Memorandum of Cooperation, Centre for Global Surgery and the Trauma and Orthopedic Research Hospital of Mongolia

The National Trauma and Orthopedic Research Center of Mongolia and the Center for Global Surgery of the McGill University Health Center concluded Memorandum of Cooperation 

On January 18th 2019, General Director of the National Trauma and Orthopedic Research Center of Mongolia, Mr. Munkhsaikhan Togtmol, and Co-director of the Center for Global Surgery of the McGill University Health Center, Mr. Dan L. Deckelbaum signed Memorandum of Cooperation. 

The parties agreed to develop mutually beneficial cooperation in human resource exchanging of health professionals; introducing relevant information technology; participation of scientists, researchers and experts in trainings, seminars, conferences; sharing the knowledge, experiences and technical skills in the field of rehabilitative service and other relevant fields. 

Director of the Division of International Cooperation of the Ministry of Health of Mongolia, Mr. Uuganbayar Tsevegsuren, Counsellor of the Embassy of Mongolia to Canada, Mr. Battushig Zanabazar and Ms. Anudari Zorigtbaatar – the Mongolian student at McGill University who had initiated the cooperation of the parties, witnessed the ceremony signing of the memorandum at the Montreal General Hospital.

Source: http://ottawa.embassy.mn/eng/index.php?moduls=101&id=394

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Trauma Registry Implementation in Ukraine

Injury surveillance through trauma registries is an important component of the healthcare system. Trauma registries provide an objective perception of the state of trauma care in a given area. Decision makers may use data from these registries to determine targeted interventions in education and prevention as well as to measure effects of such interventions on outcomes—allowing for a systematic approach to quality improvement, resource allocation, and policy change.

Currently, Ukraine does not have a national trauma registry that tracks detailed injury demographics, mechanism, type, and outcomes. This is despite the fact that in 2005, injuries were responsible for 146 per 100,000, a large proportion of which was attributable to road traffic accidents (89/100,000), according to the World Health Organization. Furthermore, the current conflict in Ukraine has led to approximately 10,000 deaths and 21,500 injuries, highlighting an acute need for enhancing trauma capacity.

The CGS has been active in Ukraine since 2012, and major highlights have included the development of a disaster preparedness plan in response to UEFA Euro 2012; implementation of the Trauma Team Training (TTT) course and training of instructors; and piloting of a trauma surveillance system in Donetsk, prior to the war.  CGS members most recently administered the TTT and Basic Life Support (BLS) courses in Odessa in July 2015 and December 2015. 

This past July, the Centre for Global Surgery (CGS) under the supervision of its co-directors Drs. Deckelbaum and Razek in collaboration with Ukrainian partners, began implementing trauma registries at emergency hospitals throughout Kyiv, the capital city of Ukraine. The sites included the National Specialized Children’s Hospital “OKHMATDYT”, the pediatric referral institution for all of Ukraine; Kyiv Emergency Hospital, the main emergency adult hospital in Ukraine; and No17 Kyiv Hospital, the second largest emergency adult hospital in Ukraine. Participating university institutions included Bohomolets National Medical University and Shupyk National Medical Academy of Postgraduate Education. The local health leadership are currently collecting preliminary data; once analyzed, this data will help determine targeted intervention to tackle the burden of injury, as well as to pass on tools for trauma registry implementation to other interested sites across the country.

At Okhmatdyt Hospital : Dr Volodomyr Povoroznuk, Nadia Demko, Dr Artem Luhovy, Dr Kristina Dzhuma, Dr Vasyl Prytula ( from left to right)

At Okhmatdyt Hospital : Dr Volodomyr Povoroznuk, Nadia Demko, Dr Artem Luhovy, Dr Kristina Dzhuma, Dr Vasyl Prytula ( from left to right)

Over the month, we also met with our partners to discuss other ideas for future collaboration, including exchanges between trainees and staff; trauma training courses in the multidisciplinary approach and patient care guidelines in the Ukrainian language. The CGS’s experience has shown that such complimentary initiatives work synergistically to augment trauma capacity. Ukraine has been an exemplary country for partnership building with the goal of capacity building for injury care. We look forward to further expanding this and other similar programs.

Outing with Drs. Kristina Dzhuma and Anton Honcharenkoat and the residents 

Outing with Drs. Kristina Dzhuma and Anton Honcharenkoat and the residents 

Written by: Nadia Demko

The Centre for Global Surgery supporting mentorship in global surgery

Interview with Dr.Mario Jacobe filmed by Dr.Fadi Hamadani in Maputo , Mozambique

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The CGS’s mission is to build trauma and surgical capacity in low and middle income countries. As part of this mission the Centre has developed significant global surgical mentorship supporting global surgery exchange programs and student’s participation in global surgical endeavors globally. More recently the CGS has welcomed a colleague from Maputo Central Hospital, Mozambique, Dr. Mario Jacobe , who spent 4 months training in the Montreal General Hospital at the McGill University Health Centre. He tells us about his experience in this interview.

How was your visit and training here in Montreal initiated?

 Dr. Jacobe: I met Dr. Dan Deckelbaum [co-director of the Centre for Global Surgery (CGS)] for the first time in Maputo Central Hospital accompanied by Dr. Otília Neves, the Head of Trauma for the Ministry of Health in Mozambique. At the time they were setting up a collaboration to implement the “Trauma Registry” in Mozambique, I was still a resident in General Surgery. Dan advised the local Mozambique leadership that the CGS would support augmenting trauma capacity in the country. So, I decided to sub-specialize in Trauma and Critical Care, and join the trauma team after doing my Residence. One year after, I met Dan again and asked for the possibility of a training in trauma in Canada, and his help to come to Canada.

What is your academic background and specialization?

Dr. Jacobe: I have finished my Basic Training in Medicine in 2006 at Eduardo Mondlane University, Maputo, while working to the Ministry of Health, and I was sent to Tete Province where I worked as a Doctor for two years in Moatize District. In 2009 I came back to Maputo for the Residence in General Surgery. Once the Specialization was done, I was hired in Maputo Central Hospital as a General Surgeon and I was also appointed as a Member of the National Trauma Executive Committee.

What exactly did you learn at the Montreal General Hospital? (skills, teaching etc.). And how are they different/similar to training you’ve had back home?

Dr. Jacobe: I have learned many things in Montreal. The most important one was the management of a Trauma Bay. As I have said, I have been working for the main hospital in Mozambique, the Maputo Central Hospital, but the way the Montreal General Hospital is organized, the available technology, the cooperation among different areas, the teaching program, the Trauma Program itself is very impressive. In Montreal, the approach of trauma patients is based on ATLS principles at the Trauma Bay. In Mozambique there is no classical trauma bay in any hospital. So, we hope to have the first classical Trauma Bay in Maputo Central Hospital after this “fellowship” in Canada.

How will you use what you’ve learned here back in Mozambique?

Dr. Jacobe: Once in Mozambique I will convince the creation of Trauma Bay in the Maputo Central Hospital and a well-organized program of training in ATLS for Doctors working in hospitals. I thing that ATLS skills without a Trauma Bay is not profitable, and vice-versa.

How would you rate your experience at the Montreal General Hospital?

Dr. Jacobe: The mini-fellowship was very good. It was the first time I worked as a Specialist abroad after I have finished my Residence in General Surgery. Although the time was too short (4 months) for a fellowship the experience was wonderful.

Trauma Team Training in Rwanda

The Trauma Team Training (TTT) course is identified as one of the rare trauma courses emphasizing on teamwork with the ultimate aim to equip doctors, nurses and other healthcare providers with appropriate knowledge and teamwork skills to safely care for injured patients and to optimize their outcomes.

 Photo taken from CNIS website (www.CNIS.ca)

 Photo taken from CNIS website (www.CNIS.ca)

The Center for Global Surgery at the McGill University Health Center in collaboration with the Canadian Network of International Surgery (CNIS), has been actively administrating this course in several Low and middle income countries including Tanzania. Most recently, the course was given at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda.

The Emergency Department (ED) at CHUK receives approximately 12,000 new patients each year where the majority are injured patients often presenting with head and extremity injuries. The ED has been under the jurisdiction of other departments such as surgery and internal medicine for many years. However, recently, the ED has started working as an independent department faced with the challenge to build capacity for its own personnel especially in trauma resuscitation. The ED has since then developed and put in place team-based multidisciplinary resuscitation systems with the TTT course contributing to the fulfillment of this goal.

The two TTT workshops have been a great success so far. All participants found the course and skills taught very useful and showed interest in having regular refreshment sessions.We are convinced that the exposure to such courses will greatly impact the quality of care delivered to trauma patients, and that team-based resuscitation skills will significantly improve especially for Emergency Department Staff.

Written by: Dr. Jean Claude Byiringiro (MD, MMED) - Head of Emergency Department/CHUK

Surgical capacity building in Ukraine

A team of healthcare professionals from the Centre for Global Surgery at the McGill University Health Centre (MUHC) recently returned from a surgical capacity building trip in Odessa, Ukraine. This was the third time that members from the Centre had traveled to Ukraine having  been to Donetsk in 2012 to help develop a disaster preparedness plan for the UEFA Euro 2012.

From July 13-17, 2015, two nurses and two trauma surgeons from the CGS provided Basic Life Support (BLS) and Trauma Team Training (TTT) courses to 26 nursing and medical staff from various hospitals in Odessa at the request of local healthcare leadership. The aim was to equip these professionals with the knowledge and skills required to respond to cardiac and trauma emergencies. In the context of the current conflict in eastern Ukraine, an effective trauma system is needed more than ever in order to help communities handle trauma and other health emergencies.

CGS team members with the graduates of the Trauma Team Training

CGS team members with the graduates of the Trauma Team Training

The training course was a collaborative initiative through contacts at the Odessa National Medical University (ONMU) and was supported by the World Health Organization (WHO).

The BLS course was taught over one day and featured an interactive workshop as well as simulations and hands-on practice on mannequins. The TTT course was taught over a three days period and included a didactic component as well as skills workshops, team building exercises, simulation and case studies.

Participants appreciated having a venue where they could reflect on how practices differed based on settings and exchange ideas with health care professionals from another country. Many participants also emphasized that trauma courses were becoming more and more crucial due to the growing number of injuries as a result of the conflict in eastern Ukraine. Overall, they were extremely grateful to have had the opportunity to participate in this training and recommended expanding the program to the entire country.

Written by: Nadine Demko

Post-earthquake response in Nepal

In the aftermath of the earthquake that hit Nepal in April of this year, there emerged a substantial need for emergency relief and support of the local health infrastructure. The Canadian Red Cross, with the support of the Government of Canada, deployed two health Emergency Response Units (ERUs), a field clinic and a field hospital. These facilities help provide quick and efficient response to emergencies and assist with the long-term needs of affected people. (www.redcross.ca)

Dr. Dan Deckelbaum, co-director of the Center for Global Surgery at the McGill University Health Center participated in the post-earthquake response and recovery with the Canadian Red Cross Emergency Response Unit. With these few pictures he shares with us his one month journey at the field hospital in Dhunche, a rural region in Nepal.