Tips for developing a successful global health career
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Transcript of Tips for developing a successful global health career
Stephen Bickler, MDAssociate Clinical Professor of Surgery and
Pediatrics University of California, San Diego
Pediatric surgery in The Gambia
Main government referral hospital All children aged <15
years treated for surgical problems during 29 months
Inpatient (n=1726)-34,625 total inpatient days-Average census = 40 pts
Outpatient (n=6606) Operations (n=1347)
Spectrum of surgical conditionsSurgical admissions to a government referral hospital in
the Gambia, Jan 1996 to May 1998 (n=1726)
gastrointestinal
6%
Surgical infections
14%
Injuries
50%
Congenital anomalies
24%
urology
2%misc.
0%
Neurological
1%
ENT
2%
Bickler et al, WHO 2000
Estimated Need for Surgical Care
Cummulative risk of requiring surgical care in a pediatric population living in
Banjul, The Gambia
0
20
40
60
80
100
0 5 10 15
Age (yrs)
%
All surgicalconditionsTrauma
CongenitalanomaliesSurgicalInfectionsMisc.
Bickler,et al, Trop Doct, 2003
Risk factors for surgical deathsAnalysis of pediatric surgical deaths
(n=88)Univariate and logistic regressionHighest in-hospital mortality
Children aged < 1 year (OR 2.9, p= .0005)Burn diagnosis (OR 5.2, p <.0001)Residence outside the Greater Banjul Area (OR
6.6, p =.01)Female sex was associated with an increased
risk of death (P=.065).PAPSA, 2005
Incidence of common conditions
Number of Cases in The Gambia
Incidence (per 10,000 children <15 years)
Expected
Observed Caucasian living in the USA
African living in the USA
African living in
The Gambia
APPENDICTITIS
506 16* 20 10 0.6#
PYLORIC STENOSIS
91 0* 3 Less common
-
For population of 270,000 living in close proximity to RVH during a 29 month period.
*Chi square P value < .001# 1/30th the rate for Caucasians living in USA
Bickler, et al, Ped J Gastro Nutrition 2000
Surgery in settings of limited resources
Strategies for improving care
The role of pediatric surgery in developing countries remains poorly defined
Health care policy does not reflect the surgical needs of children
Major problems with delivery of careLong distances Limited facilities, equipment, human
resourcesShortage of qualified pediatric surgeons
…the challenges for pediatric surgery in developing countries are those of definition, policy and delivery.
Bickler & Rode, Bull WHO, 2003
Strategies for improving care
Focusing our efforts Demonstrate the need for pediatric
surgical care Define a cost-effective package of
pediatric surgical care Improve pediatric surgical care at
the community level Strengthen pediatric surgical
education
Bickler & Rode, Bull WHO, 2002
Career tips Travel as much as possible Always go for the best opportunity, even
though it might not be the most direct route to your eventual goal
Get as much overseas work experience as possible
Career tips Learn a foreign language Acquire formal training in tropical medicine Publish, publish, publish! Create your own foundation
Career tipsIdentify mentorsGet yourself into a position where you can
influence the bigger pictureDon’t be discouraged by traditional thinkersTake risks in your careerHave fun!