Nelly-Ange Kontchou, MD, MBA, GSWG Chair
International Women’s Day is as good a day as any to reflect on my journey as an African female resident in surgery. Plainly stated, I feel incredibly grateful for my life. The elements that stick out the most to me during my life all center around freedom of choice. In a way that is arguably off the beaten path for many children of African descent, I was blessed with parents who demanded excellence but who allowed me room to explore how this excellence was to be achieved. I never once felt any pressure from them to choose a specific professional path, and I was afforded the space and time to identify my interests, develop my self-confidence, and shape my sense of self.
When I decided to become a surgeon, the decision was very much driven by a deep displeasure with the inequity in access to and affordability of quality healthcare in my home country compared with much of the Western world. Being from Cameroon yet living all over the world did a number on me every time I returned home. I realized at a very young age that opportunities are not equal, happenstance can abruptly redirect the course of a person’s life, and—the biggest lesson of them all—life is unfair. Those realizations placed me on the path to committing to cracking the code to sustainable financing of surgery in sub-Saharan Africa.
Over the past few days, I have been thinking a lot about timing of financing in terms of how to maximize the investment you make to generate the returns you’re expecting within a particular time frame. I work as an Investment and Business Development Associate for Africa Health Holdings, a healthcare management company with 45 facilities across Nigeria, Kenya, and Ghana. In my company, we are trying to solve the problems of fragmentation within the healthcare market, inadequate access to data, and scarce financial and human resources. To clearly lay out the problem, we often explain to people unfamiliar with the space that although Africa comprises only about 15% of the world's population, it bears 26% of the global health burden with less than 1% of healthcare resources to address that burden. Securing the capital is only half the battle. Identifying who needs the resources, how much of them they need, for what uses, with what predicted outcomes, and over what time can arguably all be more challenging. Working through these challenging problems day in and day out has been paramount for me in finding creative solutions to improve healthcare delivery in Africa.
I have always planned to return to Cameroon to practice surgery. However, I want the infrastructure to be bolstered by a deep pool of talent, adequate funding, robust technology, exceptional training, and intentionally inclusive planning to optimize patient outcomes regardless of socioeconomic, gender, religious, tribal, or geographic factors, amongst others. If it takes 5 to 7 years to build a surgeon, how many years does it take to build a surgical system? I don’t know, but I would venture a guess: “My lifetime. And then some.” I have committed myself to this task not only because I am passionate about it but also because it would be irresponsible of me not to do it. I have the privilege of choice, the privilege of mobility, the privilege of resources, the privilege of a top-notch education, the privilege of training at Vanderbilt, and the privilege of failing with the runway to get back up again. The fact that I can go through general surgery residency while working in corporate finance in the African healthcare space and while also executing my entrepreneurial aims for Cameroon is the greatest privilege of them all.
I get to choose. I don’t have to conform to boxes or be limited by glass ceilings. As I told my business school class at our 1-year reunion regarding dreaming big, daunting dreams, “If someone else could do it, you can do it. And, if no one has done it, you must do it.” So, until the good work is done, I will continue to dream, to plan, and to build the future that I know this world deserves.
Dr. Nelly-Ange Kontchou is in the process of completing her general surgery residency with an aim to sub-specialize in pediatric surgery or transplant surgery. Nelly-Ange seeks to devise the ideal costing and pricing models for delivery of surgical care across all income levels in an accessible, affordable, and high-quality manner in her home country of Cameroon while encouraging companies and countries to finance surgery in a self-sustaining manner throughout sub-Saharan Africa.
Nelly-Ange earned a bachelor of arts (summa cum laude) in combined Spanish and Italian studies at Duke University, then went on to earn her doctor of medicine at Harvard Medical School and her master's in business administration at Harvard Business School. In her spare time, you can find her running, hiking, and sampling local cuisine from around the world. Dr. Kontchou is an investment and business development associate at Africa Health Holdings (AHH). In these roles, she focuses on designing and executing strategic business expansion initiatives to facilitate increased market share and operational improvement. She also assists in identifying opportunities for mergers and acquisitions while keeping due diligence, financial planning, and integration at the core of these endeavors.
Prior to joining AHH, Nelly-Ange worked full time as a medical doctor in the department of general surgery at Vanderbilt University Medical Center (Nashville, TN).
I began volunteering with Global Smile Foundation (GSF) almost a decade ago, and I am currently a member of its internal review board, surgical, research, and education committees. I have been blessed to be a volunteer with GSF and have included an overview of the Foundation's profile below (gsmile.org).
GSF is a non-governmental organization (NGO) that provides philanthropic comprehensive cleft care for underserved patients of the developing world, where barriers to cleft care are numerous and diverse, ranging from financial to logistical and administrative challenges. GSF’s founding members have been involved in outreach cleft care for more than 3 decades and believe that first-class comprehensive cleft care should be accessible to all patients regardless of geographic or socioeconomic barriers. The foundation is led by a distinguished board of directors and an experienced advisory committee.
Congenital clefts of the lip and/or the palate (CLP) are more pronounced in developing countries, with an estimated incidence of one in 500 to 750 newborns. In addition to significant nutritional, respiratory, and speech deficits, CLP inflicts major economic and psychosocial constraints on individuals and their families, invariably affecting their quality of life. In severe cases, the impact of untreated CLP may result in drastic irreversible disabilities, and possibly death, while those who survive must endure a lifetime of suffering due to untreated cleft and are often ostracized by their communities. Timely surgical correction and multidisciplinary care at an adequately early age is therefore critical to ensure optimal treatment outcomes and restore patients’ quality of life.
We aim to address the urgent and pressing need for cleft care in resource-limited areas of the world by establishing long-term sustainable solutions and reinforcing capacity building. This is achieved through the regulation and standardization of surgical outreach missions among NGOs involved in overseas cleft care, organizing cleft care missions, and establishing cleft care centers at our mission sites to provide long-term sustainable cleft care.
Nine years ago, GSF founded its first Cleft Center in Guayaquil, Ecuador, the first of its kind in the country. GSF also established a sister NGO in 2014, “Fundaciòn Global Smile-Ecuador,” to assist with the operations of the center and is significantly involved in providing cleft services for underserved patients throughout the year, including surgical, dental, orthodontic, nutritional, speech, and psychosocial therapy. GSF has become the largest provider of cleft care in Ecuador, caring for 50% of patients from 18 out of 24 Ecuadorian provinces. We currently have clinical sites in Beirut, Lebanon; Guayaquil, Ecuador; Trujillo, Peru; and San Salvador, El Salvador.
In 2018, we sought to expand our sustainability initiatives and educational reach by launching an annual simulation-based comprehensive cleft care educational workshop. The goal of this annual meeting is to offer providers from areas of need around the world with hands-on, world-class education, presented by senior acclaimed physicians through lectures, discussions, and simulation-based training. Our fourth Comprehensive Cleft Care Workshop was held in Istanbul, Turkey in 2021, and it featured 60 renowned speakers from 18 countries and was attended by more than 500 learners (www.cleftworkshop.org).
Through our clinical, research, and educational initiatives, we have provided high-quality comprehensive cleft care to thousands of patients around the world and prevented significant disability to these patients and their communities, while simultaneously training the next generation of cleft care providers and establishing long-lasting sustainable cleft care initiatives in areas around the world that need it the most.
Rami S. Kantar, MD, MPH, was born in Adelaide, Australia. He has dual Lebanese and Australian citizenships. He received his bachelor of science (BS, 2008) and medical degree (MD, 2013) from the American University of Beirut (AUB) in Lebanon. He has also received a master's in public health (MPH, 2019) from Columbia University in New York, NY.
Dr. Kantar received the American College of Surgeons 2021 Surgical Resident Volunteerism Award for his work with the philanthropic not-for-profit organization Global Smile Foundation. Rami has been a volunteer with GSF for almost a decade and is a member of its internal review board and surgical, education, and research committees. Over the last decade, GSF has provided comprehensive cleft care to thousands of patients in need around the world, preventing significant disability for these patients and their communities. Rami’s roots in Lebanon and Australia, as well as immigrating to the US for surgical training, have allowed him to truly appreciate and palpate how pronounced global disparities in surgical and cleft care are, and have been key elements behind his passion for global surgery and volunteerism.
Dr. Kantar is currently a surgery resident at the University of Maryland Medical System/Shock Trauma Center in Baltimore, MD. He will be starting his plastic and reconstructive surgery training at New York University in July 2022.
Dr. Kantar has completed research fellowships in plastic and reconstructive surgery and facial transplantation at New York University (2017–2019); experimental therapeutics and viral vector gene delivery at the Massachusetts General Hospital/Harvard Medical School in Boston, MA (2013–2015); and molecular genetics at AUB in Beirut, Lebanon (2008–2009).
Dr. Kantar's clinical interests include reconstructive surgery, cleft lip and palate, craniofacial surgery, and microsurgery. His research interests focus on global surgery, cleft lip and palate, facial transplantation, vascularized composite allotransplantation, plastic and reconstructive surgery, surgical education, and value-based surgical delivery.