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UTHSC College of Medicine Student Travels to Madagascar as Part of World Health Organization’s Surgical Safety Checklist Team

emily bruno with who checklist team
UTHSC med student Emily Bruno (left) traveled to Madagascar to help train surgical teams there. She and members of her team stand in front of the ship, Africa Mercy. Photo credit: Mercy Ships, Justine Forrest

Traveling to 20 cities on the island of Madagascar to train local surgical teams is not what most medical students do between their third and fourth years of medical school. But Emily Bruno, a student in UT Health Science Center’s College of Medicine, did just that as a participant of the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School.

Although hesitant at first to take a year off from medical school, Bruno, now a fourth-year student at UTHSC  planning to pursue a residency in general surgery, hopes the experience will make her a better surgeon. And she credits UTHSC with supporting her in pursuing this “Scholar’s Year” to do research.

“Our Scholar’s Year students are a select, self-motivated group,” said Susan C. Brewer, MD, FACP, associate dean of Student Affairs and Admissions and associate professor in the UTHSC College of Medicine. “These scholars search out their own research opportunities and find their own funding, which requires a significant investment of their time and effort in addition to a busy medical school curriculum. They have a fierce commitment to research, academic medicine and service to the community on a global scale.”

Prior to medical school, Bruno, who is originally from Pennsylvania, worked for the U.S. Department of State. Being selected for the PGSSC program allowed her to combine her past experience in foreign policy with the skills she has learned in medical school.

“I feel really lucky that I was able to be part of this research year,” Bruno said. “It was a perfect fit for me, this melding of my interest in surgery and my background in foreign policy.”

emily bruno training shot
Bruno was part of a 22-stop hospital training tour in Madagascar. Photo credit: Mercy Ships

In Madagascar, Bruno was part of a partnership between PGSSC and Mercy Ships, an international nongovernmental organization that operates the world’s largest private hospital ship, staffed by an all-volunteer crew. Mercy Ships works with the host country’s ministries of health to provide free surgeries and training for surgical workforces. Serving as the only student on a rotating team of five that included two local physicians, an anesthesiologist and a nurse practitioner, Bruno was tasked with training local surgical teams in Madagascar on implementation of the World Health Organization’s (WHO) Surgical Safety Checklist.

This checklist is a tool used among surgical teams to decrease errors and potentially fatal events by increasing teamwork and improving communication in operating rooms. The checklist includes 19 items, one of which is the pre- and post-surgical counts of all instruments used during surgical procedures.

“An aspect of our training that was one of the more foreign to our audiences was the surgical counting,” said Bruno. “We take for granted in ORs here that everything on the surgical tray gets counted, every instrument, scalpel, needle driver, clamp — everything. In Madagascar, we needed to explain how this step is a critical part of patient safety and error prevention.”

Bruno and the rest of the “Checklist Team” spent their time on the road traveling from region to region. She visited 22 hospitals in 16 regions, doing three-day training workshops, along with following up on previous training sites.

madagascar checklist map
A map showing the many sites visited by Bruno and the Checklist Team. Map courtesy of Mercy Ships

The checklist was not Bruno’s only responsibility. She also worked on collecting data as part of a surgical quality improvement initiative in Madagascar. Using the indicators outlined by the Lancet Commission on Global Surgery, Bruno measured access to surgery, surgical workforce numbers, surgical procedure counts, operative mortality rates and surgical costs and expenditures at each of the hospitals she visited.

“Mercy Ships and PGSSC wanted to help to increase local surgical capacity throughout the country, and they thought this training would be a great way to do it. They also wanted to get a better sense of what the baseline capacities for surgery were in the country, so that eventually, recommendations could be made on a policy level on how to improve these numbers,” said Bruno.

Using the surgical data she collected, Bruno and two Mercy Ships colleagues discussed with the Malagasy Minister of Health and his delegation during a PGSSC-sponsored conference in Dubai how to incorporate these data into a national surgical planning process for Madagascar. The experience allowed her to see how her efforts could potentially translate into policy.

“When you talk or read about global health, you hear a lot about infectious disease, but you don’t hear a lot about surgery,” said Bruno. “We want the message to be that if you exclude surgery from global health, you are missing millions of patients who can’t access surgical care, but need it. So for me, it was very exciting and eye-opening to be part of a movement that wants to change the course of that conversation. I’ll always be grateful for that opportunity.”