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Our advocacy team members, Dr. Madeline McDonald, PGY1, in General Surgery at MacMaster University and Dr. Cara Fallis, international medical graduate from Philippines, sat down with Dr. Betty Yibrehu, a PGY2 in General Surgery at University of Toronto to chat about her experiences in global surgery.
Can you speak to your past experiences and how they have led to your interest in global surgery?
I studied global health as an undergrad and at that time had an interest at the time in reproductive health with the plan to go to medical school, and I think that gave me an awareness of what global health looked like. For a summer, I did some research in Ethiopia, where my family is from. Global surgery was a continuation of my undergrad degree and my medical school interests, and it felt like something that was still relatively new at the time. When I went to medical school, the Global Surgery Student Alliance (GSSA) had just been created, and I was a part of that. It was an exciting time to be someone interested in surgery with a global health background. At the time, there was so much enthusiasm, so much unknown, so many unanswered questions, and it was great to be a part of it as a learner. In medical school, we hosted a symposium, and I was part of the national team, and I worked on trying to stimulate interest in my local area.
How in residency have you continued your interest?
In residency, it is tough to continue the same level of involvement, but I still have an interest specifically in not only the ethics of how we view our relationship to global surgery in the West. In addition, how we design and implement global surgery and capacity-building initiatives, and I would like to continue that work in the future.
Where do you see Canada fitting into the trajectory of global surgery, and how can Canadian surgical trainees and the surgical workforce best empower low surgical access communities to articulate their own needs rather than setting an agenda?
Suppose you're well-connected to the communities you're trying to get involved in. In that case, you will see that they have experienced and enthusiastic young leadership, for example, age-mate or cohorts working on projects. There are a lot of attendees from East Africa that attend webinars, symposiums, talks, Twitter events etc. that are based in the US and Canada. It is an excellent opportunity to connect with these individuals because ultimately, we need to ask them what they need; they know this best. I think our generation is much more attuned to (this concept) of asking. This is only going to be carried further as we try to carry out the "Communicator" role of CANMEDS." So would you say that in your view, these micro-level relationships are what we need to leverage more so than the formal macro-level partnerships?
It's hard to say that if you're trying to strengthen a health system, micro-level relationships will be what "does it." But I will say that one of the problems that exist is that people in Canada have no ancestral, emotional, or personal connections to the countries and people that are often the focus of these initiatives "to help." If you don't see them, like SEE them, then how can you help them? This is our personal homework. I think that formal, bidirectional, macro-relationships work much better when we understand each other better.
Does U of T have any bi-directional relationships that you are aware of?
The obstetrics and gynecology department at the University of Toronto has a 10-year relationship with Kenya. I think there are a lot of staff surgeons that have well-established relationships with certain universities (abroad) in the form of cross-appointments, that is very common. One example is (Dr. Azzie) where there is a teaching-based capacity-building relationship with Botswana that has taken place over many years.
There is also a Global Health Education initiative program-- this is an online course-based initiative that anyone can opt-in. Within that, there is a global surgery stream, and there is an experiential learning component, and a global surgery lecture series which leads to a certificate.
How do you envision your goals/ projects/ relationships related to global surgery post-residency?
I see myself as someone that is primarily based in Canada (because that is where my family is) with interest in research and optimizing residency training/ making it more standardized so that it can be implemented in a wide variety of settings. I like the logistics of these opportunities. I see myself being a Canadian surgeon with an academic interest in medical education that I apply in Canada and abroad. My family is from Ethiopia, so I only see myself doing it there.
Do you have advice for students interested in global surgery but don't have any LMIC ties on avoiding some of the pitfalls of ethical errors that can be made in global surgery?
I don't think that you need to be from a certain country to care or empathize with global health inequities. It's good to care and to want to address these things. If you're not from an LMIC, I think you need to have a certain level of self-awareness and be willing to ask yourself serious questions like 'What is the legacy of colonialism,' and 'How do I view these people in my current society before I jump on a plane and try to apply principles to a different society.'
For people with a background in LMIC's, it may be even more important to be conscious of their privilege. After all, they may inadvertently feel they have more access or status because they identify with them. If you feel like you've learned a culture or a language, that's excellent, but there is always a difference and need to develop cultural competence. It's not always a bad thing to recognize different cultural divisions. If we are honest about our divides and our background, it sets up better relationships with our partners.
For example, I don't think it would be ethical for me to miss out on any pre-trip cultural preparation going to Ethiopia because my family is there, and I speak one of the languages. You have to acknowledge that you may not be an expert even in your own culture, and you may still need to educate yourself in the (healthcare) settings and systems. We are going to make mistakes, but if you establish relationships based on mutual trust and respect, the fallout from these mistakes is less likely to be catastrophic because you see each other as people.
Do you have any final thoughts or advice to leave with our readers and us?
There are many ways to get involved in global surgery-- it doesn't have to be research or trips. It can be through conversations, career exploration, attending conferences and meetings as a gateway. I would encourage everyone to consider what they can add to the field using their unique background.
Dr. Betty Yibrehu is a General Surgery resident PGY2 at The University of Toronto. She studied Global Health as an undergraduate student and was an active member of the pioneer cohort of the Global Surgery Students Alliance as a medical student in the United States. She has spent time working in Ethiopia and has academic research interest in surgical education, with a vision of contributing to the design of residency training that can be globally implemented.