American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

On the Shoulders of Giants: The Impact of Meaningful Mentorship in Global Surgery Training

Megan Vu, MDBeginnings

Growing up as the eldest child of an immigrant family, I learned what it meant to be a person from two cultures. Thanksgiving in my home state of Florida featured the standard turkey and stuffing with an accompanying side of Vietnamese phở. My grandmother’s stories of coming over to the U.S. after the war in 1975 made me both proud and grateful to be an American. Motivated by my heritage, I joined the U.S. Navy in medical school. I served my first year as a surgical intern at the Naval Medical Center San Diego. My interest in global health continued to develop as I was surrounded by Navy surgeons who had been to every part of the world. With guidance from these senior surgeons, I attempted to prepare for my future deployment by gaining exposure to essential surgical subspecialties such as orthopaedics and obstetrics and gynecology.

Global Surgery Residency

I continued my general surgery training at the Baylor College of Medicine (BCM) in the global surgery track. In July 2018, I entered my first global surgery year and began multidisciplinary training in several surgical subspecialties. These skills were refined during the 2018 BCM Tropical Surgery, Obstetrics and Gynecology CME Conference and through the global health courses offered during the American College of Surgeons Clinical Congress. After receiving this domestic training, I began my first international rotation in Malawi, which was facilitated by Texas Children’s Hospital (TCH) Global Health. I worked closely with providers in maternal health, learning the importance of local capacity building and the need to address maternal mortality and neonatal death in low- and middle-income countries (LMICs). I saw firsthand the physical and social damages of obstetric complications. But I also found hope in places like the Freedom from Fistula Centre at Bwaila District Hospital and the Area 25 Health Centre, which has enhanced both local obstetric delivery and surgical capacity with four new operating theaters. This was a particularly unique experience, as Area 25 also features an innovative maternal waiting home sponsored by the Bill & Melinda Gates Foundation, which allows high-risk obstetric patients to reside on campus to prevent delayed access to obstetric and neonatal care. Mothers also have the opportunity to learn about nutrition, family planning, technical skills, and agriculture through the sustainable permaculture program.

Pediatric Surgical Disparities

While working at Kamuzu Central Hospital in the capital city of Lilongwe, I met Dr. Bip Nandi, the only pediatric surgeon outside of Blantyre in the south of Malawi. I was lucky to assist Dr. Nandi in the brand-new children’s operating theatre by KidsOR. With a small but dedicated team, Dr. Nandi cared for children with a wide range of surgical problems, including inguinal hernia, intestinal atresia, gastric volvulus, imperforate anus, Wilm’s tumors, and more. There were many cases that inspired hope, but the disparities between LMICs and high-income countries (HICs) were clear. For example, children with gastroschisis born in an HIC have a survival rate of greater than 90 percent, whereas children in sub-Saharan Africa carry mortality rates of greater than 90 percent.1 As an aspiring pediatric surgeon, this stark contrast hit home. More than 50 percent of people in LMICs are children, and at least 85 percent of them will have a surgically treatable condition by age 15.2-4 These children will develop life-long complications or die if untreated.

From right to left: Drs. Megan Prin, Megan Vu, Bakari Rajab, Clare Algeo, and Mary Stokes at Kamuzu, Central Hospital in Lilongwe, Malawi

A Way to Việt Nam

At the 2018 American Pediatric Surgical Association conference, I met Dr. Marc Levitt. He invited me to learn more about pediatric colorectal surgery at Nationwide Children’s Hospital in Columbus, OH. It was an amazing experience, during which I met Dr. Uyên Thị Bích Nguyễn, a pediatric surgeon from Ho Chi Minh City (HCMC). In February 2019, I joined Dr. Levitt and the Colorectal Team Overseas on their surgical and educational mission to Đà Nẵng Women and Children’s Hospital. In conjunction with local surgeons, we cared for children with anorectal malformations, Hirschsprung’s disease, and complex cloacal anomalies. While there, I connected with Dr. AiXuan Holterman, founder of the International Pediatric Specialists Alliance for the Children of Vietnam (IPSAC-VN), and developed plans to engage in further research and capacity building efforts in Việt Nam. I was primarily based at Bệnh Viện Nhi Đồng 1 (Children’s Hospital 1) with Dr. Nguyễn and Dr. Thanh Quang Lê Đinh, and I also had the opportunity to meet with physicians at the National Hospital for Pediatrics in Hà Nội regarding our project on biliary atresia. As a first-generation Vietnamese American, being able to care for children in Việt Nam was a dream come true.

Dr. Vu with physicians and nurses from surgery, anesthesiology, critical care, and emergency medicine during the Pediatric Acute Surgical Support course at City Children’s Hospital in Ho Chi Minh City, Vietnam

Working at the World Health Organization

My first global surgery year concluded with an internship at the World Health Organization (WHO) headquarters in Geneva, Switzerland. I worked closely with Dr. Walter Johnson, lead for the WHO Emergency and Essential Surgical Care Program (EESC), and learned a great deal about the international frameworks that guide global surgery efforts. The EESC aims to strengthen surgical systems to achieve universal health coverage and attain the sustainable development goals. I also assisted in organizing the 8th Biennial Global Initiative for Emergency and Essential Surgical Care (GIEESC) Conference in Bangkok, Thailand, and the Technical Meeting on Global Surgery, Obstetric, and Anaesthetic Care at World Health Assembly 72 in Geneva.

From right to left: Drs. Megan Vu and Rachel Davis at the Palais des Nations during World Health Assembly 72 in Geneva, Switzerland

Back to Residency

Since returning to general surgery rotations in June 2019, I have continued to work on global surgery projects, including with Prof. Kokila Lakhoo and the Global Initiative for Children’s Surgery and with Dr. Holterman and IPSAC-VN. Dr. Nguyễn and I have also continued our work on pediatric surgical education in Việt Nam with case-based learning conferences held remotely across the Pacific. While travel has slowed down due to the spread of coronavirus, I am grateful that digital platforms have enabled ongoing global collaborations.

Conclusion

Dr. Halfdan Mahler, the third director-general of WHO, declared surgery the “most serious manifestation of social inequity in health care.”5 With 5 billion people without access to surgery, I sense a moral imperative for physicians, nurses, public health experts, ministers of health, and government officials. I am grateful for the many opportunities afforded to me by my mentors around the world. Armed with the foundational knowledge and unique experiences from my junior global surgery year, I look forward to growing each day as a surgeon as I enter my fourth year of general surgery residency. I am ecstatic to be part of the RAS-ACS Global Surgery Working Group and know that we will accomplish great things together.

Dr. Megan Thùy Vũ is a global surgery resident at Baylor College of Medicine in Houston, TX. In addition to the five-year clinical general surgery program, she has dedicated an additional two years to cross-training in specific subspecialties (such as point-of-care ultrasound, orthopaedics, OBGYN, rural, burn, and pediatric surgery) and to engaging in global surgery research and advocacy to prepare for a career in academic global surgery. Her professional interests include global pediatric surgery, trauma in combat and austere settings, and global surgical training and educational program development. Follow Dr. Vu on Twitter @megvu.

References

  1. Wesonga A, Situma M, Lakhoo K. Reducing Gastroschisis Mortality: A Quality Improvement Initiative at a Ugandan Pediatric Surgery Unit. World J Surg. 2020;44(5):1395-1399. doi:10.1007/s00268-020-05373-w
  2. United Nations Population Division. 2019 Revision of World Population Prospects. Published online 2019. Available at: https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf. Accessed June 18, 2020.
  3. Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. Published online 2002. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567648/. Accessed June 18, 2020.
  4. Farmer D. Audacious Goals 2.0: The Global Initiative for Children’s Surgery. J Pediatr Surg. 2018;53:2-11.
  5. Mahler H. Surgery and Health for All. Address presented at the XXII Biennial World Congress of the International College of Surgeons. June 29, 1980; Mexico City. Available online at: who.int/surgery/strategies/Mahler1980speech.pdf. Accessed June 18, 2020.