Bringing together insights on better surgical care from three different continents in one symposium is no mean feat, but that’s what occurred in Hall A on Wednesday evening as delegates witnessed a first for ESCP’s Annual Congress – a new Global Surgery symposium. Per Nilsson (Sweden) opened by noting that he hopes this will become a regular fixture in future Meetings and that by extending ESCP’s reach to all continents is what will help build new platforms to facilitate crucial colorectal research.

Presentation screen from Better Surgical Care - A Global Challenge

Co-Chair Dion Morton (UK) added that there was now a global footprint in the colorectal community and that now was the time to listen to partners around the world and learn from their experiences. Dion kicked-off the lectures by introducing Professor Martin Smith (South Africa) to the stage.

Martin, from the Department of Surgery at Witwatersrand University, began his presentation, titled ‘Developments in the global trials, the impact of the Lancet commission’ by deconstructing what ‘global surgery’ meant and suggested that the notion was only a recent endeavour but one that was vital to improve the health of the world’s population. He picked out an alarming statistic that five billion people in the world cannot access safe surgery when its needed.

There is a need to influence policy, Martin noted, along with a requirement for multi-stakeholder collaborations in order to gain momentum towards real change. The role of surgery in universal health coverage was also discussed and Martin concluded that the challenge ahead lies in the ability and desire to run pragmatic international, and relevant, trials in low- and middle-income nations.

Next up, the third co-chair Sohini Chakrabortee (UK) introduced from Queen Elizabeth Hospital, Birmingham, Aneel Bhangu (UK), who continued the theme of global surgery collaboration. His talk ‘Designing trials for the global challenge’ introduced the audience to the CHEETAH hypothesis and its patient pathway. CHEETAH is one of the first large-scale in-theatre cluster randomized trials. Aneel discussed the next steps required to take the trials forward, explaining that they are under ethical consideration and that two countries with four hospitals and 200 patients per site were still required.

Stephen Tabrir was our next speaker, having travelled all the way from Ghana to address delegates at ESCP2019. His presentation, ‘The Ghana experience’, ran through what had been achieved in the country, and what support had been received to date. He went on to explain the countries ‘Hub and Spoke’ model, which sees ‘spoke’ hospitals, such as teaching, military and district hospitals feeding in to the larger, main ‘Hub’ hospital. Stephen went on to explain the training and collaboration opportunities for surgeons and non-surgeons in Ghana, citing an example of Finance Officer training as well vascular surgical training being developed.

ESCP Congress veteran, Simon Ng, was next up to present ‘The Hong Kong experience’. He began by putting Hong Kong’s role and attitude to surgical and medical research into context by pointing out that despite a population of approximately 7.5 million people, there were only two medical schools in the country. He explained that research was just not a top priority for the medical profession in Hong Kong and its main role was to provide a clinical service first and foremost, then to offer training to surgical trainees.

Inspired by ESCP and the Korean Society of Coloproctology, in 1997 Simon founded the Hong Kong Society for Coloproctology, of which he is now President, with the primary aim of promoting the advancement of coloproctology and allied subjects.

Colorectal cancer is most common cancer in Hong Kong, and this is reflected in the research undertaken to improve colorectal surgery patient outcomes, with for example, the exploration of new surgical and robotic technology.

The symposium wasn’t done there as a ‘wildcard’ entrant took to the stage to provide insight into global surgery and research in Mexico. Antonio Ramos (Mexico). Antonio highlighted that the inequality in the country’s population extends to healthcare and that Mexico has one of the lowest percentages of GPD spent in healthcare of all OECD countries, citing a lack of proper communication in the country’s Health System as a key cause for this. He called for a need for more scientific research in Mexico and the lack of such was meaning significant challenges remained in regard to colorectal surgery research. He concluded that a national surgical plan and less inequality were important factors in making notable change in the country when it comes to the required level of surgical research.

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