JOGS

1st International Congress for Innovation in Global Surgery
FIRST PUBLISHED: 20.04.2022

Inaugural Speech: Surgery in the face of low resources

“The future belongs to those who believe in the beauty of their dreams”
– Eleanor Roosevelt

I am greatly honored to be invited to speak at the inauguration of this fantastic path-breaking conference of the cream of the world of academia, discussing Global Surgery.

When I read the list of participants and stakeholders, I felt like a rag-picker, talking to royalty. Today my heart is full of joy because this conference has made my dream for over 40 years come true. Having neither the wit, wisdom, nor authority, with all my effort, I have failed to make my peers, university teachers, and surgeons in the tertiary care hospitals see the real India, harken to the voice and pleas of the rural surgeon and rural population, to tweak their decades old curriculum to be more in sync with the needs of the country. This conference with its list of academia is the answer to my dreams.

I too am a city surgeon. I worked for 59 years in Tertiary Care Hospitals, and 31 years in a teaching hospital (Photo 1). The poor live not only in rural India, over 40% of the urban population are in a state of deprivation. My ward in 1971 (Photo 2) at the J.J. Hospital had patients on the beds, on mattresses between the beds, under the beds, and in the corridor. Lack of infrastructure, and paucity of funds for diagnostic facilities accounted for the backlog.

Laparoscopy was introduced into ward 19 of J.J.Hospital and into India in 1972 (Photo 3), not as a tribute to high technology, but to provide instant diagnosis and early treatment for patients in a hopelessly over-burdened ward. Not being able to afford an insufflator, I used a sigmoidoscope pump to create a pneumoperitoneum (Photo 4).

I found that this pump was far better for the patient because all cases were done under local anaesthesia and the slow inflation of the abdomen was more comfortable for the patient. Surgeons in cities looked down upon me and diagnostic laparoscopy with scorn, ridicule, and contempt. But surgeons in rural India who had neither ego nor diagnostic facilities accepted diagnostic laparoscopy and invited me for workshops. Diagnostic laparoscopy is affordable in developing countries (Photo 5).

I am blessed in my life. Thanks to laparoscopy, from 1975, I have been granted the opportunity and privilege of traveling all over small towns and rural India to try to spread the gospel of laparoscopy. In 1975 the word “global” was unknown – so I termed it rural surgery. Every visit I made to try and teach laparoscopy I invariably returned humbled, inspired, and educated by the quality of versitality, innovation, and dedication of rural surgeons. I realized that the future of surgery and the care of the surgical poor lies in the proliferation, education, acknowledgment, and recognition of this emerging genre that with courage, improvisation, and innovation has given a new dimension to Indian surgery. They deserve our respect and support.

In an era where professors in teaching hospitals inculcate the cult of specialization and super-specialization in their residents, the rural surgeon has shown that for the vast majority of their patients, the ultimate super-specialty is wide-based general surgery. This rural super-specialist will trephine for an extra-dural, drain an empyema, do a Ceaser, a perforation, and attend to a compound fracture. The steel of the rural surgeon is tempered in the furnace of want, deprivation, and necessity and these have inculcated in their strength and qualities of ingenuity, innovation, courage, and determination to face and meet all odds. Today rural surgery as I first saw it in 1975 has grown and advanced greatly with sophistication, training, equipment, finances
because the conditions of life and economy in rural India have improved so wonderfully.

I have all my surgical life been branded as an unorthodox, heterodox, irrational, experimental surgeon for starting diagnostic laparoscopy, using the mother’s saphenous vein valve to create a ventricular – jugular shunt, free of cost, (in place of the expensive Pudenz valve) for children with hydrocephalous, using and proving the efficacy ghee
and honey dressing for infected non-healing wounds, and several such aberrations.

After six weeks of training on homemade primitive simulators the surgical teal of War 19, JJ Hospital performed the first laparoscopic Cholecystectomy. Within weeks English surgeons condescendingly wrote in Indian Journals that sophisticated, surgery was inappropriate in developing countries and sadly, Indian surgeons wrote in the Lancet, questioning the ethics and denouncing the arrogance of surgeons advocating laparoscopic surgery in India. In surgery, the truth often starts as blasphemy. Laparoscopy is today practiced all over India, India is among the world leaders in laparoscopy.

Innovations by rural surgeons faced far greater problems. As Chairman/Editor of the Indian Journal of Surgery, I was proud to publish in a Special Issue on Rural Surgery an article by a few rural surgeons on the use of mosquito-net in place of the expensive imported mesh for tension-free hernia repair, at the cost of one cup of tea. Within weeks I was castigated by the Heads of Department of teaching hospitals for lowering the standard and reputation of the Journal by publishing a paper devoid of experimental study, comparative trials, blind studies. I wrote to all a one-line reply. It is easier to perform all their requirements in a well-financed teaching hospital compared to a 10-bed nursing, home in a tribal area! I got no reply. Today mosquito net is used in MLIC for hernia repair in Africa, South America, and Asia. I repeat, “in surgery, the truth often starts as blasphemy”.

After struggling physically and mentally over the quagmire of rural surgery with all its low resource constraints for four decades, I am convinced there is only one solution. The change must come from within each country. Without funding by the country, if necessary, with foreign aid there can be no implementation. The important message is that investment in surgical services is affordable, saves lives, and promotes economic growth. India must go the whole hog, reach for the stars, and start from scratch to create an equitable health system for all – self-sustainable surgery care from the ground
up. This utopian dream will not be possible in a few years – may take a decade or more. It can and must be done.

I have a good reason for my seemingly demented optimism. Within a span of eight short years (of which two years were lost to Covid) the Narendra Modi Government has brought to every Indian village water, electricity, roads, sanitation, schools, gas for cooking, banks, digitalization, internet, and even Rotary in a few places. Then why not add surgical care? I am sure the Modi Government has the vision, strength, and resources to provide surgical and all healthcare to every part of the country. This would be a humongous government undertaking, larger than all the infrastructure for roads and
railways, but what has to be done, has to be done.

The total solution lies in creating

1. The infrastructure
2. The manpower
3. Task sharing/Shifting

1. The Infrastructure

Fortuitously this is the only government that has for the first time in over 70 odd years taken healthcare seriously and created the ambitious Health Scheme Ayushman Bharat which has two components: The First Infrastructure to have scattered all over rural India 150,000 Primary Care Centre. It must be made mandatory these Primary Centres are not mere concrete shells, devoid of planning or equipment where the doctor is often absent, and if present is unable to deal with the situation as has been the norm for several Primary Centers so far.

To make this dream of infrastructure come true each Primary Centre needs professional, meticulous planning and construction, equipment to make it perform as a Mini-Hospital, and trained manpower allocation – Surgeons, anaesthetists, nurses, and support staff. The size and capacity of the primary centre will depend on the density of the surrounding population and could vary from 7 beds to 40 beds.

If we mean business every Centre must
– Be Accessible within timely reach – hence planning in the centre’s location
– Well managed, stocked, and equipped
– Staffed by trained, committed personnel.
– Ensure it is affordable for a rural family

Timely reach is important, an emergency that has to travel 100 kilometers to reach safe surgery has a 16 times greater mortality than one within 1-10 kilometers. Cost is a major factor for patient delay or refusal to seek help. not only the patient but the entire family becomes financially crippled and in debt indefinitely as a result of treatment.

The second component of the Ayushman Bharat is that it is the world’s largest Health Insurance Scheme, which covers the cost of treatment for millions of the underprivileged. This is a gigantic overwhelming humanitarian undertaking. However, most of the patients are taken to cities or the district hospitals adding greatly to the patient burden there. Further, this is a tremendous recurring annual expense, which could well be replaced by a sustainable permanent setup. Surgery must be self-sustainable and must be taken where it is required – in rural India.

2. Workforce

There is poor reliable data for the number of surgeons, gynaecologists, anaesthetists, and nurses in India. It is reported that India has 7 Surgeons per million population, the recommended number is almost 200. How do we increase the surgeon density to staff the 150,000 Primary Centres we plan to create?

Creating a new medical college may not be a solution India already has the largest number of Medical College in the World 595. The dearth of teaching staff and that it would take 10 years for a surgeon to emerge are deterrents.

India has scores of hospitals of 500-1000 beds in the private and public sector all over the country with a very high patient load. The National Board, after examining the Hospital could grant to these hospitals 2-5 DNB seats which over 10 years would yield 10-25 trained surgeons from each hospital.

3. Task sharing/Shifting

Task sharing is not new to India. I have seen task sharing in rural India since 1975, on numerous occasions MBBS Doctors doing excellent surgery. To me, performance is more important than a paper degree. That was almost half a century ago.

Today for safe competent task sharing there must be the proper selection, training to rise to a different level, mentorship, registration, adequate financial return, and respect. A large effort is required but all the effort for motivated safe task sharing is worthwhile for there is a large pool to draw from.

MBBS doctors who have done surgical residency could be drafted into the task-sharing force after additional training. AYUSH Surgeons who are recognized by the Health Ministry on par with allopath surgeons, could similarly with some apprenticeship be part of the force. Every surgeon in India counts. Surgeons from Teaching Hospital retire at 60. Many may be happy to come on board, also provide on the spot mentorship and training.

With the quality of life having improved so meaningfully in small towns and villages, young surgeons struggling in the cities with a dog-eat-dog environment may want to or could be induced, to move to a more peaceful and satisfying workplace. Every Surgeon in India counts.

It is futile to create a large surgical workforce if there is no proportionate increase in the number of anaesthetists, nurses – qualified or task sharing. This would require appropriate activity from the respective specialties. Creation of Primary Care Centres will be built over some time for 150000 to be functional, giving time to create more surgeons, anaesthetists, and nurses over the years as more
centres become functional.

India is not the first country to have these aspirations. Mexico, Mongolia and over 15 other MLIC have already started on this path and anticipate providing safe surgery for all by 2030 – 2032. If they can why not India? Why not other MLICs?

If at the primary centres the Bellwether conditions, i.e. cases of Caesarian, abdominal emergencies, compound fractures can be safely met, 80% of surgical care in India could be done at the peripheral level, reducing the heavy patient load in the city hospitals. At AIIMS Delhi the waiting period for surgery is 4-8 months. Unmet surgical care impacts the patient, the family, their income, and further, the National economy by 2%-3% of the GDP every year. Surgical care for all is not only a humanitarian necessity but will also be a financial windfall for the country.

This goal will require full, total committed Government action, together with an active and involved Private Sector, every Medical Association, dedicated doctors involved and concerned, and friends from abroad, many of them stakeholders for this Conference, for advice, help, support, to pool their efforts in this cause. Sincere efforts and the ultimate success will be by far the greatest triumph, the ultimate success story in the history of surgery, to ensure surgical care for all. This utopian dream can take years, a decade, way beyond my time, but when the fundamental right of surgical care, and all health care is met, India will be a fair, just, better country.

“Our doubts are traitors and make us lose the good we oft might win by fearing to attempt”
– W. Shakespeare

Success is not a destination. Success is a journey, and we have an exciting heartwarming journey ahead of us.

Dr. T.E. Udwadia
Prof Emeritus
Breach Candy Hospital Mumbai
Formerly GMC & JJ Hospital, Mumbai

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Use of autologous platelet rich fibrin in minimally invasive treatment of perianal abscess

Introduction:
Fistula in ano, once called “The Royal Disease” has been described from the time of Hippocrates. The earliest successful treatment described in literature is for King Louis XIV. This common ano-rectal disorder still continues to cause significant discomfort for patients. The traditional management of perianal abscess is a cruciate incision & drainage, resulting in morbidity. The wound takes months to heal with chronic pain, scarring and discomfort. Literature reports fistula formation in 35-50% following treatment of perianal abscess.

Methodology:
This is a case series of 5 patients (3males & 2females) who presented with perianal abscess. MRI done showed intersphincteric tract in 3 patients, horse shoe abscess in one and trans-sphincteric collection in one patient. Under anesthesia, a 3mm incision was placed at the region of maximum induration. Methylene blue+ hydrogen peroxide was injected into the cavity and internal opening was visualized. A 3mm fistuloscope was inserted into the cavity through the incision and the entire cavity was visualized upto the internal opening. All slough and unhealthy tissue was removed and the walls of the cavity fulgurated(Video). The internal opening was then closed using 2-0 vicryl in a “figure of 8” pattern. Horizontal centrifugation-Platelet rich fibrin (H-PRF) was placed into the treated cavity. Patients were discharged next day and followed up for 3 months postoperatively. All patients reported minimal pain for 2-3 days and complete cessation of discharge by 2nd week without progression to fistula.

Discussion:
Conventional treatment of acute perianal abscess is a large cruciate incision at the region of maximum fluctuation and breaking the septa within the abscess cavity. This may cause damage of the sensory nerves supplying the perianal region. Use of minimally invasive methods prevents this disruption in the anatomy of the region reducing morbidity and hastens healing. Escherichia Coli and skin commensals like Staphylococcus aureus are the most common isolates from a perianal abscess. H-PRF has tissue factors that can accelerate wound healing and also has an antimicrobial effect against E.Coli and staphylococcus.

Conclusion:
Minimally Invasive Treatment of AnoRectal Abscess with H-PRF instillation helps in efficient, early, cosmetic and cost-effective healing of this painful condition.
A large section of the population in low resource or rural settings can be benefitted by this procedure with minimal modification to the operative technique.

Keywords: Anorectal abscess, VAAFT, Minimally invasive procedure, Incision & Drainage

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Machine Learning based mortality prediction model for COVID-19 patients admitted in a tertiary care hospital, New Delhi.

INTRODUCTION

SARS corona virus 2 is found to be responsible for the COVID-19 pandemic. It caused severe acute respiratory illness with a high mortality rate. This deadly disease infected around 4 crore population in India and costs around 5.2 lakh deaths. This enveloped RNA virus is transmitted from the aerosols of infected patients. The virus attaches to the host with its spike protein to ACE2 receptors of lung epithelial cells and begins its replication. The symptoms can range from mild severity like sore throat, fever, and cough to severe category like pneumonia and ARDS which leads to increased mortality. There is a huge interindividual variation in response to the virus. It is often unpredictable to decide the course of the disease. Comorbid conditions like diabetes, hypertension, and major organ failures have been known to increase the severity of the disease. Therefore, the aim of this study was to apply an interpretative Artificial intelligence algorithm for identifying the main features which decide the course of the disease.

METHODS

It is an observational study of hospitalized COVID-19 patients. 1181 RT-PCR confirmed COVID-19 patients (both alive and dead) data was used to predict the factors responsible for the course of the disease using a ML model. Twelve features were used to train [75%] and test [25%] the datasets using logistic regression and 2 machine learning methods [ XG Boost, Random Forest (RF)]. AI model interpretability was analyzed using a SHAP summary plot.

RESULTS

Among those patients analyzed using different AI models the Random Forest algorithms had higher sensitivity (83%) and accuracy (81%) on test datasets. Among the 12 features, AI interpretable SHAP summary plot showed age, kidney disease, heart disease, diabetes, male sex, and hypertension among the top rank features which have a high impact on the outcome of the disease (death).

CONCLUSIONS

We observed that AI interpretable model ranks the major factors that are contributing to the death of the patient and is able to predict the key ranking features with 83% sensitivity. Higher the age higher the risk of mortality. It also predicts that patients with heart disease, kidney disease, and diabetes are at higher risk for mortality. This model can be implemented in all healthcare facilities for risk stratification in COVID-19 patients. It helps in the proper management and taking necessary precautions beforehand.

Keywords: COVID-19, Artificial Intelligence

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Perceived impact of trauma audit filters on trauma care in a tertiary care hospital: a qualitative analysis

Trauma, external injury in combination with the body’s response, is a major threat to global population. Trauma care is time sensitive, early identification of fatal injuries and conditions are very essential for survival and care of the person. Quality of trauma care remains a big concern in LMICs. Trauma has also been recognised by SDG 3 and targets to reduce trauma burden.

We at Maulana Azad Medical College (MAMC), New Delhi conducted a survey in a hybrid setup (in-person, phone call) with Trauma Audit Board (TAB) members associated with another ongoing Project on Trauma Filters at MAMC.

AIM: To know, the creation of TAB has been useful or burden in patient, hospital management or with Physicians etc.

Composition of TAB- Medical Director of the hospital, Heads of Emergency, Anaesthesia, Radiology, Orthopaedics, Surgery etc., and Investigators associated with the project.

Method of Survey:
A semi-quantitative questionnaire to record their feedback and impression via means using hybrid setup as per the clinician’s convenience, about TAB and their opinion about such audit board meetings, it’s impact on Trauma Care and other hospital-based problems.

Link to questionnaire:
https://docs.google.com/forms/d/e/1FAIpQLSdx8qT6LKZVYTbogCbBcRGRN8rK0lpcZ0-126C0Cus-Fw6twg/viewform?usp=sf_link

Results:
Each clinician associated with project was 3.81 years. Only the MD of the hospital changed after his tenure of 2 years. Board was intact since its inception from 2017.

Clinicians noted a mean average of 7.27 on a scale of 1 to 10, after the implementation of TAB meetings.

To exemplify the scale, 2-3 popular responses as follows:
• Monitoring of Vitals like GCS, Respiratory rate, Blood pressure were noted which were earlier missed.
• Ultrasound machines were setup near patient bedside in Casualty.
• Trauma patients were managed in a more systematic way without wastage of time in inter departmental referrals.
• More responsible, more vigilant and aware as data were recorded and cases were studied in audit meetings

Other than trauma care an impact was seen in overall hospital functioning with inter-departmental co-ordination, more productivity in patient management were seen even during Covid waves with easy referrals with just an update on WhatsApp group which were initially created for the board meetings.
Many Clinicians even realised an impact on themselves with change in behavioural, attitudinal and inter-personnel skills, with such meetings they could learn from cases and functioning of other departments which would otherwise be missed. On a scale ranging from 1 to 10 when asked about how much of a burden it was attending TAB meetings on an average only 2.36% of a burden on a monthly basis which is quite negligible, as more clinicians looked upon learning more things for better patient care. Recommendation to other Institutes about such TAB meetings was a definite Yes.

Conclusion:
Findings suggest a significant difference in healthcare management in the hospital.
Results and opinions suggest such meetings should be more periodically conducted and should be recognised as part of Hospital standardization.

Keywords: Trauma, Audits, Trauma Audit Board, Positive and negative impact

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

An innovative surgical method to operate the zygomatico-maxillary-orbital complex in the absence of intraoperative computer tomography or intraoperative navigation using novel zygoma analysis and virtual surgical planning software

Introduction:
Post-traumatic residual deformities of the Zygomaticomaxillary orbital complex (ZMOC) are challenging to operate on and may require intraoperative CT or navigation. Two major reasons for this are 1) Such devices costs crores of rupees, and 2) there is no method to quantify the amount of asymmetry of ZMOC. The purpose is to evaluate the surgical outcomes in the absence of intraoperative CT or Navigation using innovative zygoma analysis software planning and novel surgical protocol in operating these patients.

Methodology:
In this prospective study, a Zygoma analysis software planning was designed. Unilateral post-traumatic residual deformity of ZMOC (>10 weeks) was included. The uninjured side of the face was used to mirror, measure, and formulate the surgical plan after comparison with the injured side using this virtual surgical software planning. The primary objective was the symmetry and stability of ZMOC. Secondary outcome variables were changes in orbital volume, diplopia, ocular motility, mouth opening, and patient satisfaction. P < .05 was considered statistically significant. Measurements were assessed on affected and unaffected sides preoperatively, postoperatively, and six months postoperatively (Figure 1 shows measurements of zygoma analysis and virtual surgical planning). Paired t-test was used to compare the continuous variables. The continuous variable changes with time were evaluated using repeated measure ANOVA, followed by multiple comparisons using the Bonferroni test. The McNemar test assessed the changes within the categorical variable. P <.05 was considered statistically significant.

Results:
Thirteen patients were included (mean age = 28.38 ± 9.54 years; male:female = 5.5:1; left:right = 7:5). The mean duration of the residual deformity was 6.66±6.43 months. There was an improvement in the symmetry, and all parameters remained stable when measured at six months postoperatively. Patients reported a median satisfaction score of 4 out of 5. There was a significant improvement in orbital volume(P = .001) and mouth opening(P = .014).

Discussion:
The zygoma analysis virtual surgical planning software protocol results are comparable to those with intraoperative CT and navigation, thus proving a cost-effective innovation. These results proved to be stable over at least a 6-month follow-up period. Measuring the asymmetry of ZMOC and formulating a surgical plan becomes easy with zygoma analysis. This method is a solution in decision-making for treating bilateral residual deformities of the midface, aesthetic malar augmentation, aesthetic malar reduction cases, bilateral fractures of the zygomatico-maxillary-orbital complex, etc. It is now possible to operate and provide predictable outcomes in these cases when intraoperative CT or intraoperative navigation facilities may not be available.

Keywords: Zygomaticomaxillary complex, ZMC, orbital fractures, residual deformities, zygoma analysis, virtual surgical planning, symmetry, trauma, fracture

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Carica papaya fruit in the management of chronic non healing ulcer wounds

Introduction
The concept of using papaya as a debriding agent came from the use of papaya latex as a debriding agent in Ayurvedic practice. Carica papaya contains proteolytic enzymes namely papain and chymopapain in the fruit, latex, leaves, stems, and roots.It contains antioxidants like caffeic acid, myricetin, alphatocopherol and kempferol. Its proteolytic action is marked in acid, alkaline, and neutral solutions and has a digestive power at a wide range of temperatures and pH. This study aims to deduce the role of Carica papaya pulp in the management of chronic non healing ulcer wounds. Method: The study was, open-labeled interventional study carried out for 18 months in the inpatient department of General Surgery at L.G. Hospital. All patients with chronic non-healing ulcer wounds including diabetic foot ulcers, who consented to participate in the study were included. Patients with pre-existing cardiac conditions or immunocompromised states, patients younger than 15years of age, mentally challenged patients and severely anemic (Hb<6gm/dl) patients were excluded.
Detailed history of the enrolled patients was taken and details like age, history of allergies and atopic nature, and any significant past surgical and medical history were noted. Local examination of the wound was done, the presence of slough, type of discharge, and nature of granulation tissue at the base of the wound.
Patients received papaya dressing – placing autoclaved dressing gauze containing well-cleaned, peeled, and quarter sliced, steam disinfected raw papaya on the wound bed which remained in situ for 24 hours. The dressing was removed after 24hours and the condition of the wound was noted. The dressing was continued in both groups till the presence of healthy granulation tissue; serous non–foul smelling discharge; and complete absence of slough at the center of the wound. Number of days for which dressing was required before achieving the end point was noted. Results
The study included 28 patients: 26 males, 2 females from ages 18 to 65 years (mean age 51 years).
The average day on which health granulation appeared was 3rd day (mean 2.8 SD 0.93).
The average end point of therapy was 7th day (mean 7.6, SD 1.7). Mean hemoglobin at the start and end of therapy was 11.10g/dl (SD 2.14) and 10.7g/dl (SD 1.97) respectively, showing relatively less blood loss.
10 (35.7%) of the patients were diabetics.
Patients reacted to the visual analog scale (with 1 being mild bearable and 10 being the severe unbearable pain experienced) with moderate bearable pain (mean 5 SD 1.4).Conclusion:In India, with the average cost of chronic ulcer wound care being USD1956/Patient and per capita income being USD 2191/Person, the financial burden of management of chronic non-healing ulcer wounds is overwhelming. Current management methods include betadine with H2O2, silver-based dressing materials, surgical debridement, enzyme extracts, etc. Dressing with Carica papaya significantly reduces the overall cost burden owing to its easy availability, reduced hospital stay and visits. The overall patient compliance is better owing to the reduced cost of treatment and reduced/no need for surgical debridement following papaya dressing.

Keywords: Carica papaya, chronic, granulation, slough, pain, ulcer

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

The Buddy System: An initiative to slow down the antibiotic misuse

The dearth of new antibiotics and rising antimicrobial resistance (AMR) is a global challenge. With almost 700,000 people losing the battle to AMR every year and another 10 million projected to die from it by 2050, AMR is killing more people than cancer and road traffic accidents combined, in India.

Easy availability of drugs, prevailing misinformation, and the absence of proper guidelines for public use have resulted in irrational antibiotic consumption. Our innovation – the “Buddy System” is in no way an alternative to these antibiotics, but, it does have the capability to slow down this process and buy us sufficient time to make amends.

AMR has multifactorial causation, however, but our focus, here, is on the patient aspect (mainly self-diagnosis and treatment). With a population of 1.38 billion, it is extremely tough to impose the regulations, so our best bet is to increase awareness. We aim to educate the general public about the rising trends of AMR and judicial use of antibiotics, enabling them to make prudent and informed choices, resulting in lesser antibiotic abuse and a flattened curve of AMR.

The Buddy System uses a hybrid of the orthodox concept of PHONE TREES and modern tactics. Our vision is to form a network, wherein interested medical students (Buddy officers) will be allotted one school each, where they will make a team of students and educate them. These school students will further train their acquaintances, relatives, and the general public, expanding our reach exponentially.

We have planned our Buddy System from scratch and have formulated a detailed plan that addresses the financial, structural, and therapeutic hurdles, including some major challenges like the lack of consistency, standardisation of data, large population size, monitoring, and feedback.

Our intervention is unique because the person at the top of this hierarchy will be a trained medical officer and hence, the data will be evidence-backed and medically sound. Further, we plan to use our biggest challenge, i.e., huge population, as our mighty asset to expand our reach. All we need is a roadmap to create a working model by reallocating and recruiting the general public in this machinery to create this self-sustaining, community-based model of preventive health care. The sole use of trained manpower makes this project very cost-sufficient and feasible.

The most critical part, however, will be to find the source of continuous motivation for all, which we know would not be easy. We are betting on our convincing skills to try and rope in the local authorities and the educational institutes. We also hope that once we will set up a basic working model, it will be easier to get good backup from our government as well as the international agencies.

Millions of dollars are being invested globally to develop antibiotics; however, our intervention provides a much cheaper and time-effective alternative. Feeding the public correct and unadulterated information and making them realise how their everyday choices will have a much wider impact than they think, will help us win the battle against AMR.

Keywords: Antibiotic Abuse, Antimicrobial Resistance, Public Health

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

SOCH – India (Students’ Orbit for Collaborative Healthcare – India)

A study reported that 25 Indian medical institutions published more than 100 articles in a year, accounting for 40.3% of the country’s total research output between 2005 and 2014, while 332 medical colleges in the country had no publications. There is a need to encourage medical students to learn about evidence-based medicine. It helps achieve the Triple Aim’s objectives of improved quality, improved patient satisfaction, and reduced costs by influencing treatment, healthcare management and policies. However, there currently exist several lacunae in the Indian medical curriculum to involve understandings of evidence-based medicine and research in its formal training programmes. Local, regional & global collaborations can help promote research, leadership, and capacity building between medical students & health professionals. SOCH – India (Students’ Orbit for Collaborative Healthcare – India) derived from the Hindi word ‘SOCH’ which means ‘a thought / an idea’ is one of India’s first medical student-led national research collaborative networks (SCRNs). It aims to provide Indian medical students with unique applied academic training experiences, as observed in UK trainee-led collaborative study models like STARSurg.

The structure of the collaborative network involves:
1. Senior mentor guidance: Higher degrees of credibility, scientific validity, efficient methodology, and impact are made possible by faculty representatives serving as the collaborative network’s guides.
2. Core Support Team: Student members of the collaborative serve as the study’s coordinators, advancing the collaborative’s goals and objectives. They are grouped into a steering committee, operations committee, research capacity building committee, writing group, statistics group and data validators.
3. Regional, State and Local Leads: Students from different regions of the country collaborate to provide data for improved generalisability.
4. Authorship: It is inclusive and stated before participation in the study. Under a single collaborative network, all members can pose as citable authors.

There are currently 606 medical colleges offering 92115 seats for medical aspirants, according to the National Medical Commission (NMC) India, the regulating body in charge of medical education and professionals. A significant proportion of this future healthcare workforce is yet to participate in research. The most common barriers medical students face to engaging in research during all years of study include lack of formal training, inadequate knowledge, time commitments, a lack of opportunities, and the absence of research culture at their universities. SCRNs can help overcome these obstacles and promote research among medical students. Furthermore, the quality and quantity of research can be potentially increased with such collaborative research models. Due to regional diversity, collaborative networks allow a multi-centric approach study with high numbers of patients in a rapid time frame. They strengthen the principles of repeatability, validity, consistency, and timely reporting of study results. SCRNs have benefits by making research more accessible, increasing time efficiency with collective training, and cultivating research into clinical practices.

As SOCH-India expands opportunities for medical students across India, a low- and middle-income country with limited resources, it can potentiate an increase in the country’s research output. It paves the long-term path forward by promoting the use of evidence-based medicine in clinical practice, therefore, enhancing the healthcare system.

Keywords: Research, Capacity Building, Medical Education, India, collaborative

1st International Congress for Innovation in Global Surgery
ABSTRACT FIRST PRESENTED: 20.04.2022

Need of an Autopsy Kit in resource limited settings

Introduction: Autopsy is a primary source of anatomical and pathological research in human body. The instruments required in autopsy depend upon the degree of detail required in dissection and the method of autopsy used. Availability of surgical instruments, in adequate quantity or variety, their logistics to the site of autopsy is a challenge.
Methodology: The question was what decisions are made regarding supplies and sterile instruments in autopsies. Systematic analysis of literature was done where research papers dedicated to Operating room inventory, field necropsy procedures and surgical kits for different parts of human body and manuals and/or guidelines for autopsies were reviewed.
Results: The number, type and cost of instruments required in autopsy depend upon the method of dissection and type of autopsy performed, viz. Minimally Invasive Autopsy (MIA), Partial Autopsy, Complete Autopsy, Complete Diagnostic Autopsy (CDA) or Virtual autopsy, decided on technical grounds, feasibility, consent and the mandate of the authority requesting the autopsy.
Discussion: A comprehensive cost effective autopsy kit with necessary inventory of commonly used instruments could be promptly made available upon requirement with essential equipments and additional instruments as needed for special circumstances to satisfy a balanced outcome.

Keywords: Autopsy, Instruments, Postmortem, Kit