tips for developing a successful global health career

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Stephen Bickler, MD Associate Clinical Professor of Surgery and Pediatrics University of California, San Diego

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Tips for developing a successful global health career. Stephen Bickler, MD Associate Clinical Professor of Surgery and Pediatrics University of California, San Diego. Pediatric surgery in The Gambia. Main government referral hospital - PowerPoint PPT Presentation

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Page 1: Tips for developing a successful  global health career

Stephen Bickler, MDAssociate Clinical Professor of Surgery and

Pediatrics University of California, San Diego

Page 2: Tips for developing a successful  global health career

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)

Page 3: Tips for developing a successful  global health career

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

Page 4: Tips for developing a successful  global health career

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

Page 5: Tips for developing a successful  global health career

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

Page 6: Tips for developing a successful  global health career

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

Page 7: Tips for developing a successful  global health career

Surgery in settings of limited resources

Page 8: Tips for developing a successful  global health career

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

Page 9: Tips for developing a successful  global health career

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

Page 10: Tips for developing a successful  global health career

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

Page 11: Tips for developing a successful  global health career

Career tips Learn a foreign language Acquire formal training in tropical medicine Publish, publish, publish! Create your own foundation

Page 12: Tips for developing a successful  global health career

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!