Collaborative Effort Helps Bridge Global Surgery Workforce Gaps

The lack of access to surgical care worldwide is a significant concern. The ACS Health Outreach Program for Equity in Global Surgery (ACS H.O.P.E.) was established to assist low- and middle-income countries (LMICs) in capacity building, patient care, and training the next generation of surgeons.

Global surgical needs consist of both material and human resources. Fulfilling the gap in human resources necessitates a collective understanding that while most global surgeons are general surgeons, there is more need than for specialist care such as plastic surgery. Plastic surgery has traditionally been limited to global burn care, cleft lip, and palate care among other clinical conditions.

In the past decade, ongoing demands from LMICs have encouraged us to provide even more complex plastic surgery education and patient care. This viewpoint article describes a current experience developing a comprehensive plastic surgery program in Rwanda.

Recently, the ACS Oral and Maxillofacial Surgery Advisory Council started working to support Rwanda plastic and reconstructive surgery training in partnership with the Surgeons in Humanitarian Alliance for Reconstruction, Research, and Education (SHARE) program.

The Rwanda plastic surgery capacity building initiative started 5 years ago through a collaboration between the Rwanda Ministry of Health, University of Rwanda, Operation Smile, and College of Surgeons of East, Central, and Southern Africa. Notably, this partnership has shown sustained growth and development during the last 3 years. After a new and improved curriculum, approved by the University of Rwanda, was implemented both at the university medical center and affiliated hospitals, the number of trainees increased from three to 13.

 Working in silos negatively impacts progress, particularly in global health. When different organizations join hands to combine resources and avoid duplication, a lot can be achieved. One of the most important resources that was combined in this partnership was teaching faculty. With the help of ACS H.O.P.E., there was a significant increase in the number of educators and other volunteer surgeons from the US to support the expansion of the Rwanda plastic surgery training program.

The implementation of the program was harmonized with the new curriculum and featured six modules: general plastic surgery, burns, maxillofacial surgery, microsurgery, aesthetic surgery, and hand surgery. Each module consists of simulation exercises, didactics, and hands-on patient care delivered by a team of three-to-four surgeons. Some of the modules required additional partnership with industry that provided training materials to be used in the simulation laboratory.

The contributions of the US faculty have enhanced the growth of our training program with a potential to expand to other central African countries. In addition, we hope to contribute to the Committee on Certification in plastic surgery by adopting our structured curriculum for training and academics.

This collaboration with ACS H.O.P.E. is producing committed and competent plastic surgeons for Rwanda and the region. We are very excited to see our graduates excel as educators and contributors to the training of the next generation of plastic surgeons. It is notable to see that two of the most recent graduates already have obtained additional training in craniofacial surgery at the Hospital for Sick Children in Toronto, Canada, and in microsurgery at Chang Gung Hospital in Taiwan.

We are enthusiastic about continuing to grow the ACS H.O.P.E. and SHARE collaboration as we move forward and expand sites beyond Kigali, Rwanda.

Disclaimer

The thoughts and opinions expressed in this viewpoint article are solely those of the authors and do not necessarily reflect those of the ACS.

Dr. Gregory Evans is the Bruce F. Connell Endowed Chair in Plastic Surgery and a professor of plastic surgery and biomedical engineering at the University of California, Irvine (UCI). He also is the founding chair of the Department of Plastic Surgery at the UCI School of Medicine.

Dr. Faustin Ntirenganya is a consultant general and oncoplastic breast surgeon at the University Teaching Hospital of Kigali in Rwanda. He also is associate professor of surgery and head of the Department of Surgery at the School of Medicine and Pharmacy in the College of Medicine and Health Sciences at the University of Rwanda in Kigali.