Looking forward – March 2015

David B. Hoyt

David B. Hoyt, MD, FACS

Surgeons have an inherent drive to serve patients in need. To help the many surgeons who provide care to some of the most vulnerable populations in the world, the American College of Surgeons (ACS) established Operation Giving Back (OGB) in 2004. Over the last year, the ACS leadership has been examining the role of OGB in an era of greater demand for global outreach and continued disparities in access to care in the U.S. After extensive evaluation of the program’s strengths and vulnerabilities, the College has set a fresh course for this important program and has hired a new Medical Director of OGB, Girma Tefera, MD, FACS, who joined the staff of the ACS Division of Member Services in February.

Role of OGB to date

OGB was the brainchild of the ACS Board of Governors Committee on Socioeconomic Issues, then chaired by current ACS President Andrew L. Warshaw, MD, FACS, FRCSEd(Hon). The committee conducted a study, which showed that many surgeons were involved in volunteerism and considered giving back to be part of their professional identity. OGB was created to leverage the passion, skills, and humanitarian ethos of the surgical community to effectively meet the needs of medically underserved domestic and international populations. OGB provides the tools necessary to facilitate domestic and international outreach among surgeons of all specialties, at all stages in their careers.

Presently, the OGB website largely serves as a clearinghouse of information, resources, and networks for surgeons who are interested in volunteerism. Through a network of partner organizations, OGB directs surgeons to volunteer opportunities that align with their skills, passions, and beliefs. OGB cultivates innovative models and multi-sector collaborations with academic institutions, corporations, foundations, government, and not-for-profit entities to inform public policy, share information and knowledge, and reduce global health care disparities.

New leadership, new direction

Over the last decade, the need for global surgical care and international outreach has continued to rise. Likewise, geographic and socioeconomic disparities in access to optimal care in the U.S. persist. Hence, as the College seeks to move OGB forward, we have developed a broader vision for the program. According to Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services, “We want to actively engage our members—old and young and at every stage of their careers—to become active in these endeavors. In particular, we know that surgeons have different constraints on their time, and we want to build a system that will allow a surgeon to volunteer for a day or for a month, once or on a regular basis, domestically or abroad. The need is great, and we want to connect talented, interested surgeons with the opportunities we know exist for them.”

To expand the breadth of OGB and to make the program more inclusive, we intend to present a wider range of Clinical Congress programs in global surgery, lead coordinated responses to disasters worldwide, develop new programs and opportunities for surgeon volunteers, and better inform the public of the work of OGB. Most importantly, we intend to increase College participation and recognition among other similar global organizations and to redesign the OGB website to more efficiently and effectively match members’ needs with volunteer opportunities.

Dr. Tefera is uniquely qualified to lead these activities and efforts. The recipient of the ACS Surgical Volunteerism Award in 2011, Dr. Tefera is professor of surgery, department of surgery, University of Wisconsin, and vice-chair, division of vascular surgery and chief of vascular surgery, William S. Middleton Memorial Veterans Hospital, Madison. A native of Ethiopia, Dr. Tefera has trained and practiced in a broad range of international environments. He earned his medical degree at the University of Pisa Faculty of Medicine, Italy; completed a clinical fellowship in trauma at Landeskrankenhause Feldkirch, Austria; trained in general surgery at Krankenhouse Friedrickstadt, in Dresden, East Germany; and completed a vascular surgery fellowship at the University of Wisconsin Hospital and Clinics. Dr. Tefera chairs the board of directors of the Ethiopian-American Doctors Group and is an associate member of the Ethiopian Academy of Sciences. (For more information about Dr. Tefera, see related article.)

Through these experiences, Dr. Tefera has acquired “a wealth of experience as a practicing, active vascular surgeon, experience gleaned from living all over the world. He also brings with him a commitment to and experience with global health, in the narrow sense of providing surgical care, as well as in a broader sense of building infrastructure and sustainable change or creating educational opportunities that impart long-lasting benefit to patients,” Dr. Turner said.

The work begins

Dr. Tefera said his first priority is to gain a better understanding of ACS member needs and to connect them to available opportunities. “However, as part of my short-term goal, I will focus on developing programs, both domestic and international, that will provide ACS members with opportunities to give back,” he said. “These programs will leverage the existing strengths and infrastructure of the College in education, service, quality, and leadership.”

Dr. Tefera and the rest of the ACS leadership agree that OGB is facing several challenges, including: (1) securing sustainable funding opportunities for programming activities in a sustainable manner; (2) defining priorities and developing action plans at a time when global health care needs are on the rise; and (3) aligning efforts with the many organizations that focus on global surgery.

To help meet these challenges, Dr. Tefera looks forward to partnering with individual ACS members, ACS committees, nongovernment organizations, and government agencies. “In the developing world, trauma and non-communicable diseases, particularly cancer, have reached epidemic proportions. Trauma will be the third leading cause of death in most sub-Saharan countries. I believe the Committee on Trauma and the Commission on Cancer can play a major role in helping to build systems and train the health care workforce that is desperately needed,” he said.

To help cultivate opportunities to foster the expansion of domestic outreach, OGB and the ACS Committee on Optimal Access (COA) will be working closely together, as well. “Almost by definition, there is (and always will be) an indelible link between the Committee on Optimal Access and Operation Giving Back,” said ACS Past-President and COA Chair L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCS(Glasg)(Hon). “It is the vision of the committee that the priorities in addressing the myriad of health care disparities in the various surgical communities will be appropriately highlighted and underscored, thus providing specific and targeted projects for members of the OGB to consider. There is no greater challenge facing this nation than the widening disparities in health care delivery. With the COA and OGB, the American College of Surgeons will provide a two-prong effort to help address this multifaceted problem,” Dr. Britt added.

Leadership

One significant example of the College’s enhanced visibility and leadership in addressing domestic health care disparities is that we have partnered with the National Institutes of Health (NIH) to host the first State of the Science Meeting on Surgical Healthcare Disparities. This conference will take place May 7–8 at the NIH campus in Bethesda, MD, and will bring together several of the nation’s thought leaders on health care disparities with the goal of creating a national agenda for surgical disparities research. The output of this event will enable scientists and funding agencies to prioritize research projects and interventions aimed at mitigating health care inequities and improving access to surgical services. This effort is being led by Dr. Britt and Irene Dankwa-Mullen MD, MPH, director of extramural scientific programs at the National Institutes of Minority Health and Health Care Disparities. Several ACS Past-Presidents, including Carlos A. Pellegrini, MD, FACS, FRCSI(Hon); Regents; Fellows; Dr. Tefera; and senior surgical scientists have been invited to participate in this program. This event will serve as an excellent opportunity to “provide leadership to surgeons across the country to study and address disparities in care,” said COA Vice-Chair Adil H. Haider, MB, BS, FACS, Kessler Director of the Center for Surgery and Public Health at Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, and past-recipient of the Jacobson Promising Investigator Award. We will keep you informed about the upcoming conference and its outcome through reports in the Bulletin.

The ACS, with your help, is well-positioned to help resolve one of the most pressing problems facing our patients throughout the world—inequities in access to surgical care. I encourage you to find out more about how you can get involved in the OGB program by contacting ogb@facs.org. Volunteerism, even at a local level, can be a simple and inspiring experience as demonstrated by Dr. Turner and her children during the most recent Martin Luther King, Jr., holiday in January.

Dr. Turner and her daughters

Dr. Turner (left) and her daughters make meal bags for the Martha’s Table charity. The event was organized by Jack and Jill of America, which focuses on leadership development, volunteer service, and civic responsibility for children.

Dr. Turner's daughter

Dr. Turner’s daughter

 

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