Written by Florence Kinder, Major Trauma Clinical Fellow, St George’s University Hospitals NHS Foundation Trust
GECCo were delighted to be invited to deliver a workshop at the international GASOC conference in Manchester in October 2024. GASOC – or Global Anaesthesia, Surgery & Obstetrics Collaboration – is nearly a decade old and has a focus to “engage responsibly and impactfully in global surgery”. The session was led initially by final year emergency medicine trainee and GECCo veteran, Anisa Jafar who had been invited to explain what GECCo’s purpose is, and then segue into the challenges encountered when engaging in global health. The session was co-led by Thomas Hampton, a final year ENT trainee and Wellcome fellow at the Liverpool School of Tropical Medicine. Tom has been part of the GECCo milieu for a few years now and it was a great opportunity to demonstrate that we truly do traverse speciality boundaries – and we know when to call in a bit of expertise! Rachel Fletcher stepped into the foray on day 2 of the conference as she represented our GECCo-themed stall.
Brief introductions revealed a broad range of participants, from medical students to consultants, from across the UK and from the expected range of surgical, obstetric and anaesthetic specialities. Keen to keep everyone awake, thinking about issues of what experience means to different people and challenging the hierarchy, it was straight into the line up game, first in order of clinical seniority and then global health experience, followed by Tom’s infamous ‘hand size’ line up. We were certain we were in a room of surgeons when this immediately became a comparison of glove size (whilst those more familiar with the Emergency Department reflected that their glove size was widely flexible, guided by whichever pair they could find at the bottom of the procedure trolley).
It provoked some interesting conversations, namely about what people constitute to be ‘global health experience’, is it the number of ‘missions’ undertaken, the length of time spent working in a specific environment, the number of contexts exposed, or the depth of personal connection to and understanding of a context – or something else entirely?
This began developing a list of topics to explore the challenges faced in ‘global health’ (or access, resource and/or context limited healthcare as we like to remind everyone) and we were able to progress this to productive breakout groups discussing some of the key areas identified by the room, namely:
- Bi-directional learning
- ‘Working differently to how we would in the UK’
- Diaspora involvement
The idea of bi-directional learning, sparked some powerful reflections on navigating the pressure of the expectation to immediately be ‘the expert’ and ‘to deliver’ when coming from a higher resource setting, as opposed to being allowed to embed yourself and take time to observe and to learn. This brought us back to initial conversations of the importance of aiming for a flat hierarchy as well as setting clear aims and boundaries – whilst making no assumptions about what colleagues in a different setting may expect or need, especially if they are more comfortable, at least initially, in a more traditional hierarchy.
Bi-directional learning also brought us back to the challenge of needing to deliver healthcare differently to how we might in our day to day roles, and typically how this can create tensions of being ethically minded but pragmatic. However, there were a lot of positives and transferable skills to be taken – the willingness to get stuck in, the true multidisciplinary teamwork so often displayed, and the revealment of the ingenuity and frugality required to succeed.
Thinking about working frugally, with less resources and technology than we might be used to in a better resourced system, brought about its own debate. Frugality is typically seen again as a negative option: the cheaper prosthetic joint, a more narrow choice of tools, however on wider discussion, we reflected that being able to do more with less and the innovative thinking that was often required, was something that our current NHS would probably benefit from. And alongside that, the value of human factor training to improve patient safety, that requires nothing other than ourselves and a buy-in from the team.
This led us into the final exercise which challenged teams to put this innovative and sideways thinking into a practical use. The group was split into 3 and tasked with planning the staffing for a Type 2 Emergency Medical Team (per WHO definition) providing care post-earthquake. They needed to think about how we apply a lateral approach to delivering healthcare and the broad spectrum of professionals needed to achieve that delivery. It once again highlighted the role of a flat hierarchy and the lack of space for egos, the need for each team member to be willing to take on a multi-disciplinary role, the surgeon as the porter, the entire team organising the pharmacy, no us and them, just we.
And in these reflections, we could see GECCo and its members, not a who or a what but simply a way. A group of people able to adapt and evolve to what is needed, just as any emergency healthcare team must do.