The Modern International Surgical Mission Starts Local and Stays Local

The plastic surgery team poses together at the hospital in Kigali, Rwanda.
The plastic surgery team poses together at the hospital in Kigali, Rwanda.

Key Takeaways:

  • Surgical missions that focus on training and mentoring local surgeons to perform advanced procedures, rather than just performing surgeries and leaving, demonstrate immense impact.
  • Plastic surgery missions in Rwanda prioritize microsurgery training, addressing the last real gap in plastic surgery care in Sub-Saharan Africa, and equipping surgeons with the necessary skills and resources.
  • A commitment to research is critical to capacity building and ensures that local surgeons can generate and publish their own data, fostering long-term development and nuanced advances in surgical care.

We spoke with Christine Rohde, MD, MPH, the chief of plastic surgery, about advancing plastic surgery care worldwide. Dr. Rohde serves as the Research Co-Director for SHARE [Surgeons in Humanitarian Alliance for Reconstruction, Research and Education], a new program through the Plastic Surgery Foundation dedicated to improving care and surgical capacity through collaboration across the globe

How does SHARE approach surgical missions differently than many organizations have in the past? 

People think of traditional mission trips as a team that goes and does a bunch of operations and then you leave, but that's really not a modern-day surgical mission. What we're about is teaching, providing resources, and providing mentorship to surgeons around the world so that they can do the optimal surgeries for the communities where they live. Essentially, we’re visiting professors. We partner with the American College of Surgeons Health Outreach Program for Equity in Global Surgery (ACS H.O.P.E.) and right now are sending surgeons to Kigali, Rwanda to collaborate with the two plastic surgeons there, teach plastic surgery residents, and help with their curriculum. 

What types of surgical teaching are prioritized on these missions? 

I go as part of a microsurgery teaching group, but we also have hand surgery, burn surgery, general reconstruction, cosmetic surgery, and craniofacial surgery. Microsurgery is about moving tissue from one part of the body to another and then hooking up the blood vessels under a microscope. When we think about the last frontier of plastic surgery in Sub-Saharan Africa, it is microsurgical reconstruction, because the surgeons there have the equipment and surgical expertise to do pretty much everything that we do here.

Plastic surgery residents operate alongside attendings and visiting professors
Plastic surgery residents operate alongside attendings and visiting professors, including Dr. Christine Rohde.

Why is microsurgery the “last frontier?”

It might just be under-resourcing, but microsurgery requires extra training. It requires special instruments and experience in dealing with transplanting tissues around the body. And of course, it usually requires an operating room microscope. So, it’s kind of been something that has not been pursued in Africa until recently. That’s why we send the group in a way that they need the most, with a focus on microsurgery.

Will you give us a rundown of the microsurgery training program?

We do a series of lectures going from basic to advanced microsurgery, and then we do simulations. Plastic surgeons have developed a variety of ways to do microsurgery simulations. We even have a cell phone model; we can use a cell phone and a cell phone stand just to practice looking through and not looking at your hands. One of the plastic surgeons who joined us this past year has developed a 3D-printed, very inexpensive microscope that's portable. Then we do surgery, and we teach the residents the same way that we do here. We take them through the operation, let them do the parts that they feel confident about, and we talk about how to care for the patients before and after.

What kind of impact has the program had so far?

The program has been so successful that surgeons in Tanzania, Ethiopia, and Kenya want us to do the same kind of program in their centers. That’s the next expansion. What makes SHARE unique is that we also emphasize research and research training. We developed an 18-month research curriculum with fellows who are all in Sub-Saharan Africa. Teaching them about research techniques, how to develop ideas, how to get grants, and how to get published.

That’s amazing and seems like a critical part of capacity building. 

Exactly. One of our collaborators in Africa published on why it's so important that research on Sub-Saharan Africa should come out of Sub-Saharan Africa. Because a lot of research that's published, if there is anything published, is by somebody coming from America or Europe, going to Africa doing something, and then publishing about it. But it’s not local surgeon-based or local community-based. 

Plastic surgery residents look through surgical microscopes while training in microsurgery.
Plastic surgery residents in Rwanda look through surgical microscopes while training in microsurgery.

What brings you back each time and makes you so passionate about the work?

It's the relationship building that we get to do longitudinally. And it's also knowing that what we do has an exponential effect. Essentially, this residency was started in Rwanda by the two plastic surgeons in the country, one trained in France and one trained in South Africa. They got back to Kigali and realized that they were the only two plastic surgeons in a country of several million and that they couldn't possibly take care of all the plastic surgical needs mostly related to burn trauma and cancer. They couldn't possibly do it with just the two of them. So, they decided to start a residency just six years ago.

They just graduated their first class of residents! Two of them have joined the practice, and two of them have gone overseas for advanced training. We also continue to mentor those two who have gone on to a craniofacial fellowship and microsurgery fellowship. They're going to come back and be the first and only microsurgeon and craniofacial surgeon in all of Rwanda. And then they will train the next series of residents who come to their program from other African countries. 

While I was there, residents from Burundi, Zambia, and Congo came to train. It's already become a hub of plastic surgical training. And you can just see how quickly those trained in this program will go back to where they live and train more people. Because of it, there's already been really rapid growth in the number of plastic surgeons in Rwanda.



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