Promoting Affordable Surgical Care in Sub-Saharan Africa Through Global Surgery Education

Dr Barnabas Alayande operating and teaching medical students in the Butaro District Hospital operating room.

From an early age, Dr. Barnabas, Faculty in the UGHE Center for Equity in Global Surgery, yearned for something different, something expansive, and he found it by pursuing surgery. Growing up in Nigeria, he felt called to surgery due to the lack of enough quality surgical care in his country and in Sub-Saharan Africa. 

“I grew up steeped in need- Nigeria’s doctor-to-patient ratio is 1:6000; surgical specialist density is 0.75 per 100,000 in Rwanda; and Africa is dying of treatable surgical diseases. I have seen very many people with complications from surgeries performed by sub-optimally trained surgical providers, and people experience financial catastrophe because they sought surgical care,” he says. 

This experience made him feel empathy for vulnerable people whose lives were in danger because of such a huge void in surgical care. 

Public Health or Surgery?

Dr. Barnabas delivering a presentation during the COSECSA (College of Surgeons of East, Central and Southern Africa) Scientific Conference in Namibia

Dr. Barnabas encountered surgery deficit constraints firsthand when his mother underwent five surgeries in difficult conditions, in addition to observing such difficulties on other patients at various stages throughout his career. 

“One defining moment occurred when there was a need for health care and my family couldn’t afford it. As the search for money went on around the house, and everyone realized what we had would not be enough, my younger sister asked, “Where do they (literally)make money?” Mom answered, “The national printing and minting company”. My sister replied, “I want to work there when I grow up.” I, however, asked a different question. “Where do people who do not have access to healthcare go? How can we begin to create systems of medical and surgical care that are affordable, accessible, available, and timely?” Barnabas says.  

When he graduated from medical school with prizes in public health and a passion for surgery, he still didn’t grasp the intersection between the discipline of scale and the scalpel. He was perplexed in deciding between two careers he loved. 

” I still have the book in which, I drew a map of Africa, and underneath it wrote my contradiction and dilemma, “public health or surgery?” wondering which would make the greatest impact. For me, global surgery has made that connection,” he says. 

In pursuit of the answer to these questions, Dr. Barnabas had gone down three intercalated paths of surgical research- education, improvisation for local contexts, and surgical safety. Education, because of his near-miss education experiences and the gaps he experienced in surgical residency training; surgical improvisation and innovation, because of the needs in sub-Saharan Africa that do not match available resources; and surgical safety because despite younger, low-risk patients, surgery in sub-Saharan Africa results in twice the likelihood of death and many more preventable complications. 

Challenged by UGHE’s Space 

These are Center for Equity in Global Surgery colleagues at Butaro Campus

Dr. Barnabas found his way to UGHE through the Harvard Program in Global Surgery and Social Change, an innovative global surgery team heavily involved in surgical work around the globe. His focus was largely on surgical education as the best way for improving surgical care globally.  

He says, “UGHE is the first university created to drive equitable delivery of health care to the world’s most vulnerable populations. I identify strongly with the values that drove Dr. Paul Farmer to move to “shift the center of gravity” of Global Health Education. When I joined, I was glad to work with the team in the initiation of the curriculum for the global surgery option in the MGHD program and the undergraduate surgical clerkship designs.” 

Top on the list of his motivations for joining UGHE is a sense of purpose, of birthing a new institution and contributing to Africa’s future. He believes that witnessing the birth of a Center for Equity in Global Surgery was particularly important to him as the lead fellow on the Harvard program research pillar from which he became a faculty member. He says, “starting up a center for global surgical care in sub-Saharan Africa was on the list of my career life goals.” 

At UGHE, his daily motivation includes mentors in the surgical community, peers and colleagues, and students. He admits that they have shown him what partnerships, focus, versatility, and courage can do as well as defined the power of accompaniment, trust, a pursuit of equity, friendship, and sponsorship. “I am privileged to share this space with such great people, colleagues, mentees, and students.” 

Through his work, Dr. Barnabas is supporting UGHE’s mission of radically changing the way health care is delivered around the world, by contributing to surgical education and training through designing innovative curriculum, and global surgery research and innovation for both medical students and post-graduate learners. 

He says, “my work is embedded in both the Medical School and the Center for Equity in Global Surgery and revolves around 5 key pillars of the center which are: Education and Training, Global Surgery Research and Innovation, Policy, Advocacy and Financing, Global Convenings, as well as Fellowship and exchange in global surgery”. 

Leveraging Partnerships to Promote Equity in Global Surgery 

Dr. Barnabas with UGHE Medical Students in the classroom.

One of the Late Chancellor and Co-Founder, Dr. Paul Farmer’s most inspiring quotes reminds us that nothing can be achieved without partnerships. Dr. Barnas highlights that the CEGS (Center for Equity in Global Surgery) has leveraged different local and global partnerships to promote equitable surgical care.  

He says, “from student organizations to our local hospitals to UN adjacent institutions, we work together to make surgical care available and affordable. All surgical curriculum design and delivery at UGHE, at both undergraduate and postgraduate levels, is possible only through our deep and equitable partnerships with several academic, and non-academic partners, who have contributed over the years to this work.” 

Global Surgery Option in the MGHD Program 

Till recently, surgery has been known as the “neglected step-child of Global Health”, particularly in Sub-Saharan Africa where there is a need for homegrown leaders at ministries of health, academic institutions, and research institutes who will be the drivers and leaders of the interdisciplinary global surgery equity movement. To prepare those kinds of leaders, UGHE recently opened the Global Surgery option in its Master of Science in Global Health Delivery, an exciting opportunity to promote equitable surgical care in global health.  

Dr. Barnabas considers this crucial in equipping individuals who will advocate for affordable surgery in vulnerable communities.  

 “I believe this program will be a critical part of the solution and help raise individuals who will be influential voices for surgical equity in LMICs. It will change the narrative for the patient at the remote district hospital, the person who sells everything for his appendectomy, the woman who needs a c-section, but does not have access to a hospital within 4 hours of home, the advocate at the ministry of health fighting the system to get surgery on the agenda.” He says. 

The Global Surgery option will provide interdisciplinary and leadership training for the next generation of healthcare professionals, researchers, and advocates. 

Applications for the UGHE’s Master of Science in Global Health Delivery (MGHD) are still open with Options in Global Surgery, Health Management, One Health and Gender, Sexual, and Reproductive Health. Learn more here.