In this Issue:

“After meeting a surgeon, you’re never the same person”: A Conversation with Dr. Miguel Gasakure

On October 14th, 2025, we had the honor of sitting down with Dr. Miguel Gasakure, a General Surgeon at the University Teaching Hospital of Kigali in Rwanda, who was visiting the University of Michigan’s Department of Surgery. We were deeply inspired by Dr. Gasakure’s genuine and compassionate approach to caring for his patients and are truly grateful for the opportunity to share his insights. Click below to keep reading...

Snapshots of the Global Surgical Community

Ghana’s New Stoma Support Group

Access to Surgical Care Amidst the Sudan Civil War

On September 19, 2025, the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana launched a Stoma Support Group for individuals who have undergone an ostomy, a surgical procedure creating an opening on the abdomen (stoma) to permit bodily waste to exit the body. The program was launched by Ghana’s Community, Engagement, and Involvement team. Click to keep reading...

Research Collaboration Addresses Barriers to Family Planning and Contraceptive Care for Postpartum Women in Ghana

A research partnership between the University of Michigan (UM) in the U.S. and Kwame Nkrumah University of Science and Technology (KNUST) in Ghana, announced on November 10, 2025, received a five-year grant worth $2.9 million from the National Institutes of Health (NIH). The collaboration was established due to a gap in family planning and contraceptive usage for postpartum women. Click below to keep reading...

On October 26, 2025, the Rapid Support Forces (RSF) seized the city of El-Fasher, Sudan after an 18-month siege, forcibly displacing an estimated 82,000 people and consolidating the RSF’s control in Darfur.1 Since April 2023, the RSF and Sudanese Armed Forces (SAF) have competed for control of Sudan following the power vacuum created by the deposition of dictator Omar Al-Bashir. Click below to keep reading...

What is happening in the international and local communities of global surgery? Find out below...

'25-'26 Research Award Winner:

Rachel Lim!

Rachel Lim joined the Prasov Lab as a pre-med student interested in ophthalmology and surgery. She sought a deeper understanding of the eye, especially since few undergraduate courses explore it in detail. Over the past two years as a senior research assistant, that curiosity has grown into an honors thesis project focused on the genetics of nanophthalmos, a rare condition characterized by small but structurally normal eyes. Click here to continue reading Lim's fascinating research story...

PROFESSIONAL PROFILE

“After meeting a surgeon, you’re never the same person”: A Conversation with Dr. Miguel Gasakure

By: Nathalie Tsimhoni and Anam Noor

On October 14th, 2025, we had the honor of sitting down with Dr. Miguel Gasakure, a General Surgeon at the University Teaching Hospital of Kigali in Rwanda, who was visiting the University of Michigan’s Department of Surgery. We were deeply inspired by Dr. Gasakure’s genuine and compassionate approach to caring for his patients and are truly grateful for the opportunity to share his insights.

Background:
Dr. Miguel Gasakure was born in Burundi and grew up in France before moving to Rwanda in 1996. He completed his primary education in Butare and his secondary education in Kigali, where he remained from 2008 to 2013 for medical school at the National University of Rwanda. After receiving his Bachelor’s of Medecine and Surgery in 2013, he worked as a general practitioner across Rwanda: Rwamagana, Ruli, and finally Kibagabaga. By this time, residency programs were well underway, having started in 2012, and Dr. Gasakure began a neurosurgical residency before changing course to pursue general surgery residency, which he completed in 2021. He started working as a consultant at the University Teaching Hospital of Kigali (CHUK). In February of 2025, Dr. Gasakure was appointed as the Program Director of the University of Rwanda’s General Surgery Residency Program.

Throughout his many roles, Dr. Gasakure has continuously prioritized education and academic collaboration, building strong relationships with various universities and organizations. He serves as the General Secretary for the Rwanda Surgical Society, where he works on outreach programs to support surgeons, trainees, and medical students in Rwanda.

Dr. Gasakure's initial interest in medicine stemmed from an early passion for IT and technology; he was fascinated by the rapidly developing internet and inspired by media works such as the manga Monster: “The manga talks about a neurosurgeon who chose to save a child, but it turns out he saved the wrong person. However, he kept believing in his ethics, despite having saved an assassin—a psychopath—and so he tries his best to stop him himself. It was really interesting, and I really liked the character. At the time, I was introduced to Telemedicine, and it seemed that Medecine could be so much more. I always wanted to help people, and so it made me realize that the best place for me would be as a doctor.”

The intersection of his interests opened up a world of possibilities: “It was not always easy to access medicine throughout the country. So, Telemedicine was really very inspiring at the time.” He has harnessed this potential by turning his IT passion into tangible projects. One of these projects is an “e-logbook”: a logbook that residents can access from anywhere to submit their portfolios, allowing the consultants or the program director to review what the residents are doing. This project will allow Dr. Gasakure and program faculty to use data to better understand which aspects of their teaching and training need improvement. Dr. Gasakure explains, “The resident should not only say: ‘I don't like it here; I don't feel they are helping or supporting me.’ There's actual data that backs it up and helps you make an informed decision to change the pathway of that resident.” A lot changed after COVID because virtual teaching became a more mainstream reality. “We have different virtual professorships throughout the different programs, particularly in Plastic Surgery, for example. We also have a research mentorship program in collaboration with the University of Minnesota.” Dr. Gasakure continues to transform the world of surgery using his passion for technology. One such project: a simulation trial for laparoscopic surgery. “We are looking into the possibility for such simulated exercises, done using a laparoscopic trainer, to be translated into real life or in the OR.” The future of surgery, Dr. Gasakure says, lies in augmented reality.

Dr. Gasakure’s perspectives on the patient-physician relationship:

Dr. Gasakure views the patient-provider relationship as an equal, bidirectional partnership. Providing the best care, from his perspective, is about truly wanting to learn from patients. “We, as doctors, don't live with the disease—we don't understand how long our patients have lived with that disease. So, it's important to be respectful of that and be humble enough to realize that the patient trusted you enough to wait for sometimes years, months, or the whole day just to discuss with you.”

Every moment he spends with patients is deeply valuable: “You're going to discuss with them for about 15 minutes, so it should be a good experience for them. You should learn about them and learn from them.” Dr. Gasakure is deeply committed to building these partnerships with his patients. “It's always about how you make rapport with the patient. You want to make them understand that you're on their side. You want to help as much as possible, even when you can't, and you want to be frank about it. They will feel it, and they will continue discussing it with you, even afterwards, even when you cannot help them.” It can feel challenging to build these relationships, but this comes from misunderstanding the patient’s experience.

“The first thing you have to understand is that all patients come to you in their most vulnerable state, even when they look pissed and want to lash out. It's not really about that; it's mostly that they are angry at themselves. Maybe it took so long to seek care that now they must meet with a surgeon, and meeting with a surgeon is usually for radical things. It's going to be life-changing.” Accordingly, physicians—and surgeons, in particular—should give patients grace.

“Surgeons are drastic, so it’s going to be life-changing for their patients. After meeting a surgeon, you're never the same person. This is important, and I particularly emphasize that to our patients with advanced cancer, because they come in with their families, and they should understand and believe that they’ve done everything in their ability to seek care. They could never have predicted that what happened would happen. Otherwise, when they don’t feel that you are trying to connect with them, they will go look for an alternative treatment, or they will keep on hoping for something else to happen.

You do not want that, because that is a patient who will not heal, and then the burden will also be shared by the family or the caretaker. It's important to try your best to comprehend their understanding and belief about their own disease. There are some good ways to gain someone’s trust, like learning their names. Different cultures have different traditions for greetings and how you discuss specific things. Ask genuine questions such as: ‘I have heard you're Muslim, and I would like to examine you. Should we bring in someone else, or are you comfortable?’ You should always try to truly learn from them.”

Dr. Gasakure highlights how frustration and negative emotions expressed by a patient are often not truly about the physician; rather, they reflect a patient’s understanding of their own state. Thus, you should always try your best to acknowledge that to build that inestimable trust. If your patient feels you are being arrogant, paternalistic, or even worse, dismissive, they will not adhere to your treatment plan.

Accordingly, “When the patient feels like they are involved in their own treatment, they will help you treat them.” For example, “How do you know that the patient is taking their treatment? At some point, you must trust them to do the right thing.” Even if you know that when they get home, “there is an aunt who learned about this new medication, or there is an advertisement about a drug or clinic on TV. Therefore, trust in medicine is very much a two-way street.”

A meaningful story Dr. Gasakure shared with us:
“A young man in his thirties was newly diagnosed with Diabetes Mellitus at his district hospital. He had consulted for a wound on his foot that had not healed for over 3 months. The shock was incredible, but he was started on insulin and sent to us at the tertiary hospital.

Here, we had to do a CT-angiography that revealed extensive peripheral artery disease with obstructive thrombosis at mid-tibia level. After discussion with the vascular surgeon, an amputation was recommended. However, when we informed the patient, he immediately fell into depression. We thought that it was because of the sad news we gave him and tried to emphasize that it would help with his ‘healing’; he will ‘heal’ faster like that. He was young and would ‘heal’ easily.

One day, he confided to a resident that he did not think he was going to ‘heal’ because, for the first time in his life, he had saved enough money to buy a brand-new truck. He finally got a driving license, and his business had just started. So, how could we say we were ‘healing’ him when everything else in his life was crumbling down?

The ‘healing’ for us doctors might be different from the ‘healing’ of our patients. It is important to align with what patients actually envision without lying or giving false hope. That balance is crucial but quite difficult to achieve.”

Dr. Gasakure’s current initiatives:

Dr. Gasakure believes that his duty to medicine extends beyond the walls of a hospital. Physicians have a responsibility to reach as many people as they can and help in any way they can. Dr. Gasakure practices these values through several health initiatives. He is currently involved in different clinical trials whose main themes are surgical safety practices and surgical site infections. “One of the earliest trials we worked on showed that the simple change of gloving and gowning during certain steps for abdominal surgeries decreased the rate of surgical site infection by around 13%. So, now we are looking into combining that with the use of single-use material, such as gowns or drapes, versus reusable ones.”

He is also co-leading multiple global initiatives to this end: “We have a couple of worldwide clinical trials around surgical safety and infection prevention that I lead at CHUK under the supervision of and collaboration with the Global Surgery Research Hub of the University of Rwanda, the NIHR Global Health Research Unit on Global Surgery, the University of Edinburgh, and the University of Birmingham. You can look them up on the internet: EMUs, CAMELs, PENGUIN, GECKO, to name a few (Yes, only animal names! Surgeons are facetious like that!).”

Dr. Gasakure also believes in disseminating his knowledge as best he can to inspire an informed future generation of medical professionals: “I am very interested in medical education and simulation, as I was mentioning before, such as trying to translate a laparoscopic or virtual simulation into actual skills within the OR and to see how much it impacts the residents or the medical students.” To this end, he is working on “creating digital tools to help with self-learning for residents: e-logbooks, patient waiting lists, and a skills simulation app. I think the future of surgery resides in being safe while practicing, and what better way to do so but through simulation?”

Among many other initiatives, he is working “to revamp the whole General Surgery Programme by making sure it is truly focused on the residents' needs but also pushing them to academic excellence.” This entails “more mentorship, better clinical rotations, timely feedback, involving them in research projects, and encouraging them to teach undergraduates. Of course, this cannot work without the involvement of the seniors, so I am also trying to find the best ways to incentivize and acknowledge the work of all our esteemed lecturers.”

Further, he is supporting all the new fellowships in Rwanda that are directly affiliated to General Surgery: colorectal, vascular, breast, thoracic, and transplant, so far. “I do so not only by providing the necessary logistics for those teams through the University, but also by working with them in matters such as the review and revision of their curricula, assessment tools, exam materials, etc. I'm an academic advisor in a way.”

While Dr. Gasakure is “still mostly working on system and medical education”, he is slowly working his way “towards community engagement initiatives.” He is ensuring a commitment to cultural humility and sustainable initiatives, “because sometimes we think we know better and are helping people, but we are not even considering their issues or queries. In fact, going to a remote area for only one week and not training the local surgical teams, in the end, only gives poor performance.”

Dr. Gasakure is excited for future global collaborations, including with the University of Michigan. He is currently working to “create bridging programmes for research, but also clinical rotations between our University and the University of Michigan and Virginia so far. This could benefit the trainees and the trainers as well. We are working on the best framework to properly and legally learn from each other.”

Concluding Remarks:

Dr. Miguel Gasakure’s profound respect for his patients and their lived experiences, dedication to medical innovation, and commitment to both intentional leadership and mentorship of future healthcare professionals exemplify ethical engagement in medicine and global health. His wisdom and perspectives have been deeply impactful in our lives, and we are confident that his insights will resonate throughout the global surgery community. We are excited for the future of collaboration between the University of Rwanda and the University of Michigan.

We would like to thank Dr. Miguel Gasakure for the opportunity to learn from him, our mentor Dr. Robin Petroze for her truly invaluable guidance and support, and Michelle Staples and Laura Rivard for their instrumental roles in making this possible. Thank you for your continued support of us and of the University of Michigan’s Global Surgery Student Alliance.

GLOBAL

Ghana’s New Stoma Support Group

By: Ach’sah Gubena and Rowena Kannaiyan

On September 19, 2025, the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana launched a Stoma Support Group for individuals who have undergone an ostomy, a surgical procedure creating an opening on the abdomen (stoma) to permit bodily waste to exit the body. The program was launched by Ghana’s Community, Engagement, and Involvement team, funded by the United Kingdom’s National Institute for Health and Research [1]. Despite the severe need across low- and middle-income countries (LMICs), this initiative is one of very few aimed at providing support to individuals living in these countries.

Background of Stomas in LMICs

LMICs often face similar challenges in their healthcare systems due to a generalized lack of available resources, training, trained staff, and hospitals. Many LMICs face an increased burden of patient overcrowding; in Ghana, for example, the majority of the nation's population funnels into a few large hospitals located in central cities. The Komfo Anokye Teaching Hospital (KATH) is one such example. As the second-largest hospital in Ghana, it serves as a major referral center for most of northern and central Ghana, taking patients from over a dozen regions [2]. KATH has been reported to cover roughly 9.7 million people with a bed capacity of around 1,200 beds [2,3]. Additionally, a lack of established registries in LMICs means that the prevalence of conditions—in this case, stomas—goes severely underreported, contributing to the lack of resources those communities may receive [4]. All of these factors contribute to a wide gap in the health of those who live in LMICs compared to those living in high-income countries (HICs). This discrepancy in healthcare infrastructure doesn’t just impact patients within the hospitals, but it also affects those living with chronic conditions that require continuous care, such as patients with stomas. In fact, the overall complication rate for stoma patients in LMICs exceeds 50% as compared to the 20-43% typically reported in HICs [5].

A mixed-methods study was conducted in six hospitals across a two-year interval for four different LMICs: Philippine General Hospital (PGH) and Makati Medical Center (MMC) in the Philippines; Lagos University Teaching Hospital (LUTH) in Nigeria; Kamuzu Central Hospital (KCH) in Malawi; and Christian Medical College and Hospital (CMCH) and Government Medical College-Patiala (GMC-P) in India [6]. Qualitative interviews across all hospitals reflected that patients with ostomies lacked general knowledge about daily stoma management and emotional and psychosocial support.

Across the 446 patients included in the study, only 13.9% received pre-operative stoma counseling. Furthermore, only 44.4% received post-operative support, and 23.5% had experienced in-hospital complications [1,6]. Without the proper pre- and post-operative care, ostomates encounter detrimental health outcomes and a reduced quality of life, facing skin irritation, leakage, stoma prolapse, parastomal hernia, or pain and discomfort around the stoma site [7,8]. In addition to physical complications, patients with inadequate stoma care may also face stigmatization, increased anxiety regarding leakage, reduced mobility, and diminished participation in life activities [9,10]. Stoma complications, inadequate preparation and care, and the resulting psychological and physiological complications are highly correlated to reduced quality of life, underscoring the importance of supporting proper stoma care in ostomates [11].

Exacerbating these conditions, access to resources for patients with stomas in Ghana has historically been minimal. According to a clinical report from the Ghana College of Physicians and Surgeons, many peripheral facilities in Ghana lack stoma care nurses with adequate training and low rates of follow-ups [12]. These conditions may negatively impact healthcare experiences for patients, leading to declining frequencies of healthcare treatment and follow-up attendance [12]. Patient experience is a crucial, yet overlooked, aspect of healthcare that contributes heavily to patient adherence to treatment schedules and treatment-seeking behavior [12]. To address these barriers to adequate care and treatment often faced by stoma patients, the Komfo Anokye Teaching Hospital launched a stoma support group designed to empower and uplift the ostomy community [1].

Komfo Anokye Teaching Hospital’s Stoma Support Group

KATH’s innovative support group for patients with stomas has been piloted with 42 eligible pediatric and adult patients, caregivers, and healthcare professionals. Filling a previous gap in psychosocial support available for ostomates, this new initiative cultivates a safe and collaborative environment where ostomates can share personal testimonies about challenges they face, including stigma, school exclusion, and lack of insurance coverage for stoma care, providing a much-needed sense of community and support.1 In combination with providing and facilitating support, the team at Komfo Anokye Teaching Hospital expanded its work by forming a national network via WhatsApp to reach stoma users across Ghana and provide them with remote education and support. This addresses the previous accessibility challenges where peripheral healthcare centers in Ghana faced a more severe lack of stoma care resources. By utilizing telecommunication platforms, such as WhatsApp, the KATH team is able to provide remote education and support to these healthcare centers, better equipping them to care for patients with stomas.

Providing remote access to educational materials is an impactful way to sustainably support and connect with healthcare workers and providers in LMICs globally [13]. With these improvements in telecommunication, previously isolated healthcare facilities are now able to receive external training and support, narrowing the gap of inequity between central hospitals and peripheral healthcare centers. KATH’s new stoma support group represents an initiative that aims to improve patient access to education and psychosocial care, fundamental features of comprehensive healthcare. This underscores a remarkable milestone for healthcare, providing sustainable patient-oriented care and expanding it to a national scale.

What will the future look like?

KATH’s new initiative serves as a crucial blueprint for other nations with similarly structured healthcare systems to provide remote and in-person care for people with stomas. The focus on stoma users serves as a reminder that healthcare encapsulates more than just a surgical procedure or follow-up appointment. Psychosocial care remains an underemphasized but essential component of healthcare [14,15]. Not only is psychosocial care crucial for patient mental health, but it can improve the patient experience by reducing treatment barriers, thus improving adherence to treatment schedules and follow-ups [16]. KATH’s Stoma Support Group demonstrates the transformational impact that increased accessibility to training and education can have on both healthcare professionals and their patients.

References

[1] Leigh, G. (2025). CEI in action: Ghana’s new stoma support group. Global Surgery Unit. https://www.globalsurgeryunit.org/cei-in-action-ghanas-new-stoma-support-group/

[2] Komfo Anokye Teaching Hospital. (n.d.). About us. https://kath.gov.gh/about-us/

[3] PIMR Journal. (2025). Paediatric cardiac surgeries at Komfo Anokye Teaching Hospital: A 15-year retrospective study. https://doi.org/10.47799/pimr.1303.25.72

[4] Mowafi H, Ngaruiya C, O'Reilly G, Kobusingye O, Kapil V, Rubiano AM, et al. Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research. BMJ Global Health. 2019;4:e001442. https://doi.org/10.1136/bmjgh-2019-001442

[5] Williams, A., et al. (2024). Global perspectives on stoma care in low-resource settings. British Journal of Surgery, 112(Suppl. 15), xv62. https://academic.oup.com/bjs/article/112/Supplement_15/xv62/8376602

[6] Lapitan, M. C. M., Sacdalan, M. D. P., Lopez, M. P. J., Cruz, M. F. P., Msosa, V. J., Ademuyiwa, A. O., Alakaloko, F. M., Jain, R., Mahajan, A., Michael, V., Ghosh, D. N., Haque, P. D., Kumar, A., Aggarwal, M., & Glasbey, J. C. (2024). Mixed-methods exploration of challenges to stoma care for people with ostomies in four low- and middle-income countries: STomacARe For Improvement reSearcH (STARFISH) study. Journal of Global Health Reports, 8, e2024017. https://doi.org/10.29392/001c.117626

[7] Burch, J. (2005). The pre- and postoperative nursing care for patients with a stoma. British Journal of Nursing, 14(6), 310–318. https://doi.org/10.12968/bjon.2005.14.6.17799

[8] Nichols, T. R., & Riemer, M. (2008). The impact of peristomal skin complications on the quality of life of persons with an ostomy. Journal of Wound, Ostomy, and Continence Nursing, 35(2), 159–165.

[9] Bekkers, M. J., van Knippenberg, F. C., van den Borne, H. W., Poen, H., Bergsma, J., & van Berge Henegouwen, G. P. (1995). Psychosocial adaptation to stoma surgery: A review. Journal of Behavioral Medicine, 18(1), 1–31. https://doi.org/10.1007/BF01857702

[10] Marcomini, I., Iovino, P., Rasero, L., Manara, D. F., Vellone, E., & Villa, G. (2024). Self-care and quality of life of ostomy patients: A structural equation modeling analysis. Nursing Reports, 14(4), 3417–3426. https://doi.org/10.3390/nursrep14040247

[11] Pittman, J., Kozell, K., & Gray, M. (2009). Should WOC nurses measure health-related quality of life in patients undergoing intestinal ostomy surgery? Journal of Wound, Ostomy, and Continence Nursing, 36(3), 254–265. https://doi.org/10.1097/WON.0b013e3181a39347

[12] University of Ghana. (n.d.). [Title unavailable]. https://repository.gcps.edu.gh/server/api/core/bitstreams/a45572da-2ad7-43e2-93dc-240f91b2d7bd/content

[13] Karamagioli, E., Pikouli, A., Chatzi, E., Lykoudis, P. M., & Schizas, D. (2025). A review of remote surgical technologies and training strategies in low- and middle-income countries. Telemedicine and e-Health. https://doi.org/10.1177/15305627251395121

[14] Jordans, M. J. D., & Kohrt, B. A. (2020). Scaling up mental health care and psychosocial support in low-resource settings: A roadmap to impact. Epidemiology and Psychiatric Sciences, 29, e189. https://doi.org/10.1017/S2045796020001018

[15] Lovero, K. L., Giusto, A. M., & Wainberg, M. L. (2020). Evidence for efficacy of psychosocial interventions in LMICs. The Lancet Psychiatry, 7(2), 113–114. https://doi.org/10.1016/S2215-0366(19)30531-0

[16] Reiss, M., & Sandborn, W. J. (2015). The role of psychosocial care in adapting to health care reform. Clinical Gastroenterology and Hepatology, 13(13), 2219–2224. https://doi.org/10.1016/j.cgh.2015.09.010

Access to Surgical Care Amidst the Sudan Civil War

By: Shailesh Gullipalli and Wynne Byard

On October 26, 2025, the Rapid Support Forces (RSF) seized the city of El-Fasher, Sudan after an 18-month siege, forcibly displacing an estimated 82,000 people and consolidating the RSF’s control in Darfur [1]. Since April 2023, the RSF and Sudanese Armed Forces (SAF) have competed for control of Sudan following the power vacuum created by the deposition of dictator Omar Al-Bashir [2]. In addition to outbreaks of disease and famine, both sides have committed significant human rights violations against civilians [2,3,4]. The most recent estimates from the UN indicate that 14.5 million people have been displaced, and 8.5 million are facing famine [4]. Death tolls are far more difficult to estimate, with the Sudanese government restricting data collection by outside organizations [5]. As Sudan enters its fourth year of violent conflict with no end in sight, urgent questions need to be addressed about the country’s future.

Understanding Sudan’s Pre-War Healthcare System

A critical lens through which to assess this crisis is the collapse of Sudan’s healthcare system, particularly its surgical capacity. Prior to the ongoing war, Sudan's health infrastructure did not have sufficient capacity to provide proper care for its population, due to a long history of colonialism, ethnic violence, and government corruption [6,7]. Following 2018, Sudan experienced a revolving door of health administrations with limited continuity or plans for expansion [7]. Vaccination coverage was especially poor; DTP3 vaccine rates sat around 60%, and resultant cases of diphtheria, tetanus, and pertussis were exacerbated by regular flooding and limited or no access to clean water for over a quarter of the population [8,9]. These limitations were illuminated by the COVID-19 pandemic, which exposed the health system’s limited ability to respond to large-scale health crises [7,8,9].

The pre-war health system was critically understaffed, with only 3.7 physicians, 14 midwives, and 9.1 other health professionals for every 10,000 patients [6]. In order to achieve the median Sustainable Development Goal health targets, WHO guidelines recommend a minimum threshold density of 44.5 skilled health workers per 10,000 people [8,10]. Brain drain, largely caused by political instability and a lack of training opportunities, was a significant driver of this low threshold density [8]. In 2020, Sudan had one of the highest maternal mortality rates in the world, at around 295 deaths per 10,000 live births [11]. Financial barriers further compounded these issues. In 2019, it was reported that 95.94% of patients paid out of pocket for treatments [6]. Altogether, understanding the barriers that the healthcare system already faced is critical for understanding its rapid collapse.

A Current Snapshot of Surgical Care

Only a month after the conflict started, a majority of the hospitals in war-torn areas shut down, with staff fleeing and supply routes being cut off. Notably, around 70% were shut down in the state of Khartoum [6,7,12,13]. Due to Sudan’s centralized healthcare organization, this was a significant blow. Khartoum is home to around 19% of Sudan’s population, but, prior to the war, provided around 70% of Sudan’s health services and one-third of health provisions [7,12]. Remaining hospitals have faced severe constraints due to workforce shortages and disrupted supply chains. The focus of the remainder of this article will be on surgical care through the first year of war.

During armed conflict, demand for surgical services—essential to preventing death and long-term disability—is considerably heightened. In addition, conditions routinely requiring surgical intervention, including cancer, cesarean sections, infections, and a multitude of others, are often exacerbated during war due to a lack of access to food, water, and regular checkups, as well as limited surgical capacity. Reduced access to surgical care has not only had disastrous impacts throughout the war but also has troubling implications for Sudan’s post-war healthcare capacity.

In an October 2024 survey of 90 surgical practitioners across Sudan, half of respondents stopped practicing within the first year of war, mainly due to displacement or hospital shutdowns, and two-thirds of respondents were displaced, either within or outside of the country [14]. For emergency theater sessions, the number of surgeons performing fewer than three lists per month nearly doubled from 22 pre-war to 42 post-war, while those performing more than 12 lists fell from 18 to 6. Similar decreases were reported in elective surgery (those performing <3 lists increased from 10 to 38, while >12 lists fell from 30 to 8), outpatient clinics (<3 sessions rose from 8 to 36), and teaching activity (<3 sessions increased from 26 to 44) [14]. This data demonstrates a widespread decrease in operative capacity and training in only the first year. Qualitative themes reported included junior and student surgeons picking up more of the burden, increased fear of assault on medical centers, and lack of supplies, including electricity, making the task of providing proper healthcare exponentially harder [14].

One June 2025 study surveyed 1,457 patients who underwent a variety of surgical procedures during the first year of the war. This study found significantly higher rates of infection occurring after these surgical procedures [15]. Conflict zones had around double the rate of postoperative complications as zones that were considered safe at the time the survey was conducted [15].

A more recent July 2025 study focusing on orthopedic surgery emphasized the higher incidence of explosive trauma and crush injuries [16]. Since Sudan already had only 1.5 orthopedic surgeons per 100,000 individuals, forced relocation of these surgeons is creating geographical gaps in care for many orthopedic procedures [16]. Notably, the paper reports a significant lack of equipment and medications. Without essential supplies, anesthesia, and antibiotics, complication rates are increasing, with around 60% of reported extremity injuries resulting in infection at the time the paper was published [16].

What is being done to address this?

Currently, healthcare workers are increasingly performing remote consultations through mobile video calls and messaging apps to deliver care where in-person services are unsafe or unavailable. In many resource-limited and high-risk settings, telemedicine represents one of the few viable options for postoperative care and specialty consultation [14,17]. A survey of 2,463 Sudanese physicians, including 371 surgeons, reported that over half used telemedicine to provide care for patients in conflict settings [17]. This system was generally reported as cost-effective and useful, with over 73% of those surveyed reporting increased patient trust [17]. However, only about 60% reported telemedicine as comparable to in-person visits [17]. Although telemedicine is a limited tool, it demonstrates the Sudanese physicians’ adaptability and resourcefulness to sustain care amidst infrastructure collapse and resource scarcity.

In addition, junior doctors and volunteers are filling gaps where experienced surgeons have fled [6,14]. Organizations are calling for better protections for healthcare facilities, improved reporting systems, and coordinated rebuilding efforts. This includes Médecins Sans Frontières (MSF), an organization committed to working with local authorities to provide immediate medical relief, clean water, food, and primary care [18]. According to the Sudanese Doctors Network, hospitals and clinics in the state of Khartoum (which is now under SAF control) are going through the stages of repair and reopening. An estimated 57 of the 120 hospitals that initially closed have resumed at least partial operation [17]. Mobile clinics are also beginning to operate in the neighborhoods of Khartoum most affected by conflict [17]. These efforts are early and limited, but they represent initial attempts to maintain care and plan for post-conflict reconstruction.

What will Sudan’s healthcare system look like post-conflict?

As the war is still ongoing, it is difficult to know. Sudan’s healthcare system, which has faced considerable challenges, will undoubtedly need a long time to rebuild post-war. The length of this period will depend upon the immediate mobilization of resources and staff to address what has now become Sudan’s largest humanitarian crisis ever [3,6,7].

It is imperative that a much larger international investment in Sudan’s healthcare system is delivered before the end of the war. A team from Sudan’s Federal Ministry of Health, the University of Greenwich, and Case Western Reserve University Hospital identified that the most pressing needs were medical supplies and financial support. It highlighted the need for a collaborative, bottom-up approach with international organizations, local government, and NGOs, to enhance healthcare capabilities in the communities that remain [6]. The most pressing needs for each community must be identified at a local or facility level, especially when looking at differences across regions [6]. Many surgeons identified long-term goals as strengthening healthcare infrastructure, ensuring surgeon safety, and supporting the return of displaced medical professionals [14].

Outside of international investment, an important step to increase patients’ access to healthcare is for digital infrastructure to be expanded across states with the most damaged health systems [17]. Surgical training programs also need to be redesigned to include remote triage and digital communication [17]. These will be especially important to maintain sufficient preoperative and postoperative care through the end of the war and beyond.

The people of Sudan are facing unimaginable hardships and an uncertain future. It is crucial that they receive not only compassion and action now, but also continued support throughout the end of the war and rebuilding of systems that sustain everyday life.

References

[1] Ali, M. (2025, November 6). Where are tens of thousands of people in Sudan fleeing to? Al Jazeera. https://www.aljazeera.com/news/2025/11/6/where-are-tens-of-thousands-of-people-in-sudan-fleeing-to

[2] United Nations. (n.d.). Sudan conflict. UN News. https://news.un.org/en/focus/sudan-conflict

[3] BBC News. (2025, November 5). Where are tens of thousands of people in Sudan fleeing to? BBC News. https://www.bbc.com/news/articles/cpvdn8pmmd1o

[4] Cooper, Y. (2026, February 6). It feels like humanity has died in Sudan. The Times.

[5] Roberts, L. (2025, February 26). How many have died in Sudan’s civil war? Satellite images and models offer clues. Science. https://www.science.org/content/article/how-many-have-died-sudan-s-civil-war-satellite-images-and-models-offer-clues

[6] Elamin, A., Abdullah, S., ElAbbadi, A., Abdellah, A., Hakim, A., Wagiallah, N., & Ansah, J. P. (2024). Sudan: From a forgotten war to an abandoned healthcare system. BMJ Global Health, 9(10), e016406. https://doi.org/10.1136/bmjgh-2024-016406

[7] Hemmeda, L., Ahmed, A. S., & Omer, M. (2023). Sudan's armed rivalry: A comment on the vulnerable healthcare system catastrophe. Health science reports, 6(8), e1517. https://doi.org/10.1002/hsr2.1517

[8] Wharton, G., Ali, O. E., Khalil, S., Yagoub, H., & Mossialos, E. (2020). Rebuilding Sudan's health system: opportunities and challenges. The Lancet, 395(10219), 171-173.

[9] Fadul, N., Hussein, M. E., & Fadul, A. A. (2021). Re-opening Sudan: the balance between maintaining daily living and avoiding the next peak of COVID-19. Current tropical medicine reports, 8(3), 231-237.

[10] Ahmat, A., Asamani, J. A., Abdou Illou, M. M., Millogo, J. J. S., Okoroafor, S. C., Nabyonga-Orem, J., Karamagi, H. C., & Nyoni, J. (2022). Estimating the threshold of health workforce densities towards universal health coverage in Africa. BMJ global health, 7(Suppl 1), e008310. https://doi.org/10.1136/bmjgh-2021-008310

[11] Abdelmola A. (2023). Antenatal Care Services in Sudan Before and During the 2023 War: A Review Article. Cureus, 15(12), e51005. https://doi.org/10.7759/cureus.51005

[12] Elnoor, S. (2026, January 12). In Sudan, war erodes what remains of a battered health system. Assafir Al-Arabi. https://assafirarabi.com/en/68670/2026/01/12/in-sudan-war-erodes-what-remains-of-a-battered-health-system/

[13] Sudan Tribune. (2025, December 31). Sudan doctors network says 284 health facilities resume operations in Khartoum. Sudan Tribune. https://sudantribune.com/article/308857

[14] Bashary, M., Eltyeb, D., Hassan, S., Eltyeb, M., Mohamedahmed, A. Y., & Eltyeb, H. (2024). Scalpel and strife: Assessing the impact of Sudan’s ongoing civil war on surgical practice and healthcare delivery. The Surgeon, 22(5), 301–306. https://doi.org/10.1016/j.surge.2024.04.015

[15] Ashraf, A., Ibrahim, A., Ibrahim, S., Adam, T., Mohammed, S., Adam, A., Elbager, R., Abdulaziz, L., Gameraldeen, A., Izzeldin, A., Yassir, R., Khalid, S., & Azhari, A. (2025). The impact of war on surgical interventions: A comparative analysis on prevalence and types of postoperative complications across conflict and safe Sudanese states. British Journal of Surgery, 112(Supplement 10), Article znaf128.475. https://doi.org/10.1093/bjs/znaf128.475

[16] Nawari, A., Zahir, J., & Gomez, J. (2025). Orthopaedic trauma in Sudan: Delivering care and improving outcomes in a war-torn system. Orthopedic Reviews, 17, Article 142600. https://doi.org/10.52965/001c.142600

[17] Suliman A. (2025). Mobile phone-based surgical telemedicine in Sudan: a conflict-driven innovation with global relevance. BMJ global health, 10(9), e020184. https://doi.org/10.1136/bmjgh-2025-020184

[18] Médecins Sans Frontières Canada. (2026, February 11). Sudan: MSF launches an emergency response in El Obeid, close to one of the country’s most active frontlines. Doctors Without Borders / Médecins Sans Frontières. https://www.doctorswithoutborders.ca/sudan-msf-launches-an-emergency-response-in-el-obeid-close-to-one-of-the-countrys-most-active-frontlines/

LOCAL

Research Collaboration Addresses Barriers to Family Planning and Contraceptive Care for Postpartum Women in Ghana

By: Anam Noor and Iris Pan

A research partnership between the University of Michigan (UM) in the U.S. and Kwame Nkrumah University of Science and Technology (KNUST) in Ghana, announced on November 10, 2025, received a five-year grant worth $2.9 million from the National Institutes of Health (NIH). The collaboration was established due to a gap in family planning and contraceptive usage for postpartum women; 84% of women who wish to family plan, use contraceptive care, and avoid unwanted pregnancy are unable to reach their goals [2]. Despite significant investment into bridging this gap, low uptake of contraceptive care persists due to health concerns and side effects [2]. Moreover, without proper guidance and matching of contraceptive care, adverse outcomes continue to escalate. Previous research on contraceptive care in Ghana has been led by quantitative methods, such as structured surveys, that overlook the nuanced experiences of postpartum patients. The purpose of this initiative is to gain qualitative insight into the barriers to contraception to aid postpartum women in Ghana in identifying and reaching their contraceptive and family planning needs.

Contraceptive care in Ghana

Despite many postpartum women in Ghana intending to limit or delay future pregnancies, only a small percentage are actively using contraception, including condoms, emergency contraception, and birth control. Even with investment in the quality and supply of contraceptive care, this gap remains. Interviews with 48 postpartum women in urban Kumasi, Ghana identified lack of counseling and education, along with word-of-mouth misinformation, as the primary barriers to contraception [3]. Some perspectives suggest that emergency contraceptive pills are subject to misuse, potentially as a result of inadequate guidance [5]. Many families in Ghana lack access to proper counseling and guidance on what types of contraceptive care will work best for their particular situation, resulting in dissatisfaction and discontinuation of the birth control method. Oftentimes, those open to contraception are deterred by stories of side effects and misconceptions from their social networks.

While existing quantitative research has investigated barriers to accessing contraceptive care, it may overlook the lived experiences that can discourage women in Ghana from utilizing these services. As a result, some women turn to alternative practices, such as the withdrawal method and following calendar rhythms, which may increase the risk of unintended pregnancy and sexually transmitted infections [2,6,8]. These outcomes highlight the reasoning behind the KNUST–UM research team’s intention of utilizing qualitative analytical tools—interviews, case studies, focus groups, and more personal tools—to better understand why women might be hesitant to use contraception [3,7].

How will the NIH grant be utilized?
Over the past 16 years, the international project team has been modifying a tool called My Family Planning Ghana. This is an application that supports families in Ghana in making family planning decisions through informed conception method selection and improved instruction [1]. The team has been working to develop this decision-support tool for use among low-literacy women in Ghana, and recent testing of the tool has shown improvement in knowledge about family planning [2].

The grant’s purpose is to broaden the tool’s impact by funding the development of a study to help postpartum women in meeting their desired contraceptive needs. The partnership will work to diminish misconceptions and educate on contraceptive care by assessing whether developing a patient-centered approach will lead to more informed decisions and allow women in Ghana to match the method they use with their family planning needs. In addition to this objective, the study’s investigative parameters are being expanded to include child health outcomes, such as nutrition, healthcare utilization, growth, and the impact on adolescent mothers. This expansion will facilitate comprehensive analysis of the research project’s downstream impacts [3]. The efficacy of this initiative—and the tool—will be tested using a clustered-randomized trial by granting women access to the technology during routine visits to child immunization and health clinics. The project team will monitor the postpartum period for two years after delivery to measure the impact on both child and maternal health outcomes.

The analytical tool places greater emphasis on qualitative over quantitative analysis. It is investigating the role of sociocultural dynamics on the perception of contraceptive care in support of the group’s primary goal of ensuring women in Ghana can make educated decisions about family planning and contraceptive care.

What is going to happen in the future?

While this international partnership is making significant strides towards bridging the educational and access gap of contraceptive care, there is still a lot of work to be accomplished. Collecting research is only the first step; meaningful systemic change is needed to address the root causes of misconceptions about contraception. Some evidence suggests that increasing healthcare workers’ literacy in the world of family planning would be effective in improving education for women in Ghana about contraceptive care [4]. Initiatives like group health education for healthcare workers could discuss contraceptive care, the benefits of family planning, and the risks of pregnancy [4].

There are also policy developments underway through Ghana’s Family Planning Costed Implementation Plan (GFPCIP) 2024–2030, which aims to ensure that by 2030, all people of reproductive age will have access to quality family planning information and services [9]. This objective is being achieved through government funding for family planning resources, increasing insurance coverage, modern contraceptive prevalence, promoting reproductive education among adolescents, and implementing targeted social change [9].

The future of contraceptive care for women in Ghana should include unbiased, comprehensive information on all methods, alongside supporting informed choice to best match each family’s fertility goals [2]. However, reaching this goal will require changes at the local, systemic, and institutional levels.

Works Cited:

[1] Sonalkar, S., Maya, E., Adanu, R., Samba, A., Mumuni, K., McAllister, A., Fishman, J., Schurr, D., Schreiber, C. A., Kolev, S., Doe, R., & Eluned Gaffield, M. (2021). Pilot monitoring and evaluation of the WHO postpartum family planning compendium mobile application: An in-depth, qualitative study. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 153(3), 508–513. https://doi.org/10.1002/ijgo.13631

[2] Guzman, N. M., Nakua, E., Moyer, C. A., Lori, J. R., Dzomeku, V., Otupiri, E., & Compton, S. D. (2025). Unmet need for contraception? Understanding postpartum family planning desires and use in Kumasi, Ghana. Frontiers in reproductive health, 7, 1625242. https://doi.org/10.3389/frph.2025.1625242

[3] International Research Team Secures $2.9 Million NIH Grant to Improve Postpartum Contraceptive Care in Ghana. (2025). https://globalhealthequity.umich.edu/news-events/news/international-research-team-secures-29-million-nih-grant-improve-postpartum

[4] Wuni, C., Turpin, C. A., & Dassah, E. T. (2017). Determinants of contraceptive use and future contraceptive intentions of women attending child welfare clinics in urban Ghana. BMC public health, 18(1), 79. https://doi.org/10.1186/s12889-017-4641-9

[5] Kalamar, A., Bixiones, C., Jaworski, G., Lerma, K., Mwansa, M., Lawerh, R., & Adjei, S. (2022). Supporting contraceptive choice in self-care: qualitative exploration of beliefs and attitudes towards emergency contraceptive pills and on-demand use in Accra, Ghana and Lusaka, Zambia. Sexual and Reproductive Health Matters, 29(3), 198–212. https://doi.org/10.1080/26410397.2022.2045065

[6] Ogum, D., Maya, E. T., Modey, E., Manu, A., & Torpey, K. (2025). Family planning and abortion service availability and utilisation during the COVID-19 pandemic in Ghana. Reproductive Health, 22(Suppl 3), 234–1. https://doi.org/10.1186/s12978-025-02122-x

[7] Tenny, S., Brannan, J. M., Brannan, G. D. (2022). Qualitative Study. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470395/

[8] Biney, A. A. E., Kayi, E., Atiglo, D. Y., Sowah, L. R., Badasu, D., & Ankomah, A. (2023). COVID-19, relationships, and contraception: Qualitative perspectives from emerging adults during the COVID-19 lockdown in Accra, Ghana. SSM. Qualitative Research in Health, 3, 100216-. https://doi.org/10.1016/j.ssmqr.2022.100216

[9] Ghana. Family Planning 2030. (2024). https://www.fp2030.org/commitment-maker/ghana/#:~:text=The%20Republic%20of%20Ghana%20has%20committed%20to,targeted%20social%20and%20behavior%20change%20communication%20plan

RESEARCH AWARD

'25-'26 Winner: Rachel Lim

By: Zahraa Alfatlawi

Rachel Lim joined the Prasov Lab as a pre-med student interested in ophthalmology and surgery. She sought a deeper understanding of the eye, especially since few undergraduate courses explore it in detail. Over the past two years as a senior research assistant, that curiosity has grown into an honors thesis project focused on the genetics of nanophthalmos, a rare condition characterized by small but structurally normal eyes.

Her current project, “Pathogenic Loss of Function Variant in MYRF ICA Domain Results in Isolated Nanophthalmos”, focuses on understanding how a newly identified MYRF variant may contribute to isolated nanophthalmos. While the condition is known to have a genetic basis, only about 20% of cases can currently be explained by identified genes. In the Prasov Lab, an R695C variant in MYRF was found in a patient with isolated nanophthalmos, and Rachel’s work aims to understand what that specific change actually does. She studies whether the variant affects how MYRF functions in the retinal pigment epithelium (RPE), a cell layer that plays an important role in maintaining retinal health.

To explore this further, Rachel combined patient sequencing data with structural modeling and lab-based experiments. Using tools such as Ensembl VEP and AlphaFold3, she examined how the R695C variant might affect the shape and stability of the MYRF protein. The modeling suggested that this substitution disrupts a hydrogen bond within the ICA domain. Since the ICA domain cleaves MYRF to activate it as a transcription factor, any disruption in this process could prevent the protein from entering the nucleus and carrying out its role in regulating gene expression.

She then moved into cell-based experiments to test this prediction in ARPE-19 cells using engineered DNA constructs. Imaging revealed that the R695C variant remains in the endoplasmic reticulum rather than entering the nucleus, as observed in known cleavage-deficient controls. Getting to that point was not straightforward. She redesigned primers, adjusted experimental conditions, and worked through multiple rounds of troubleshooting when results did not initially align with expectations. Rather than viewing setbacks as failures, she learned to treat them as useful information. As she describes it, “a no is still a yes,” since each unexpected outcome helped guide the next step of the project.

Beyond the results themselves, this project has played an important role in Rachel’s growth as a researcher. With guidance from her mentor, Dr. Gabrielle Rozumek, and support from Principal Investigator Dr. Lev Prasov, she learned how to work through setbacks and rethink experiments when things did not go as planned. Over time, she became more comfortable taking ownership of the project and making decisions about next steps. She credits her mentors for being patient and invested in her development, helping her learn to approach challenges thoughtfully and adjust her methods rather than get discouraged.

Working on a rare disease has also given the project personal meaning. Each experiment adds another piece of understanding to a condition that has many questions still unanswered. Seeing how patient data can be translated into molecular mechanisms has strengthened her interest in pursuing medicine, potentially in pediatric surgery or pediatric ophthalmology. As she prepares for the MCAT and plans for a gap year, Rachel hopes to continue working on service-oriented initiatives, including projects supporting children in underserved communities.

Research has given Rachel a way to explore her interest in ophthalmology in a hands-on manner. Over time, she’s learned how to handle setbacks, rethink experiments, and stay patient when results don’t come easily. With guidance from her mentor and support from her lab team, she’s been able to contribute to understanding how MYRF variants relate to nanophthalmos. At the same time, the experience has helped her grow more confident in her abilities and clearer about the kind of physician and researcher she hopes to become.

ABOUT THE AUTHORS:

Shailesh Gullipalli

Iris Pan

Zahraa Alfatlawi

Nathalie Tsimhoni

Ash'sah Gubena

Rowena Kannaiyan

Wynne Byard

Anam Noor

Anam Noor is an undergraduate senior at the University of Michigan studying Creative Writing & Literature and Neuroscience on the pre-medical track. She has been a member of GSSA for five semesters. She is passionate about global surgery, literacy, poetry and neuroscience, and hopes to pursue a career in Epilepsy Surgery.

Shailesh Gullipalli is an undergraduate senior at the University of Michigan studying ___. He has been a member of GSSA for ____ semesters and is the incoming ____. He is passionate about ____ and hopes to pursue a career in _____.

Dear Reader,

The Global Surgery Student Alliance is an organization committed to educating, inspiring, and uniting students through engagement and mentorship in topics related to global surgery and global health as a whole. The GSSA Globe is a journal committed to engaging our members and the larger global health community with current events in global surgery, while situating our local University of Michigan community in larger conversations about global health.

I am excited and honored to present Volume 1 of The Globe. The first edition constituted four main sections: first, in the professional profile, we had the honor of interviewing an esteemed general surgeon and innovator in the world of global health; next, the global section underscored events impacting global surgery on an international scale with Sudan’s Civil War and Ghana’s Stoma Support group; this was followed by the local section that discussed barriers to contraception and family planning for postpartum women in Ghana, the research target of a collaboration between KNUST and UM; finally, we were incredibly proud to present our '25-'26 research award to Rachel Lim.

I would like to thank the following individuals for their support of this edition:

Dr. Robin Petroze, MD

Alex Mamonov

Romir Jha

Angelina Hamati

Nathalie Tsimhoni

Thank you for your readership. We hope you enjoyed, and stay tuned for more issues!

Sincerely,

Anam Noor

Editor-in-Chief of the GSSA Globe

Editor's Note

Primary Contact:

gssaleadership@umich.edu

Thank You!

Stay tuned for updates on our next issue!