Publications

On May 3rd, 2025, the 13th Annual Global Surgery Conference gathered 158 participants from 23 countries under the theme of Equity in Global Surgery. Organized by the McGill Chapter of the Canadian Global Surgery Trainees’ Alliance (CGSTA) in collaboration with the McGill Centre for Global Surgery (CGS), this hybrid event aimed to reimagine global surgery education through principles of inclusion, decolonial practice, and shared leadership. The program featured keynote lectures, trainee research presentations, and a disaster-response case competition. Voluntary pre- and post-conference surveys (n=45) suggested increases in participants’ self-reported understanding of global surgery, confidence in pursuing related opportunities, and awareness of equity-oriented strategies. Mean knowledge scores increased from 3.16 to 4.12 (+0.96), with the largest gains in familiarity with global surgery programs (+1.17) and confidence applying for related opportunities (+1.23). As responses were anonymous and unpaired, findings are descriptive and exploratory. This hybrid and low-cost conference model led by trainees offers a practical framework for advancing equity and engagement in global surgery education.

Africa faces a US$66 billion annual health financing gap, compounded by a sharp decline in official development assistance and persistent constraints on domestic public expenditure. While domestic allocation remains central to health financing, it alone cannot compensate for this critical gap. Blended finance, the strategic use of public or philanthropic capital to mobilize private investment for development outcomes, presents a credible opportunity to narrow this gap in parallel with increased domestic allocations.

This commentary examines how existing platforms in Africa could advance blended finance for health. The Program for Investment and Financing Africa’s Health Sector (PIFAH) serves as a continental platform for pipeline development and investment structuring, offering AU endorsement, government buy-in, and a pool of bankable health investment opportunities through its Health Market Atlas. This creates a fertile ground for collaboration with health-focused blended-finance initiatives such as the Transform Health Fund (THF), which bring the financial structuring expertise and an established track record needed to attract development finance institutions and private investors to health.

We argue that PIFAH’s sovereign-anchored pipeline, when overlapped with health-focused blended finance facilities like THF, can generate the early evidence needed to establish African health markets as a credible destination for commercial capital. While structural risks around equity, governance, and capital concentration require deliberate design, an operational framework anchored by PIFAH linking the Health Market Atlas to a cohort of facilities could offer a scalable and replicable pathway to strengthen private capital-supported health financing that neither public platforms nor blended finance facilities can mobilize alone.

Background: Despite proven efficacy of case logging systems to track volume, breadth, and progression of surgical experiences, they can be burdensome in low- and middle-income countries (LMICs). In this study, we evaluate the current use of the Pan-African Academy of Christian Surgeons (PAACS) case log system. This study is the first to examine the challenges of surgical case logging from the perspective of trainees and faculty in LMICs.  Methods: We used a multi-method qualitative design consisting of focus groups, individual interviews, and a survey. 44 people participated in either focus groups or one-on-one interviews representing 11 PAACS training programs. One focus group consisted of 23 faculty members while the other consisted of 13 residents. Eight individual interviews were conducted at two hospitals. Everyone who participated in the study was asked to complete a 26-item survey. Results: Necessary case log entry fields based on majority agreement between residents and faculty during focus groups and interviews included: procedure, date, post-operative diagnosis, patient identifier, sex, age, degree of supervision, and outcome. Three parameters were unanimously deemed “non-negotiable” for a future case log system in the LMIC context: mobile compatibility, offline data collection, and adherence to the residency accreditation governing body. Survey results revealed over 70% of surgical residents and faculty felt the current logging system should be restructured or completely replaced. Conclusions: This study highlights LMIC-specific barriers as described by PAACS surgical residents and faculty- including intermittent internet accessibility, reliability, and cumbersomeness that must be mitigated in the next generation of case-logging systems.

Background: Perioperative pain management is constantly evolving, with recent advances trending toward multimodal techniques to decrease overall narcotic use. The intersection of culture and perioperative pain control is not well studied. Our study evaluates perioperative anesthesia and pain management strategies in Low-to-Middle Income Countries (LMIC) as compared to High-Income Countries (HIC). We hypothesized that postoperative pain scores and narcotic use would be different between the two settings.  Methods: A retrospective chart review was performed on patients undergoing thyroidectomy on a medical mission trip to Carmona, Cavite, Philippines and at a tertiary medical center in Memphis, Tennessee, USA. Institutional review board approval was obtained from both institutions. Variables included operation, indication, anesthesia modalities, narcotic use in morphine milligram equivalents (MME), and postoperative pain scores. Univariate analyses were completed to compare narcotic use and postoperative pain scores between patients in HIC and LMIC settings.  Results: Forty-four patients were included for analysis. Sixteen patients underwent total thyroidectomy and twenty-eight underwent partial thyroidectomy. Patients in LMIC settings received less non-narcotic anesthetic modalities (3 vs 4, p < 0.01) and less MME (30 vs 60, p 0.05).  Conclusion: In this small observational study, patients undergoing thyroid operations in HIC settings were administered more diverse anesthetic modalities, and despite comparable postoperative pain scores, received higher total MME than patients in LMIC settings. These differences suggest that the relationship between perioperative narcotic use and postoperative pain is variable and may not be directly correlated in patients undergoing thyroidectomy. Differences in cultural or institutional practices may influence perioperative narcotic prescribing in these settings.

Background: Organ transplantation is a critical treatment for end-stage organ failure, yet its success hinges on availability of donor organs and public willingness to donate. In Uganda, with a newly established transplantation program, healthcare students are future key advocates. This study assessed the knowledge, awareness, and attitudes toward organ donation among Ugandan healthcare students. Methods: A cross-sectional study was conducted among 400 undergraduate healthcare students from ten Ugandan universities, using a structured online questionnaire. Data were analyzed using SPSS version 20. Knowledge was assessed using 15 questions and categorized using the median score into higher or lower scores (≥8 vs ≤7). Attitudes were measured on a 5-point Likert scale. Factors associated with higher knowledge scores were examined using univariable logistic regression for each demographic variable, yielding crude odds ratios (OR) with 95% confidence intervals (CIs). A p-value < 0.05 was considered statistically significant. Results: Although general awareness was high (89.0%), the overall knowledge was low, with a mean score of 6.62 (±1.91 SD) out of 15. Only 33.5% of students had a higher knowledge score (score ≥8). Knowledge was particularly poor regarding legal frameworks (23.0% correct) and the identification of eligible organs (6.2% correct). Knowledge of clinical brain death criteria was notably low, with only 30.3% correctly identifying the apnea test and only 9.3% aware that a neurologist's involvement is not compulsory. Attitudes were overwhelmingly positive at a systemic level, with strong support for national policies (96.5%) and government funding (96.5%). Students showed more favorable attitudes toward receiving an organ (84.8%) than toward donating. No demographic factors, including age, sex, program, year of study, or religion, were significantly associated with higher knowledge scores in univariable analysis. Conclusion: Ugandan healthcare students demonstrate high awareness and strong support for organ donation but possess significant knowledge gaps and personal hesitancy. There is an urgent need to integrate comprehensive, structured education on the ethical, legal, and clinical aspects of organ donation into medical curricula to prepare students as confident and informed champions for Uganda's nascent transplantation program.