Strengthening Emergency Care in Bulgaria and Ukraine Through Partnership and Preparedness

In response to the ongoing humanitarian crisis caused by the war in Ukraine, Bulgaria has played a vital role in supporting displaced individuals, with nearly 2 million refugees having transited through the country, around 200,000 granted temporary residence status, and approximately 60,000 still remaining in Bulgaria. To help strengthen the country’s health system, the Canadian Red Cross (CRC) and Bulgarian Red Cross (BRC) partnered with the Centre for Global Surgery (CGS) at the Research Institute of the McGill University Health Centre. Leveraging its expertise in healthcare training in conflict-affected low- and middle-income countries (LMICs), the CGS secured significant funding from the CRC in June 2025. This support enabled a coordinated launch and laid the groundwork for a two-year program focused on improving emergency care capacity in both Bulgaria and Ukraine.

Over the past year, the project has moved from planning to action. Early groundwork included preparatory calls, on-site visits, and collaboration with local institutions such as the Medical University of Plovdiv (MUP) and BRC. This laid the foundation for launching Mobile Health Units and enhancing academic ties in health and disaster response. A comprehensive plan was developed, and crucial partnerships were solidified—guided by a clear needs assessment.

Between spring 2024 and 2025, major strides were made. A certifying body (European Resuscitation Council) was secured, and the first round of Basic Life Support (BLS) training was successfully completed at the Red Cross Lozen Training Facility in Bulgaria on June 16–20, 2025. A total of 118 healthcare providers—both Bulgarian and Ukrainian—were trained, including 16 future instructors.

Additionally, academic engagement deepened with the delivery of a keynote lecture on disaster resilience at the Medical University of Plovdiv, reinforcing the bridge between practical and academic healthcare systems.

Institutional exchanges also enriched the program, with visits between Bulgaria and Canada facilitating cross-border learning in prehospital care and emergency response systems. As part of its mission, the CGS continues to promote equity in surgery by ensuring that access to life-saving skills and systems is not limited by geography, displacement, or economic status—empowering providers from both host and refugee communities to deliver high-quality care.

This collaboration stands as a powerful example of how locally informed, globally supported action can build resilience where it’s needed most. With each step forward, the shared commitment between the CRC, BRC, CGS, and local institutions continues to shape a more responsive, inclusive, and equitable emergency care system for both Bulgarian citizens and Ukrainian refugees.

Driving Change in Global Surgery: Insights from the 13th CGS Annual Conference

On May 3rd, 2025, the 13th Annual Global Surgery Conference brought together 158 participants from 23 countries for a powerful day of learning, reflection, and action. Guided by the Centre for Global Surgery and organized in collaboration with the Canadian Global Surgery Trainees’ Alliance (CGSTA), this student-led event focused on the urgent theme of “Equity in Global Surgery.” More than just an academic gathering, the conference served as a platform to mobilize a global community working toward safe, timely, and accessible surgical care for all.

Keynote speaker Dr. Susan Briggs, a surgeon and faculty member at Harvard Medical School, shared powerful lessons from decades of frontline work in disaster response, emphasizing the importance of ethical, adaptable surgical systems. Dr. Dan Poenaru challenged traditional models of global health, advocating for community-led approaches and the decolonization of care. Other featured talks included Dr. Dan Deckelbaum on surgical resilience in crises and Dr. Emilie Joos on training non-surgeon clinicians in South Sudan through the innovativeVitalSurg program.

The conference also spotlighted groundbreaking trainee-led research from across Canada, Africa, and Asia. Awards were presented to Mathilde Billau -from British Columbia- for her work on trauma care in remote Indigenous communities and to Alex Kihunyu –from Nairobi- for exploring neurosurgical access in low- and middle-income countries. A new hands-on case competition placed participants in a high-stakes disaster scenario in rural Malawi, reinforcing the leadership and ethical challenges of delivering surgical care under extreme pressure.

With 92% of attendees expressing interest in returning, and strong gains reported in global surgery knowledge and confidence, the conference proved both impactful and inspiring. More than just an event, it reaffirmed a collective commitment to building equitable, inclusive systems of surgical care through collaboration, education, and advocacy.

As part of this year’s gathering, the conference was officially dedicated to the memory of Dr. Richard Deckelbaum, a visionary in global health whose lifelong commitment to equity, compassion, and collaboration shaped countless lives. In recognition of his enduring impact, the event will now carry his name moving forward. The Dr. Richard Deckelbaum Global Surgery Conference stands not only as a tribute to his legacy but as a continued call to action. Equity in global surgery is not a distant ideal—it is a responsibility we share. And this year, that call resonated with more clarity and urgency than ever before. For additional information visit our website here.

Narrative by Kacylia Proulx

Three health professionals from the MUHC-MGH recognized!

CGS Co-director Dr. Dan Deckelbaum and Cedric Gibouin -MGH Operating Room Nurse.

CGS Co-director Dr. Dan Deckelbaum and Eric Villeneuve -MGH Pharmacist.

The Centre for Global Surgery (CGS) and the Global Surgery Foundation (GSF) acknowledged the significant contributions of pharmacists Madeleine Genest, and Eric Villenueve and operating room nurse Cedric Gibouin, all from MUHC–Montreal General Hospital, who provided valuable input for the development of the Damage Control Surgical Modular Concept for the United Nations Medical Support Section. This section plays a vital role in supporting the overall operations of the United Nations by providing essential healthcare to deployed staff worldwide.

These health professionals’ expertise was essential in shaping a modular approach designed to address both low and high acuity needs in emergency and trauma surgery, as well as mass casualty scenarios. Their contributions are especially relevant for rapid deployment to conflict zones, where flexibility in medical care delivery is critical.

This important work supports the United Nations mission in assisting member states, particularly in high-risk environments.  Madeleine Genest, Eric Villenueve and Cedric Gibouin were formally recognized for their dedication during the 23rd Annual LD MacLean General Surgery Visiting Professor event on May 8, 2025.

CGS and the GSF expressed their gratitude for their commitment and the lasting impact their expertise is expected to have in these challenging settings.

Advancing Trauma Care in Nepal: CGS’s Successful TDTR Training Course

From April 23-25, 2025, in collaboration with Dhulikhel Hospital and Kathmandu University, CGS, co-directed by Drs. Deckelbaum and Grushka, successfully delivered its second Trauma and Disaster Team Response (TDTR) course in Nepal -under the grant from the Royal College of Physicians and Surgeons of Canada. This three-day training targeted a diverse group of 32 healthcare professionals—including medical officers, paramedics, nurses, residents and interns—with a gender distribution of 65% male and 35% female.

Participants began the course by completing an online lecture series hosted on the United Nations Global Surgery Learning Hub (SurgHub), laying a solid theoretical foundation. The in-person component emphasized practical skill stations, team-based intraprofessional simulations, and interactive exercises essential for trauma care and disaster response.

Post-course surveys reflected significant improvements in core competencies. For example, 25 out of 27 participants reported either “a lot of improvement” or having “mastered” the skills related to trauma care and disaster response. Similar gains were observed across technical skills such as airway management, chest decompression, and spine immobilization, as well as in understanding team roles, transfer protocols, and the value of trauma registries.

Participant feedback also highlighted the effectiveness of the course’s hybrid structure. All participants “agreed” or “strongly agreed” that the balance between online learning, live Q&A, and in-person skill sessions was appropriate (100%), and that the content was relevant to their professional training (100%). Lectures were widely considered accessible and clearly delivered, and 89% felt the instructors were available and responsive. Moreover, participants valued the opportunities to apply learned concepts in practice, and most rated the hands-on components as well-matched to their skill level.

Results from the skills assessment indicated significant improvements among participants. Notably, approximately 93% of respondents reported a lot of improvement or mastery in performing surgical airway techniques. Similarly, spine immobilization skills showed the highest gains, with about 96% of participants indicating substantial improvement or mastery. Splinting skills were also enhanced, with roughly 82% of respondents reporting a lot of improvement or mastery. These figures reflect the course’s effectiveness in advancing practical competencies critical to trauma care and disaster response.

Feedback highlighted strengths including effective instructor engagement, clear explanations, and relevant practical exercises that fostered teamwork. However, participants noted challenges with limited time allocated for hands-on practice and large group sizes. Recommendations included extending skill station duration, conducting exercises in real clinical settings, and adhering to course schedule.

This recent TDTR course, which trained 4 new instructors and 28 new healthcare professionals, further exemplifies CGS’s commitment to strengthening healthcare systems in resource-limited settings—made possible by the generous support of the Royal College of Physicians and Surgeons of Canada.

Strengthening Trauma and Emergency Care in Senegal: TDTR & PHC Training

To address critical gaps in trauma and emergency medical care, the Centre for Global Surgery (CGS), in partnership with the Gaston Berger University, successfully implemented two essential courses in Saint-Louis, Senegal, on February 26-27 and February 28, 2025 in French. The Trauma and Disaster Team Response (TDTR) and the Prehospital Care Training (PHC) courses were specifically designed to enhance the capacity of both healthcare professionals and non-healthcare responders in trauma management, with a strong focus on fostering surgical equity and improving access to urgent care in underserved regions.

The TDTR course trained 45 healthcare professionals, including surgeons, emergency doctors, nurses, and students, with a participant breakdown of 73% males and 33% females. It equipped them with essential skills for managing trauma in disaster settings. The course consists of two components: an online portion featuring didactic lectures, available for free on the UNITAR platform, and an in-person segment that includes team exercises and simulations. Of those who provided feedback, 97% expressed strong satisfaction with the knowledge they gained, either strongly agreeing or agreeing with the course's effectiveness.

The Prehospital Care (PHC) course, attended by 35 participants, mainly firefighters, focused on equipping emergency responders with critical skills for the early stages of trauma treatment. Designed based on a local needs assessment, it emphasized the importance of training non-healthcare providers. Practical skills such as chest compressions, wound packing, and airway management were specifically selected to address urgent medical needs in the prehospital setting, especially in rural and underserved areas where healthcare access may be limited.

The courses combined on-site presentations and discussions with in-person simulations, ensuring participants received both theoretical and practical experience. The structure was designed to overcome barriers identified in the needs assessment, such as limited resources and time constraints. The emphasis on hands-on practical sessions, interactive simulations, and group discussions provided participants with the tools they need to respond effectively in emergency situations.

This initiative, supported by CGS, the Royal College of Physicians and Surgeons of Canada, and local partner Gaston Berger University, is a key part of the effort to provide surgical equity. It strengthens local healthcare capacities and fosters long-term improvements in emergency medical response, ensuring that more communities in Senegal have access to the critical care they need, particularly in times of disaster and trauma.

CGS and Juzoor Deliver Groundbreaking TDTR Course at Al Makassed Hospital in East Jerusalem

In the noteworthy collaboration between the Centre for Global Surgery (CGS) and Juzoor for Health and Social Development, the Trauma and Disaster Team Response (TDTR) course was successfully delivered to Palestinian healthcare professionals at Al Makassed Hospital in East Jerusalem. This training initiative aimed to enhance the learning experience and strengthen trauma care response—critical needs in a region deeply affected by ongoing conflict.

Held from February 4-6, 2025, the course trained 28 healthcare professionals from across Palestine, including surgeons, physicians, nurses, paramedics, and residents. Designed to equip participants with essential skills for managing trauma patients in disaster and conflict settings, the course addresses the urgent need for qualified medical professionals in the region’s strained healthcare system.

Given the ongoing conflict, the need for effective medical response is critical. The CGS TDTR course empowers local professionals to manage complex trauma and mass casualty situations, directly improving their ability to treat the wounded. The course plays a crucial role in strengthening the region's healthcare capabilities. It combines online lectures (available for free on the UN platform) with in-person training, including skills stations, team exercises, and simulation-based learning, ensuring both theoretical and practical expertise.

A key highlight of the program is its sustainability. Of the 28 trainees, 6 new trainers were trained, expanding the capacity of the local healthcare system. These newly trained trainers will now pass on their knowledge to other healthcare professionals, amplifying the course's impact across the region.

The Juzoor Hospital team, now consisting of CGS-trained local leaders, successfully led the course, marking an important step in Juzoor’s transition to independently delivering the TDTR course, ensuring long-term sustainability. This collaboration highlights the dedication of Palestinian healthcare professionals in strengthening their healthcare system, even in the face of significant challenges.

With continued support from CGS and the Royal College of Physicians and Surgeons of Canada, through its International Development, Aid, and Collaboration funding program facilitated by Royal College Canada International, this partnership is committed to expanding trauma care capacity, empowering Palestinian healthcare professionals, and ensuring that the knowledge gained will benefit the community for years to come.

Key Highlights from the Centre for Global Surgery in 2024

As 2024 comes to a close, the Centre for Global Surgery (CGS) reflects on a year of meaningful progress in its mission to improve global health through surgical care. From January through the fall, CGS has advanced initiatives that expand access to quality surgical services, foster international collaboration, and drive innovation in global healthcare. This article highlights the Centre’s major accomplishments and milestones throughout the year, showcasing its unwavering commitment to transforming global surgery and enhancing healthcare outcomes worldwide.

To view the continuation click here.

Additionally, you can read the full summary in the Summer-Fall Square Knot Newsletter, prepared by the McGill Department of Surgery.

Pioneering Remote Care: A Vision for Mars!

Exciting news! The CGS's Co-Director, Dr. Dan Deckelbaum, is leading an innovative partnership with the Canadian Space Agency at the Steinberg Centre for Simulation and Interactive Learning. Drawing on his expertise from working with partners in war zones and under-resourced settings, he’s developing a way to deliver remote medical care on Mars!

To Learn more visit: ow.ly/3NEl50Tzrnf

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Des nouvelles passionnantes !

Dan Deckelbaum, codirecteur du CCM, dirige un partenariat novateur avec l'Agence spatiale canadienne au Centre Steinberg pour la simulation et l'apprentissage interactif. S'appuyant sur l'expertise qu'il a acquise en travaillant avec des partenaires en zones de guerre et des régions dépourvues de ressources, il met au point un moyen de fournir des soins médicaux à distance sur Mars !

Pour plus d'information visitez: ow.ly/3NEl50Tzrnf

CGS Awarded $90K Grant from RCPSC to Expand GLOBal Training Initiative

🎉 The Centre for Global Surgery (CGS), led by co-directors Dr. Deckelbaum and Dr. Grushka, is thrilled to announce that it has been awarded a $90K grant from the Royal College of Physicians and Surgeons of Canada, through its International Development, Aid and Collaboration funding program facilitated by Royal College Canada International. This 3-year funding will support CGS’s international training initiatives in low and middle-income countries (LMICs), focusing on Nepal, Palestine and Senegal.

This generous support will enhance CGS’s Trauma and Disaster Team Response (TDTR) course, allowing CGS to collaborate with partners and expand to more low-resource settings. The project includes training local health workers, establishing sustainable training structures through local trainers, and ensuring equal access and gender representation among participants and trainers.

By providing continuous mentorship, CGS will help trainers and trainees improve their clinical and teaching skills, fostering long-term advancements in medical education and healthcare within their communities.

CGS is excited about the impact of this funding and grateful to the Royal College of Physicians and Surgeons of Canada for their belief in the mission. Stay tuned for updates on progress and follow CGS on social media to learn more about the work.

CGS’s TDTR Course Ranks 2nd on United Nation’s Platform, Enhancing Global Education Accessibility

Image courtesy of UN Global Surgery Learning Hub

The Centre for Global Surgery (CGS) is pleased to announce that, through its partnership with the United Nations Institute for Training and Research (UNITAR) and the Global Surgery Foundation (GSF), its Trauma and Disaster Team Response course (TDTR) has gained notable recognition on the SURGhub platform. Since its launch on June 28, 2023, the course has become the second most popular, with over 850 enrolled learners. As of September 29, 2023, it has also been available via a mobile app for both iOS and Android devices.

The TDTR course is designed to improve care management for injured patients, including disaster response, with a multi-disciplinary approach tailored for frontline healthcare workers in low- and middle-income countries (LMICs). It features a hybrid-learning format, combining online lectures with in-person skill sessions, including team exercises and simulations. To explore the course in detail, click here.

Since its inception, the TDTR course has been delivered in partnership with local organizations in LMICs across Asia, Eastern Europe, sub-Saharan Africa, and the Middle East. Both the online and in-person components have been successfully implemented. The TDTR online component is available free of charge in English and French.

Participant Demographics

Since the UN SURGhub platform’s launch in 2023, over 804 learners have enrolled in the English version of the online course, and 47 in the French version. Participants from over 85 countries, particularly from LMICs, have joined, demonstrating a diverse range of specialties and professions, including Trauma and General Surgery, Obstetrics and Gynecology, Emergency, Critical Care, Orthopedics, Anesthesia, Nursery, Pediatrics, among others.

Feedback and Insights

1. Overall Satisfaction: Participants have expressed satisfaction with the course content and delivery. One participant noted, "The course provided valuable insights into managing trauma patients that are applicable to my role in an emergency and trauma setting."

2. Relevance and Practicality: Feedback highlights the course’s relevance to participants, especially in LMICs. Another participant mentioned, "The practical approach of the course, combined with theory, helps participants gain the essential knowledge needed to save lives."

3. Learning Outcomes: Participants have reported significant improvements, including better preparedness for disasters and enhanced patient-care skills. They noted a better understanding of critical care procedures and effective crisis communication.

4. Course Delivery: Instructors have been praised for their expertise and engaging teaching style. Participants appreciated the clear explanations and interactive sessions that enriched their learning experience.

5. Areas for Improvement: While feedback is mostly positive, suggestions include adding more regional case studies and increasing interactive elements in online modules.

SURGhub Platform and CGS Partners

The virtual platform has been crucial in making the CGS TDTR course accessible worldwide. It allows learners to access online lessons through their mobile devices, making it easier for healthcare workers to complete the course from almost anywhere and at their own pace. Upon completing the lessons and quizzes, participants receive a UN certificate from the platform, validating their advanced knowledge and skills.

Since the TDTR course was made available on the UN SURGhub platform, the following partner countries have completed both the online and in-person components:

• Tanzania:34 participants, Aug 16-18, 2023

• Nepal: 36 participants, Aug 29-31, 2023

• Palestine: 25 participants, Dec 26-27, 2023

• Nepal: 23 participants, Jan 11-12, 2024

• Senegal: 35 participants, Mar 20-21, 2024

• Nepal: 33 participants, May 7-9, 2024

Since the UN SURGhub platform’s launch, 186 healthcare workers from CGS’s partner institutions, including Muhimbili Orthopaedic Institute in Tanzania, Dhulikhel Hospital in Nepal, Juzoor for Health and Social Development hospital in Palestine, and the Gaston Berger University in Senegal, have completed the online component. Additional learners from around the world have also joined the platform to improve their skills.

Future Actions

In response to the growing interest from additional institutions and countries, CGS is poised to broaden the reach and content of the TDTR course. The organization plans to continue expanding its efforts to improve trauma care in low-resource settings by increasing the course’s availability and accessibility. Future actions include partnering with more local organizations, enhancing course content based on feedback, and exploring new delivery methods to support healthcare workers globally.

CGS is committed to advancing trauma care worldwide and will work towards further integrating the course into more regions, ultimately aiming to elevate care standards and support frontline workers in their critical roles.

Acknowledgements

CGS extends its gratitude to all collaborators for their invaluable contributions to the TDTR online component, to UNITAR and GSF for its support; and to the MGH Foundation and its donors for their continued backing of CGS’s international initiatives to enhance trauma care globally.