The importance of surgery and anaesthesia in improving global health outcomes has long been championed by the World Federation of Societies of Anaesthesiologists (WFSA). In 2015 this was highlighted by the Lancet Commission on Global Surgery, in addition to Disease Control Priorities 3: Essential Surgery and the World Health Assembly (WHA) Resolution 68.15 – all three of which called for greater involvement in both research and advocacy in the area of global surgery and anaesthesia. Similarly, the 2017 Lancet Neurology Commission on Traumatic Brain Injury demonstrated the profound effect of traumatic neurological injury in low and middle-income countries (LMICs).
In light of this, in 2017 the UDA was a founding partner of the NIHR Global Health Research Group on Neurotrauma, a multidisciplinary, international, group of researchers working to map, understand, and improve Neurotrauma care in 11 partner countries across the world. This venture combines the experience of the UDA and the Division of Neurosurgery in the investigation and management of traumatic brain injury, with a new focus on the context in the low and middle-income countries (LMICs) in which this disease is most prevalent.
In addition, the Division is closely allied to the Cambridge Yangon Trauma Intervention Project ICU Programme (CYTIP-ICU). This institutional partnership, funded through the Tropical Health Education Trust and managed by Cambridge Global Health Partnerships, pairs Cambridge University Hospital NHS Trust with Yangon General Hospital (YGH), Myanmar. The aim of CYTIP is to improve the care of trauma patients at YGH, with the ICU focus on systems improvement at both the local and national level.
The UDA research focus in Global Health is based on a systems approach, in partnership with the Healthcare Design Group in the Engineering Design Centre, University of Cambridge. We are exploring how systems approaches can help understand and inform the improvement of trauma care, both in the context of traumatic brain injury and ICU care more generally in LMICs.
Global Neurotrauma Outcomes after Surgery (GNOS-1)
Outcomes following emergency surgery for traumatic brain injury – a prospective, multi-centre, international cohort study
This project is based within the NIHR Global Health Research Group on Neurotrauma and supported by the World Federation of Neurosurgical Societies (WFNS). It aims to provide a global picture of the management and outcomes of patients undergoing emergency surgery for TBI, while establishing a platform and clinical network to facilitate future research in global neurotrauma and neurosurgery.
A Systems Improvement Approach to Traumatic Brain Injury (ASIA-TBI):
Developing a participatory approach to the systems improvement of traumatic brain injury care in Yangon, Myanmar
This project is a collaboration between the UDA, the Engineering Design Centre (EDC), and the NIHR Global Health Research Group on Neurotrauma. It seeks to use a Soft Systems Methodology within a wider engineering systems approach to understand and model the care of TBI patients in Yangon, with a view to developing improvement projects.
A Systems Improvement Approach to Intensive Care Medicine (ASIA-ICM):
Mapping the systems of Intensive Care provision in Myanmar
Instituted as a research element of the Cambridge Yangon Trauma Intervention Project (CYTIP) run by Cambridge Global Health Partnerships this project seeks to map the provision of Intensive Care in Myanmar across two different time points, measuring not only material resources but also the systems and processes which underpin intensive care.
Bashford T, Gore-Booth J, James J, Pickering S, Paris, B, Ross O, Shamambo N. Chapter 1: Context (Humanitarian Assistance and International Development). In Craven R, Edgecombe H, Gupta B (Eds). Oxford Specialist Handbook of Global Anaesthesia. Oxford. 2020. ISBN 978-0-19-880982-1. https://doi.org/10.1093/med/9780198809821.001.0001
Bashford T, Morriss W, Roques C, Shamambo N, Wilkes M. Chapter 5: Perioperative Care (Consent in global anaesthesia). In Craven R, Edgecombe H, Gupta B (Eds). Oxford Specialist Handbook of Global Anaesthesia. Oxford. 2020. ISBN 978-0-19-880982-1. https://doi.org/10.1093/med/9780198809821.001.0001
Whiffin CJ, Smith BG, Esene IN, Karekezi C, Bashford T…Kolias A et al. Neurosurgeons’ experiences of conducting and disseminating clinical research in low- and middle- income countries: a qualitative study protocol. BMJ Open 2020;10:e038939. http://dx.doi.org/10.1136/bmjopen-2020-03893
Clark D, Joannides A, Abdallah OI, Adeleye AO, Bajamal AH, Bashford T…Hutchinson PJ et al on behalf of the Global Neurotrauma Outcomes Study (GNOS) collaborative, Management and outcomes following emergency surgery for traumatic brain injury – a multi-centre, international, prospective cohort study (the Global Neurotrauma Outcomes Study), International Journal of Surgery Protocols (2020), doi: https://doi.org/10.1016/j.isjp.2020.02.001
Wenlock RD, Bath MF, Bashford T, Kohler K, Hutchinson PJ (2020) The global variation of medical student engagement in teaching: Implications for medical electives. PLoS ONE 15(2): e0229338. https://doi.org/10.1371/journal.pone.0229338
Bath M, Bashford T, Fitzgerald JE. What is ‘Global Surgery’? Defining the Multidisciplinary Interface between Surgery, Anaesthesia, and Public Health. BMJ Global Health. 2019:e001808 http://dx.doi.org/10.1136/bmjgh-2019-001808
Bashford T, Joannides A, Phuyal K, Bhatta S, Mytton J, Harrison R, Hutchinson P. Nuancing the need for speed: temporal health system strengthening in low-income countries. BMJ Global Health. 2019. doi:10.1136/bmjgh-2019-001816.
Howell V, Bashford T. Tropical diseases and anaesthesia. Anaesthesia & Intensive Care Medicine. 2019. doi:10.1016/j.mpaic.2019.06.008
Bashford T, Vercueil A. Anaesthetic research in low- and middle-income countries. Anaesthesia. 2018. doi:10.1111/anae.14518
Moonesinghe SR, Bashford T, Wagstaff D, Implementing risk calculators – time for a Trojan horse?. British Journal of Anaesthesia. 2018. 121(6): 1192e1195 doi:10.1016/j.bja.2018.09.025
Bashford T, Nwe Myint PP, Win S, Thu M, Naing MM, Burnstein RM, Hlaing TT, Brealey E, Hutchinson PJA, Clarkson PJ. A systems approach to trauma care in Myanmar: from health partnership to academic collaboration. Future Healthcare Journal. 2018. 5(3). p171-175. doi: 10.7861/futurehosp.5-3-171.
Abou El Ela Bourquin B, Gnanakumar S, Bath M, Bashford T, Menon DKM, Hutchinson PJA. The international health elective: a stepping stone for tomorrow’s global surgeons and anaesthetists. Perspectives on Medical Education. 2018. (7) p228. https://doi.org/10.1007/s40037-018-0439-4
Bashford T, Clarkson PJ, Menon DK, Hutchinson PJA. Unpicking the Gordian knot: a systems approach to traumatic brain injury care in low and middle income countries. BMJ Global Health 2018;3:e000768. dx.doi.org/10.1136/bmjgh-2018-000768
Maas AIR, Menon DK et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology , Volume 16 , Issue 12 , 987 – 1048. https://doi.org/10.1016/S1474-4422(17)30371-X
Bashford T, Howell V. Anaesthesia & Tropical Disease 2. BJA Education. 2017. Mar 18(30), p75-81 https://doi.org/10.1016/j.bjae.2017.11.009
Bashford T, Howell V. Anaesthesia & Tropical Disease 1. BJA Education. 2017. Feb 18(2) , p35 – 40 https://doi.org/10.1016/j.bjae.2017.10.004
Gibbs A, Bashford T, Wilson IA. Pulse oximetry in a high income setting: how big is the gap? Anaesthesia. 2017.72(12): 1565–1567. doi: 10.1111/anae.14146
Bashford T, Reshamwalla S, McAuley J, Allen NH, McNatt Z, Gebremedhen Y. Implementation of the WHO Safe Surgery Checklist in an Ethiopian Referral Hospital. Patient Safety in Surgery. 2014 Mar 8(16). doi:10.1186/1754-9493-8-16.
Walker IA, Bashford T, Fitzgerald E, Wilson IH. Improving Anesthesia Safety in Low-Income Regions of the World. Current Anesthesiology Reports. 2014. doi 10.1007/s40140-014-0056-7.
Bashford T. Anaesthesia in Ethiopia: providers’ perspectives on the current state of the service. Tropical Doctor.2014 Jan 4(1) p6-13. doi.org/10.1177/0049475513512642
Key References & Links
Wellcome Trust Cambridge Centre for Global Health:
World Federation of Societies of Anaesthesiologists. Vision and mission. Available at: www.wfsahq.org/about-us/vision-and-mission.
Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624.
Mock CN, Donkor P, Gawande A, et al. Essential surgery: Key messages from Disease Control Priorities, 3rd edition. Lancet. 2015;385(9983):2209-2219.
World Health Assembly Resolution 68.15: Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage. Sixty-Eighth World Health Assembly. Available at: http://apps.who.int/gb/ebwha/pdf_ﬁles/WHA68/A68_R15-en.pdf.
United Nations. Sustainable Development Goals. Available at: www.un.org/sustainabledevelopment/sustainable-development-goals/.
World Health Organization. Global Reference List of 100 Core Health Indicators, 2015. Available at: www.who.int/healthinfo/indicators/2015/en/.
Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH. International standards for a safe practice of anesthesia 2010. Can J Anaesth. 2010;57(11):1027-1034.
Kempthorne P, Morriss W, Mellin-Olsen J, Gore-Booth J. The WFSA global anesthesia workforce survey. Anesth Analg. 2017;125(3):981-990.
World Federation of Societies of Anaesthesiologists. WFSA position statement on universal health coverage. Available at: www.wfsahq.org/latest-news/latestnews/682-wfsa-releases-position-statement-on-anaesthesiology-and-universal-health-coverage-uhc.