|Title||Lifebox Ethiopia Fellow – Clean Cut|
|Role||Data collection and project development to drive Lifebox’s surgical site infection prevention work|
|Location||Jimma University Teaching Hospital|
|Training||3rd year surgical resident, Stanford University|
|Dates||July 2016 onwards|
What global surgery experience did you have before starting your Lifebox Fellowship?
At the end of my medical school training I wanted to see what surgery was like elsewhere – my experience had only been in the United States. I spent time at a couple hospitals in Nepal, which was incredibly eye-opening. I took call with the residents, scrubbed in on operations, and witnessed how few resources they had but how talented the surgeons are.
While I was in Kathmandu, at Patan Hospital, they performed their first laparoscopic nephrectomy – removal of kidney using minimally invasive techniques – due to nephrolithiasis (or kidney stone disease). They were able to do it with incredibly limited and relatively older instruments (one mono polar instrument, a grasper, and a twenty year old camera).
In the U.S. we’d remove the stones much earlier with either medical treatment or laser technology – but those methods are not available in Nepal. The stones get bigger and either way you usually have an open operation.
So here’s an incredibly talented surgeon, hamstrung by the environment and using a surgical set up from the 1980s – but doing life-altering surgery.
You spent a week in Ethiopia in preparation for your Fellowship. What did you learn?
I really got to see the difference between surgical care across countries – what we train with in the U.S., and what’s available there.
For instance, cautery tips. The surgeon’s ability to cut through tissue easily, and have hemostasis is something we take for granted every day. In Jimma that was a luxury at time. At times, they had to physically plug in the electrocautery, use it sparingly and then unplug it before they get an electric shock.
That small piece of equipment speaks to the difficulty of doing surgery in a low-income country, and the amount that is done when resources are incredibly limited – it’s a totally foreign concept to any trainee in the US.
What are you looking forward to?
Here in the U.S., surgery is set in its ways, and change can be like moving a mountain. Not that we don’t need change here too – absolutely we do. There’s a large population of low-income patients served in county hospitals who fall through the cracks.
But the need elsewhere can be much more obvious with an opportunity for improvement on such a larger scale.
I’m excited to go back and catch up with the surgery team I met there – Dr Seifu and Dr Abebe. Dr. Seifu is an incredibly talented surgeon, aspiring for pediatric surgical training in Jimma. He has fought against the “brain drain” and continues to push the surgical culture forward there. Dr. Abebe is a fantastic thoracic surgeon who is well traveled. He has a large colleague group and sees what surgery in Ethiopia can be, and what steps are needed to get there. He’s an inspiring person to work with.
How did you get into surgery?
I grew up in Colorado, in a family of four. My father is an intensivist – a medical physician who specializes in the care of critically ill ICU patients. While we did not aspire to be physicians early on, as life would have it both my brother and I are surgical residents – we’re training together, actually.
I went to San Diego to play football (with a few surgeries on the way myself…). It was an incredible experience to play under Jim Harbaugh – one of those instrumental leaders, who understands and makes teamwork an incredible part of what you do.
That’s what drew me to trauma surgery at Milwaukee: seeing a team in action successfully resuscitate a patient; having the technical skills to do an intervention that was truly life-altering.
Have you seen the Checklist making a difference?
Like all Lifebox programmes, Clean Cut takes its lead from the WHO Surgical Safety Checklist and its systematic approach to reducing surgical complications and mortality.
It’s been so ingrained in surgery in the U.S. – younger residents, we don’t really have any other experience.
But I’ve definitely noticed that the surgeons who’ve adopted it best run incredibly organized operations; they don’t feel forced. In other hospitals you see growing frustration during a case – the proper equipment isn’t ready, no one’s been alerted to potential blood loss, and there is a lack of communication.
And I can tell you that when we *don’t *do it for life-altering procedures, things go differently. If you’re in the ER and a trauma comes in, you might need to do an emergency thoracotomy, or another technical procedure, right there. You need this, you need that, you have to yell out. The chance that everything is delivered and there’s a smooth coordination of care is fairly low. That’s frustrating – and dangerous.
What do you like about working with Lifebox, and what are your goals for this year?
I’m surprised how a small group of people can have such a large impact. To deliver 13,000 oximeters around the world with such a small team is pretty impressive. It’s inspiring, really. It’s reinforced the fact that I can hopefully make a difference myself, as just one person.
In the beginning I almost viewed going into surgery like getting a mechanic to operate on your car – it didn’t matter where you went, just go in, re-tune, get out. It was only when I started seeing it as a medical student, and now a resident, that I realized there’s a range of technical ability and communication inside the OR.
Even more so now I’m seeing operations around the world – there’s incredible variety, some of which puts patients at risk. It’s why this work is incredibly important. I guess my goal is really to be able to really build Clean Cut one center at a time, and support some improvements in their hospital processing so that down the line, they can help impact the system.