The Global Engagement Panel Session Monday morning described a range of the surgical volunteerism efforts that the American College of Surgeons (ACS) Operation Giving Back (OGB) program and other medical organizations are involved in at home and abroad.

Barry D. Mann, MD, FACS, program director, general surgery residency training program, Lankenau Medical Center, Wynnewood, PA, spoke about his experience developing and working on what is now known as the Health Career Collaborative, a program staffed by volunteer medical students and medical professionals that provides an opportunity for disadvantaged high school students to learn about career opportunities that exist in health care if they stay in school.

“After a decade of experience, we’re demonstrating how medical organizations can work together to create a pipeline of the next generation of health care providers at all levels,” Dr. Mann said.

Liana Gefter, MD, MPH, research associate, Stanford University Center for Research and Education in Family and Community Medicine, CA, joined Dr. Mann and expanded the Health Care Collaborative, now formally supported by the ACS, to cities across the U.S. The expansion has in part been made possible through the development of a codified curriculum. “The goal of our ready-made, validated curriculum is to make sure that the richness of the experience can happen in the classroom with mentorship,” Dr. Gefter said.

A significant focus of OGB’s domestic volunteerism efforts in the last year has been on continuing to provide assistance to Puerto Rico after the 2017 hurricane season wreaked devastation on the island commonwealth. Matthew O. Dolich, MD, FACS, clinical professor of surgery, and director, general surgery residency program, University of California-Irvine School of Medicine, is one of the leaders of the ongoing OGB Puerto Rico program. “What struck me on my first trip to Puerto Rico after [Hurricane Maria] was watching a humanitarian crisis unfolding in slow motion,” Dr. Dolich said.

The College and OGB quickly responded, putting out a call for volunteers that was met by hundreds of surgeons who wanted to help meet the medical needs of Puerto Rico’s people. Dr. Dolich explained the process, including performing a needs assessment, visiting potential sites for a surgical hub, identifying potential partners, and responding to the challenges at hand.

Between the initial visit in 2017 and the follow-up visit in August of this year, the OGB worked with partners on the island, including Puerto Rico’s Secretary of Health, Rafael Rodríguez Mercado, MD, FACS, to address issues that arose and to set the stage for upcoming work in Puerto Rico. Dr. Rodríguez Mercado followed Dr. Dolich as a guest speaker at the Panel Session.

“Just imagine, everybody in Puerto Rico went to sleep on September 19, 2017, and we woke up on the 20th of September in 1945,” Dr. Rodríguez Mercado said. “No communication, roads obstructed by debris—we only know about the situation at 17 hospitals of the 69 on the island; the Department of Health has almost 5,000 employees, and we only know about 10, including myself.”

Hurricane Maria caused nearly 3,000 deaths among the American citizens of Puerto Rico, as well as infrastructure damage to an island that is home to the population equivalent of Connecticut, Dr. Rodríguez Mercado said, and existing economic constraints and political circumstances have made recovery difficult. He expressed his appreciation for the OGB Puerto Rico program but noted that because people in his position come and go, “the problem is the continuity. We need to make sure the people that come after me continue work in collaboration with the American College of Surgeons.”

Transitioning to OGB’s international activity, Joseph V. Sakran, MD, MPH, MPA, FACS, director, emergency general surgery, and assistant professor of surgery, Johns Hopkins Medicine, Baltimore, MD, discussed how OGB focused its global efforts after Girma Tefera, MD, FACS, Medical Director of OGB and moderator of the Panel Session, assumed his position in 2015. According to Dr. Sakran, Dr. Tefera asked a few important questions: What are the objectives we’re trying to achieve by developing a global surgery program? What are the multidisciplinary partnerships we need? And what resources will we require? Answering these questions would ideally lead to “long-term, sustainable interventions that would allow for capacity building, ensure we had structured opportunities for our trainees, open bidirectional collaboration, and really ensure we are delivering high-quality care,” Dr. Sakran said.

Continuing discussions led to the idea of the ACS having a more permanent presence in a low-resource setting. After choosing sub-Saharan Africa as the focus point because of its pressing need for a sustainable medical presence, the concept germinated into a partnership with the College of Surgeons of East, Central and Southern Africa (COSECSA) to open a surgical training hub in Hawassa, Ethiopia, Dr. Sakran said. After a meeting with key stakeholders earlier this year at the ACS headquarters in Chicago, IL, and with the support of 13 organizations, it was decided that the ACS COSECSA training hub will open in January 2019. At the meeting, the joint group discussed the goals of this program, including creating a codified training and education curriculum; focusing on the clinical delivery of surgical care; maintaining high quality through using appropriate data metrics; and performing research to tailor training, treatment, and data to the region.

Dr. Sakran reiterated that the project will rely on strong, continuing partnerships. “This is not going to be done based off of one person, one institute. To ensure that we have sustainability and capacity building, it really requires all of us to put our best foot forward,” he said, also indicating that the hub in Hawassa is just a beginning point and the concept will hopefully proliferate to other areas of the world.

Other speakers at the session included David M. Barash, MD, executive director of the global health portfolio and chief medical officer, GE Foundation, Boston, MA, who spoke on the foundation’s Safe Surgery 2020 initiative; Prof. Pankaj G. Jani, MB, ChB, MMed, FRCPS, FCS(ECSA), president of COSECSA, who spoke on COSECSA’s background; and Glenn W. Geelhoed, MD, FACS, founder of Mission to Heal, a not-for-profit global medical mission agency.