of specialized care, infrastructure and consumables needed for safe surgery to be conducted.

According to the NGO Kids OR around the world, 1.75 billion children live in countries without access to safe or timely surgery, another way of analyzing this data would be looking at the shocking statistics that state that 9 out of 10 children in LMICs do not have access to a safe, well equipped and well staffed Operating Room (OR).

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STRIDES BEING MADE Some technological advances, like portable ultrasound devices that are readily available in rural areas have been successfully implemented in some contexts [5]. Such devices can enhance prenatal diagnosis and this is most of the time vital to early diagnosis of congenital malformations, such as spina bifida.

There are many non-for-profit organizations working towards more accessible and affordable pediatric surgical care. Kids OR, works towards the provision of safe operating rooms for children in locations where they lack.

Operation Smile focuses on maxillofacial surgery for children with cleft lips and/or palate, which requires a very high level of specialization that often lacks in many contexts globally.

CURE International is acting in many countries, more specifically: Ethiopia, Kenya, Malawi, Niger, Philippines, Uganda, Zambia, Zimbabwe towards free surgical treatment for children thanks to donations and the building of a network of pediatric hospitals in these countries.

With increased survival of children with birth defects, the focus has shifted to long-term follow-up. It has become clear that long-term outcome is largely determined by morbidities that are directly related to the congenital malformation, the natural course of the disease and its impact on family life. Paying attention to morbidity rather than just mortality, and transition of care to adulthood is vital (IJsselstijn et al., 2017) [7]. There are several tools developed to aid in research such as the Modell Global Database of Congenital Disorders (MGDB) that combines general biological principles and available observational data with demographic data (Moorthie et al., 2017) [8]. This will assist in improving the clinical practice and development of policies that focus on congenital malformation.

“Pediatric surgery is increasingly improving quality of life of children with birth defects...”

Furthermore, there are many NGOs that work locally in contexts in which social inequality is high within the country, this is the case of Surgeons for Little Lives which is based in South Africa and works with financially disadvantaged families.

FUTURE PLANS Capacity building is of importance,with human resources including surgeons , nurses and anesthesiologists needed to bridge the gap.

Additionally, training programs can also focus on enhancing the skills and knowledge of existing healthcare professionals to provide specialized care for pediatric patients.

Pediatric surgery is increasingly improving quality of life of children with birth defects with studies in Uganda showing that congenital hydrocephalus can be surgically managed for USD$59-$126 per Disability-Adjusted Life-Year (DALY) averted (Sitkin & Farmer, 2016) [6].

CHALLENGES INVOLVED Advancement in pediatric surgery has been made in high income countries with existing disparities in LMIC.These countries often lack necessary resources, infrastructure and healthcare systems required for adequate provision of services.

Congenital diseases like tracheoesophageal fistula,neural tube defects and abdominal wall defects still continue to be a burden and are often mismanaged. Early diagnosis prenatally is key, collaboration with fetomaternal medicine to improve outcomes is vital.

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Often neonatal transportation to centres that can manage such cases still pose a challenge with the financial cost and logistics.

Due to these reasons, we have an increasing disability index in children born with malformations in LMICs. We don't have sufficient data on congenital defects since they include genetic studies, prenatal diagnosis, and premature outcomes that fail to survive long enough to see the progression of the condition.

In addition, there is often less money for study and inadequate data in LMICS.The deficiency in epidemiological data on the prevalence and its impact on healthcare, makes it difficult to come up with policies and funding in most countries.

REFERENCES 1. Johnson WD, Donnelly JP, Ferguson T. Rural children's access to timely surgical care: a study of pediatric rural surgical emergencies. Surgery. 2019;165(4):805-811.

2. Ozgediz D, Kijjambu S, Galukande M, et al. Africa's neglected surgical workforce crisis. The Lancet. 2008;371(9613):627-628.

3. Smith ER, Vissoci JRN, Rocha TAH, et al. Geospatial analysis of unmet pediatric surgical need in Uganda. J Pediatr Surg.

2020;55(12):2650-2655.

4. Brown JC, Sossou AR, Wang J, et al. Pediatric surgical capacity in low-income and middle-income countries: evidence from 21 national surveys.

BMJ Glob Health.

2018;3(4):e000554.

5. Crispín Milart, P.H., Diaz Molina, C.A., Prieto-Egido, I. et al.

Use of a portable system with ultrasound and blood tests to improve prenatal controls in rural Guatemala. Reprod Health 13, 110 (2016). https://doi.org/10.1186/s12978-016-0237-6 6. Sitkin, N., & Farmer, D. L. (2016). Congenital anomalies in the context of global surgery. Congenital Anomalies in the Context of Global Surgery, 25(1), 15–18. https://doi.org/10.1053/j.sempedsurg.2015.09.004 7. IJsselstijn, H., Gischler, S. J., Wijnen, R. M. H., & Tibboel, D. (2017). Assessment and significance of long-term outcomes in pediatric surgery. Seminars in Pediatric Surgery, 26(5), 281– 285. https://doi.org/10.1053/j.sempedsurg.2017.09.004 8. Moorthie, S., Blencowe, H., W. Darlison, M., Lawn, J. E., Mastroiacovo, P., Morris, J. K., & Modell, B. (2017). An overview of concepts and approaches used in estimating the burden of congenital disorders globally. Journal of Community Genetics, 9(4), 347–362. https://doi.org/10.1007/s12687-0170335-3

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FROM CONFLICT TO COLLABORATION: INCISION UKRAINE HAS HAD A REMARKABLE YEAR

By Inioluwa Atowoju (Head of Education, InciSioN Ukraine) Proofread/Edited by Marvellous Sowunmi (Assistant Head of Education, InciSioN Ukraine) In the face of unprecedented challenges caused by the ongoing conflict in Ukraine, InciSioN Ukraine emerged as a beacon of resilience and determination. Despite the physical distance imposed by the war, our National Working Group has adapted, innovated, and continued to thrive, showcasing our unwavering commitment to global surgery education, research, and advocacy.

Adapting to the New Normal The conflict not only disrupted the lives of millions, but also posed unique challenges to medical students in accessing education and maintaining their studies, as well as healthcare professional practice across the country.

InciSioN Ukraine recognized the need to adapt swiftly to the changing educational landscape.

We transitioned to virtual platforms, harnessing the power of technology to connect members, host a series of impactful events, and maintain the momentum of our initiatives.

Virtual Research Webinars The Research Team of InciSioN Ukraine took the initiative to host virtual research webinars with knowledgeable lecturers from different geographical locations. These webinars provided a platform not only for members, but also for non-members, opening the doors of knowledge exchange to a wider audience. One of the webinar topics explored “The Art of Writing an Opinion Piece as an Early Career Researcher”, offering valuable guidance to budding researchers. Another enlightening session delved into “How to Find a Research Mentor and the Role of Mentorship in Global Surgery Research”.

These topics exemplify the depth and breadth of knowledge that InciSioN Ukraine has brought to its members and broader community.

Additionally, InciSioN Ukraine conducted monthly journal clubs, fostering critical thinking and scholarly discussion.

Continuing the Research Scholar Program The Research Scholar Program, a visionary initiative conceived before the war, was temporarily halted because of this conflict. Initially, approved members underwent rigorous scrutiny to join this esteemed program. However, just as the programme was about to commence, the war broke out, causing a temporary delay. Despite these setbacks, InciSioN Ukraine’s spirit remains unbroken. After a few months of uncertainty, the program made a triumphant return with classes held weekly. Renowned global surgery research mentors generously dedicated their time to imparting invaluable insights into the field of global surgery research. From these classes, research ideas flourished into projects, with abstracts presented at international conferences and full-text publication in a reputable journal.

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Building a Virtual Library and Monthly Educational Content Recognizing the crucial need for accessible and comprehensive resources, the Education Team of InciSioN Ukraine meticulously curated a vast virtual library housing over 100 handpicked books, including handbooks, textbooks, and manuals, covering a spectrum of global surgery and various surgical specialties.

This was done in a bid to empower medical students and future global surgeons to continue learning and honing their skills despite the challenging circumstances.

Monthly educational content was also shared on the social media platforms of InciSioN Ukraine, illuminating the global surgical aspects of various specialties.

These included specialties, such as global neurosurgery and global cardiac surgery.

Furthermore, the surgical case series featuring monthly quizzes served to advance knowledge in the field of surgery.

Empowering Women in Surgery Our International Women's Day webinar was a testament of our commitment to diversity, inclusivity and equality. InciSioN Ukraine organized a remarkable Women in Surgery webinar, celebrating the achievements of women in the field and inspiring future generations. This event served as a powerful reminder that even in the face of adversity, our dedication to empowering individuals knows no bounds.

Advocacy for Peace and Solidarity Amidst turmoil, InciSioN Ukraine stood as a voice for peace. One year after the war began, we launched an online campaign for peace, urging for an end to the violence and a return to normalcy. This initiative highlighted our unwavering dedication to humanitarian values and the well-being of fellow Ukrainians.

A Global Surgery Bootcamp Perhaps one of the most ambitious projects undertaken by InciSioN Ukraine was the Global Surgery Bootcamp that ran from October 14 to November 18, 2023.The bootcamp was held in collaboration with four other InciSioN NWGs across Europe and Africa, with a focus on five surgical specialties. This bootcamp had renowned and reputable experts who gave virtual lectures on various surgical pathologies, introduced the concept of global surgery, and equipped attendees with the knowledge and skills needed for their global surgery career.

A Brighter Future In the face of conflict-induced challenges, InciSioN Ukraine has emerged as stronger, showcasing our unwavering commitment to global surgery. These trying times have demonstrated that unity, adaptability, and determination can overcome even the most formidable obstacles.

As we reflect on our resilience, we look forward to 2024, with optimism. Anticipating a blend of virtual and on-site activities, we are poised to continue championing the cause of global surgery, fostering education, research, and advocacy.

Together, we embrace the opportunities ahead, united in our resolve, for a positive change.

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THE IMPACT OF WAR AND ARMED CONFLICTS ON GLOBAL SURGICAL CARE - A CASE STUDY OF UKRAINE Alagbo Habib (National Co-Chair, InciSioN Ukraine) The Oxford dictionary defined "war" as a state of armed conflicts between different countries or different groups within a country while "armed conflict" is defined by the Canadian association for refugee and forced migration studies (CARFMS) as a contested incompatibility that concerns government and/or territory where the use of armed force between two parties, of which at least one is the government of a state, results in at least 25 battle-related deaths in one calendar year. The world has and continues to experience many of these wars and armed conflicts, among which to mention but a few is the afghanistan war, the Gulf war, the syrian civil war, the currently ongoing russia-ukraine war, etc. These wars have a devastating impact on the healthcare surgical system of the country due to disruption of medical services, increase in conditions requiring surgical interventions, destruction of surgical facilities, loss of surgical personnels, and disruption of surgical education among others, thereby increasing the global burden of Surgical care.

The ongoing russia-ukraine war is once again showing the damaging impact these wars have on global surgical care. The war which began in February has led to the damage of 627 medical facilities with 105 of them completely razed to the ground according to the preliminary data from the Ukrainian ministry of health. This war has also led to the displacement of over 7 million Ukrainian citizens internally according to reports from the UN high commission for refugees. Data from the office of the high commission of human rights of the United Nations has shown that 11,862 civilian casualties have been recorded, with 5,110 killed and 6,752 injured. Also, there have been various reports from human rights watch, red cross and many non governmental agencies about the inability to deliver essential medical needs (instruments, medications, etc.) to the most affected regions.

Furthermore, aside from the disruption of normal activities like education which has greatly affected the continued education of surgical residents and medical students, many have had to abandon their training altogether and flee to another country.

Also, many residents and fellows in other surgical specialties have had to focus on treating traumatic injuries, hence increasing the burden of other conditions requiring surgery. Also, among those displaced, killed or injured are surgical specialists and medical researchers, thereby further reducing both the surgical and research capacity of the country. In addition, many advocacy campaigns have to focus on more urgent needs like shelter, feeding and protection of human life resulting in the neglect of surgical needs at a time that it is needed the most.

In conclusion, wars or armed conflicts have damaging impacts on the global surgical care due to various reasons, and while there are humanitarian organizations like Médecin Sans Frontière (MSF), red cross and the likes that help to relieve these burdens, i will further recommend the strengthening of the surgical system of various countries to help prepare and combat the huge burden that may arise as a result of these wars and armed conflicts.

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PIONEERSIN INGLOBAL GLOBALSURGERY: PIONEERS SURGERY Philippines Grace Malolos, Rena Mallillin

What started out as a casual conversation about two aspiring surgeons’ careers bore fruit to an application for InciSioN. After patiently waiting, InciSioN Philippines is the InciSioN's newest National Working Group. InciSioN Philippines is founded by two friends-- Grace and Rena with a shared passion in global surgery.

Grace Malolos is a fresh medical graduate from the University of the Philippines (UP) and she completed her medical internship at the UPPhilippine General Hospital. She is an aspiring cardiothoracic surgeon with a growing passion for global surgery, public health, multi-sectoral collaboration, and research. Grace previously served as the Regional Liaison for Asia-Pacific of the Gender Equity Initiative in Global Surgery (GEIGS) and was a member of the Activities Team of the Global Cardiac Surgery Initiative (GCSI). She was also the Vice President for External Affairs of the Asian Medical Students’ Association - Philippines (AMSA-Phil).

Rena Mallillin is a fifth year MD-MBA student from the Ateneo School of Medicine and Public Health (ASMPH). Global surgery is the union of her two passions-- global and public health, and surgery. She is a student-leader with deep interest in health systems strengthening, research and medical education. While her surgical path-- whether orthopedic surgery or neurosurgery is still uncertain, she aims to ultimately be in the cutting field. She is a member of GEIGS and is the former President of AMSAPhil.

Rena (left) and Grace (right) on their first meeting about InciSioN-Philippines

According to the Lancet, the Philippines has 0.9 surgeons per 100,000 people. As an archipelagic country, many patients from the geographically isolated and disadvantaged areas (GIDA) in the Philippines would require long hours of travel time to avail health services including surgeries.

InciSioN Philippines envisions to be at the forefront of the advocacy on safe and equitable access to quality surgical, obstetric, and anesthetic care as the Philippines progresses towards universal health care.

It aims to pioneer the field of Global Surgery in the Philippines by introducing the advocacy and uniting people from different sectors, by providing avenues for holistic education and capacity building, and by contributing to the sustainable development of the country’s healthcare system through a multisectoral collaboration.

Living in a country where six out of ten Filipinos die without seeing a doctor. Filipinos remain burdened by the cracks and gaps of the Philippine healthcare system. While the Philippines continues to strive for health for all, surgical access remains a luxury and–daringly– may have even been forgotten.

InciSioN-Philippines Logo

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MALAYSIA’S SURGICAL RENAISSANCE: BRIDGING BORDERS AND BUILDING BRIDGES IN GLOBAL HEALTHCARE Dr Lim Yee Siew, Shee Loke Yuan, Lau Jin Ren, Joanna Wong Mei Jye, Nelson Lee Jia Qian (InciSioN-Malaysia) Malaysia has been a center of worldwide surgical developments in recent years and it is essential in resolving healthcare inequalities globally. Malaysia, with its dedication to provide affordable, high-quality healthcare has emerged as a key player in projects to improve surgical infrastructure and skills. The increasing focus on global surgery is indicative of the country’s commitment to promoting healthcare solutions that are inclusive.

Malaysia's significant role in global surgery was underscored at the International Surgical Week 2022 in Vienna, where a lecture on 'Patient-Centered Global Surgery' showcased the country's commitment to equitable healthcare access. The lecture was delivered by the former Director-General of Health Malaysia, Tan Sri Dr Noor Hisham Abdullah. To date, with 20 hospitals implementing the 'Global Surgery' initiative and plans for expansion, Malaysia aims to ensure universal access to crucial surgeries, including emergency surgery. Collaborations with nongovernmental bodies further extend this commitment, addressing issues like cataract surgery and low risk maternity care. Malaysia's leadership in 'Global Surgery' is evident on the world stage, holding key positions as the Vice-Chair of the WHO Executive Board for the Western Pacific Region from 2022 to 2023 and Member of the WHO Executive Board for the year 2021 to 2024. This recognition reinforces Malaysia's dedication to shaping international healthcare policies and promoting health equity globally. (1)

Malaysia’s surgical renaissance is intricately associated with its commitment in the medical device industry. The remarkable surge in medical device exports, amounting to US$5.6 billion in 2019, highlights Malaysia's competence in producing top-notch equipment (2). This growing industry exports to over 90 percent of countries, with a significant amount going to key international markets including the US, Germany, Japan, and China (2). As Malaysia continues to facilitate improvement in the surgical infrastructure, this further solidifies the nation's role in building partnerships across national boundaries, creating a shared goal towards an advanced global surgical landscape.

At the heart of Malaysia's healthcare journey, the nation steps up as a driving force in global surgical innovation, steering towards a future where high-quality healthcare transcends geographical boundaries. Exemplified through initiatives like the 'Global Surgery' program and highlighted at the International Surgical Week 2022, Malaysia's commitment to patient-centered and inclusive healthcare, under the leadership of Tan Sri Dr Noor Hisham Abdullah, speaks volumes. With 20 hospitals actively leading the 'Global Surgery' initiative, the nation is on a mission to broaden universal access to critical surgeries, addressing emergencies and collaborating with non-governmental organizations on issues like cataract surgery and low-risk maternity care, reflecting a holistic approach to bridging healthcare disparities.

Notably, Malaysia's leadership positions on the world stage, including the Vice-Chair of the WHO Executive Board for the Western Pacific Region and Member for 2021 to 2024, solidify its dedication to shaping international healthcare policies and fostering equity worldwide. This commitment is further emphasized through the nation's flourishing medical device industry, exporting top-tier equipment to over 90 percent

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of countries, cementing Malaysia's role in fostering collaborative partnerships and advancing towards an advanced global surgical landscape that values quality, accessibility, and inclusivity.

References: 1. Halim, I.A. Malaysia pertingkat akses Dan Ekuiti ‘global surgery’, Harakahdaily [Internet].

2022 [cited 2023 Nov 18]. Available at: https://harakahdaily.net/index.php/2022/08/16 /malaysia-pertingkat-akses-dan-ekuiti-glob al-surgery/ 2. Medina AF. Malaysia’s healthcare sector: A rising giant in ASEAN [Internet]. 2020 [cited 2023 Nov 18]. Available from: https://www.aseanbriefing.com/news/malaysia s-healthcare-sector-a-rising-giant-in-asean /

Brief Introduction of InciSioN-Malaysia

InciSioN Malaysia, the International Student Surgical Network Malaysia is a national non-profit organization for medical students, residents, and young doctors who come together to discuss, educate, advocate for, and perform research in global surgery. Our general aim is to provide inpin terms of research, continuing to advocate for safe surgery, and social opportunities campaigns to raise awareness of surgical diseases for the general public and these include providing educational materials and resources for both medical and nonmedical populations. We also aim to inspire medical personnel to take on research, advocacy, and education to further improve health globally and to help the World Health Organization (WHO) to reach sustainable development goals in terms of surgical care.

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CLINICAL ONCOLOGY: HOW IT LOOKS LIKE IN DEVELOPING WORLD? Amit Kumar Mishra

One of my cousin sisters went for evaluation of an acute headache for which she underwent MRI revealing a doubtful mass in nasopharynx. It was biopsied and a diagnosis of Non-Hodgkin lymphoma was made. For treatment, she was referred to a renowned cancer institute in India.

There, the doctor repeated the biopsy which found features suggestive of reactive lymph node. My sister (being newly married) and the whole family underwent a lot of psychological and financial turmoil for no reason for a period of 2 months.

Third case was of a patient who had been living alone drinking whole day with little food after his wife left him because of suspected Tuberculosis and his son committed suicide. He was brought to our centre by his niece. He was sad and starring up to roof in despair when I first met him during my clinical postings. He was diagnosed with cholangiocarcinoma. Learning about his diagnosis, he outrightly refused to go for its treatment saying “I would rather die than getting treated. I do not have money. Please discharge me. I beg.”

Another story is about the father of one of my students. He was diagnosed with laryngeal carcinoma and the mass was resected at a tertiary hospital. Later, the mass grew up again and causing profound disability. He opted to seek service in India and was operated there at the cost of his lifetime saving and a huge loan. However, he died of an infection 2 months after surgery. The devasted family had no choice other than to leave the capital city towards their village leaving behind the education of their children.

These three different stories reflect different aspects of clinical oncology in developing worldThe diagnostic, and treatment challenges, associated healthcare cost, and its devastating consequences capable of draining out the future of whole family. These stories appeal for development of a more comprehensive cancer care in low resource setting.

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COMPARATIVE ANALYSIS OF LASER INTERSTITIAL THERMAL THERAPY AND GAMMA KNIFE RADIOSURGERY FOR TRIGEMINAL NEURALGIA: EFFICACY IN PAIN RELIEF AND COMPLICATION MITIGATION Otari Chankseliani, American MD Program (USMD), Tbilisi State Medical University, Georgia.

Introduction:

Results:

Trigeminal neuralgia, an incapacitating ailment characterized by excruciating facial pain, presents therapeutic avenues such as Laser Interstitial Thermal Therapy (LITT) and Gamma Knife radiosurgery. This research endeavors to meticulously evaluate and juxtapose the efficacies and rates of complications stemming from these two therapeutic modalities, as they relate to the mitigation of pain in individuals afflicted with trigeminal neuralgia.

Within Group A (mean age 55±7.2, 62% females), the average pain relief score exhibited a profound and statistically significant enhancement relative to baseline (p<0.001). Impressively, a staggering 80% of patients reported experiencing complete pain relief, while a commendable 15% noted partial pain alleviation.

Recurrence of pain manifested in a modest 5% of patients during the stipulated follow-up interval.

Notably, complications, inclusive of transient numbness or dysesthesia, surfaced in 6% of patients; however, conspicuous by their absence were instances of infection or major adversities. In contrast, Group B (mean age 58.3±6.8, 67% females) displayed an analogous enhancement in the pain relief score (p<0.001). Herein, complete pain relief was evident in 75% of patients, with partial relief materializing in 20% of cases. A relatively higher recurrence rate of 10% was observed within this subset.

Complications, characterized predominantly by facial numbness or weakness, surfaced in 8% of patients, with no occurrences of radiation-induced complications noted.

Materials and Methods:

Conclusion:

A comprehensive cohort of 240 individuals diagnosed with trigeminal neuralgia was thoughtfully incorporated into this study. Of these, 150 subjects underwent LITT (Group A), while 90 participants were subjected to Gamma Knife radiosurgery (Group B). Scrupulous recording of patient demographics occurred, with meticulous evaluation of pain relief outcomes, recurrence tendencies, and complications being conducted, employing statistical methodologies congruent with the scope of the study.

Preliminary scrutiny of the data unambiguously indicates the commendable efficacies of both LITT and Gamma Knife radiosurgery in ameliorating pain among patients affected by trigeminal neuralgia.

Notably, LITT exhibited a superior prevalence of complete pain relief, whereas Gamma Knife radiosurgery displayed a distinct edge in terms of reduced recurrence rates. Furthermore, the incidence of complications remained relatively infrequent for both therapeutic avenues, with LITT registering a lower occurrence of transient numbness or dysesthesia. The implications of these findings underscore the need for extended follow-up investigations and comparative examinations to definitively discern the optimal therapeutic regimen for addressing trigeminal neuralgia.

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Mapping InciSioN

A Global Network on the World Map

InciSioN Albania InciSioN Australia InciSioN Bangladesh InciSioN Belgium InciSioN Benin InciSioN Bosnia & Herzegovina InciSioN Brazil InciSioN Burundi InciSioN Cameroon InciSioN China InciSioN Colombia InciSioN Croatia InciSioN Czech Republic InciSioN DR CONGO InciSioN Ethiopia InciSioN Grenada InciSioN Germany InciSioN Ghana InciSioN Greece InciSioN Haiti

InciSioN India InciSioN Indonesia InciSioN Ireland InciSioN Italy InciSioN Japan InciSioN Jordan InciSioN Kenya InciSioN Libya InciSioN Malaysia InciSioN Morocco InciSioN Nepal InciSioN Nicaragua InciSioN Nigeria InciSioN Pakistan InciSioN Philippines InciSioN Rwanda InciSioN Serbia InciSioN Sierra Leone InciSioN Somalia InciSioN Somaliland

InciSioN Sudan InciSioN Switzerland InciSioN Taiwan InciSioN Tanzania InciSioN Uganda InciSioN UK InciSioN Ukraine InciSioN Zambia Operation Health Egypt The Global Surgery Organization of Kosova (GSOK) Canadian Global Surgery Trainee Alliance (CGSTA) Global Surgery Israel Global Surgery Student Alliance USA Global Surgery The Netherlands

Explore your passion for global surgery and Take the lead in your own country by spearheading an InciSioN National Working Group, kindly reach out to us to express your interest in starting a new NWG. Contact us at incision.students@gmail.com.

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Connect With Us

@InciSioNGlobal

incision.students@gmail.com

Disclaimer: All visuals in InciSe 2023 are either provided by the author(s) upon submission or sourced from Canva's stock photo collection. They are used for illustrative purposes, and efforts have been made to comply with copyright regulations.

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