Global Surgery and Trauma Research

An estimated 11–32% of the global disease burden is due to surgically correctable illnesses. Lancet Commission on Global Surgery estimated that 5 billion people do not have adequate access to safe affordable surgical care when needed. Contrary to belief, investing in surgical services in low- and middle-income countries (LMICs) is affordable, saves lives, and promotes economic growth.  Global Surgery is defined as an area of study, research, practice, and advocacy that seeks to improve health outcomes and achieve health equity for all people who need surgical and anaesthesia care, with a special emphasis on underserved populations and populations in crisis. Among these surgically treatable diseases, trauma causes over four million deaths annually, predominantly in LMICs and is an important aspect of Global surgery. Cancer, similarly, is the second most lethal noncommunicable disease after cardiovascular disease and accounted for about 9.9 million deaths, globally in 2020. Around 9% of all cancer deaths occurred in the Indian population. Hence, our research in Global Surgery and Trauma aims to focus on trauma and injury, cancer care, and barriers and solutions to surgical care delivery through

  1. Building on the existing national and international research consortia and grants on various surgical care research topics relevant to LMICs. 
  2. Working with regional units to build collaborations. 
  3. Develop funding streams to sustain the Global Surgery Program within The George Institute.

We are also in the process of being designated as WHO Collaborating Center for Emergency, Critical and Operative Care (ECO). The mandate of the WHO Surgical care is based on the Framework on Integrated People-centred Health Services (IPCHS) which perfectly aligns with the Institute’s mission and values of  better treatments, better care and healthier societies. The Universal Healthcare Compendium work goes beyond single diseases, across the life course, to identify patient-centred approaches to care that can be implemented at scale.

We have currently received following Grants and contracts at The George Institute:

  1. Grants from WHO HQ with GIS in 2023 for support in technical work and activities related to the development and revision of surgical instrument sets to be posted and organized in MeDeviS and MeDevPacks (USD 46,000) for WHO’s work on Universal Healthcare Compendium
  2. Grants from WHO HQ with GIS in  Nov 2023 2023 for support in technical work and activities related to the development, revision of surgical instrument sets and harmonization with existing UHCC packages organized in MeDeviS and MeDevPacks for WHO’s work on Universal Healthcare Compendium ( 21000 USD)
  3. Rick & Sadhana Downs Foundation and Boston Children’s Hospital. (USD 500,000) 2016 Boston’s Children Hospital and Harvard Medical School Program in Global Surgery and Social Change.
  4. Gerdin Wärnberg Martin Network grant UF-5 Does training in the care of trauma patients in hospitals improve patient outcomes? A network of Swedish and Indian researchers Public health science, global health, social medicine and epidemiology, Other clinical medicine Karolinska Institute Year 1 SKr. 3,95,010 Year 2 SKr. 3,95,010 Total: SKr. 7,90,020 
  5. The Ethics of Adverse Outcomes: An Ethnography of Second Victim Syndrome Among Health Workers in India (15000 USD) Collaboration between The George Institute and Duke University global health humanities pilot research funding scheme.
  6. Grant applied for HCL tech Grant: Health on Wheels (HoW):  Bridging Healthcare Gaps in Remote Tribal Areas (Rs 50000000)

2021-2024 The George Institute-affiliation Publications to build the Body-of-work with The George Institute India on the portfolio of Global Surgery and trauma by Nobhojit Roy and Anita Gadgil are listed here. The publications are focused on Trauma and violence, surgical care delivery in limited resource settings and cancer care.

The detailed list is added as Annexure:

Trauma & Violence :

  1. Effects of trauma quality improvement program implementation on mortality: A multicenter controlled interrupted time-series study, Johanna Berg, Siddarth David, Girish D. Bakhshi, Debojit Basak, Shamita Chatterjee, Kapil Dev Soni, Ulf Ekelund, Li Felländer-Tsai, Manjul Joshipura, Tamal Khan, Monty Khajanchi, L N Mohan, Anurag Mishra, Max Petzold, Sendhil Rajan, Nobhojit Roy, Rajdeep Singh, Martin Gerdin Wärnberg; medRxiv 2024.05.27.24307748; doi: https://doi.org/10.1101/2024.05.27.24307748
  2. Ghoshal R, Patil P, Sinha I, Gadgil A, Nathani P, Jain N, Ramasubramani P, Roy N. Factors associating with help-seeking by women facing Intimate Partner Violence in India: insights from National Family Health Survey-5.
  3. Jayaram A, Dutta R, Kim EK, Mahajan A, Pendleton A, Nathani P, Veetil DK, Stossberger R, McClain CD, Grewal M, Gadgil A. Alternative strategies for emergency blood transfusion in low-resource settings: A scoping review. Transfusion. 2024 May 14.
  4. Amato S, Culbreath K, Dunne E, Sarathy A, Siroonian O, Sartorelli K, Roy N, Malhotra A. Pediatric trauma mortality in India and the United States: A comparison and risk-adjusted analysis. Journal of pediatric surgery. 2023 Jan 1;58(1):99-105.
  5. Basak D, Chatterjee S, Attergrim J, Sharma MR, Soni KD, Verma S, gerdinwärnberg M, Roy N. Glasgow coma scale compared to other trauma scores in discriminating in-hospital mortality of traumatic brain injury patients admitted to urban Indian hospitals: A multicentre prospective cohort study. Injury. 2023 Jan 1;54(1):93-9.
  6. Basak D, Anthony AA, Banerjee N, Rath S, Chatterjee S, Soni KD, Sharma N, Ogawa T, O'Reilly G, Attergrim J, Wärnberg MG. Mortality from fall: A descriptive analysis of a multicenter Indian trauma registry. Injury. 2022 Dec 1;53(12):3956-61.. 
  7. Berg J, Alvesson HM, Roy N, Ekelund U, Bains L, Chatterjee S, Bhattacharjee PK, David S, Gupta S, Kamble J, Khajanchi M. Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries. BMJ open. 2022 June 1;12(6):e059948.
  8. Soni KD, Bansal V, Arora H, Verma S, Wärnberg MG, Roy N. The state of global trauma and acute care surgery/surgical critical care. Critical Care Clinics. 2022 Oct 1;38(4):695-706 
  9. Wärnberg MG, Berg J, Bhandarkar P, Chatterjee A, Chatterjee S, Chintamani C, Felländer-Tsai L, Gadgil A, Ghag G, Hasselberg M, Juillard C. A pilot multicentre cluster randomised trial to compare the effect of trauma life support training programmes on patient and provider outcomes. BMJ open. 2022 Apr 1;12(4):e057504.
  10.  Rakhi Ghoshal, Anne-Charlotte Douard, Shefa Sikder, Nobhojit Roy & Dell Saulnier (2023) Risk and Protective Factors for IPV in Low- and Middle-Income Countries: A Systematic Review, Journal of Aggression, Maltreatment & Trauma, 32:4, 505-522, DOI: 10.1080/10926771.2022.2154185
  11. Sikder SS, Ghoshal R, Bhate-Deosthali P, Jaishwal C, Roy N. Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015–2020). BMC women's health. 2021 Dec;21:1-3. 
  12. David SD, Aroke A, Roy N, Solomon H, Lundborg CS, Wärnberg MG. Measuring socioeconomic outcomes in trauma patients up to one year post-discharge: A systematic review and meta-analysis. Injury. 2022 Feb 1;53(2):272-85.
  13. Banerjee N, Sharma N, Soni KD, Bansal V, Mahajan A, Khajanchi M, Wärnberg MG, Roy N. Are home environment injuries more fatal in children and the elderly?. Injury. 2022 Jun 1;53(6):1987-93.

Global surgery/ Surgery in limited resource settings

  1. Roy, N., Bhushan, P., Mohan, M. and Paonaskar, A. (2024), The Task-Sharing Path to Safe and Accessible Anaesthesia Care in India: The Role of Professional Associations in Health Policy Reform. Public Health Chall., 3: e205. https://doi.org/10.1002/puh2.205
  2. Sheneman N, Hirschhorn L, Roy N. Better Together: Opportunities to Integrate Global Surgery and Primary Health Coverage: Surgery and PHC. Impact Surgery. 2024 May 23;1(3):81-2.
  3. Dutta R, Pendleton AA, Shukla M, Jayaram A, Hembram S, Kumar N, Gadgil A, Roy N, Raykar NP. The blood deserts of Bihar and implications for postpartum haemorrhage care. Transfusion. 2024 May;64(5):952-954. doi: 10.1111/trf.17804. PMID: 38733610.
  4. Kumar N, Sawhney R, Roy N, Raykar N. Rapid diagnostic testing: the key to ensuring sufficient supply and safe access to blood in emergencies. BMJ Global Health. 2024 Feb 1;9(2):e014613.
  5. Nwagbata A, Dutta R, Jayaram A, Thivalapill N, Jain S, Faria I, et al. (2024) Beyond the Ivory Tower: Perception of academic global surgery by surgeons in low- and middle-income countries. PLOS Glob Public Health 4(3): e0002979. https://doi.org/10.1371/journal.pgph.0002979
  6. Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO. Academic global surgical competencies: A modified Delphi consensus study. PLOS global public health. 2023 Jul 14;3(7):e0002102
  7. Schell CO, Khalid K, Wharton-Smith A, Oliwa J, Sawe HR, Roy N, Sanga A, Marshall JC, Rylance J, Hanson C, Kayambankadzanja RK. Essential emergency and critical care: a consensus among global clinical experts. BMJ Global Health. 2021 Sep 1;6(9):e006585.
  8. Barth CA, Wladis A, Roy N, Blake C, Kolo SM, O'Sullivan C. Ways to improve surgical outcomes in low-and middle-income countries. Bulletin of the World Health Organization. 2022 Nov 11;100(11):726
  9. Bhandarkar P, Gadgil A, Patil P, Mohan M, Roy N. Estimation of the national surgical needs in India by enumerating the surgical procedures in an urban community under universal health coverage. World Journal of Surgery. 2021 Jan;45:33-40.
  10. Jumbam DT, Kanmounye US, Alayande B, Bekele A, Maswime S, Makasa EM, Park KB, Ayala R, Onajin-Obembe B, Samad L, Roy N. Voices beyond the Operating Room: centring global surgery advocacy at the grassroots. BMJ Global Health. 2022;7
  11. Kim EK, Dutta R, Roy N, Raykar N. Rural surgery as global surgery before global surgery. BMJ Global Health. 2022 Mar 1;7(3):e008222.
  12. Patil P, Nathani P, Bakker JM, van Duinen AJ, Bhushan P, Shukla M, Chalise S, Roy N, Gadgil A. Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review. World Journal of Surgery. 2023 May 16:1-0.
  13. Fowler, Z., Dutta, R., Kilgallon, J.L. et al. Academic Output in Global Surgery after the Lancet Commission on Global Surgery: A Scoping Review. World J Surg 46, 2317–2325 (2022). https://doi.org/10.1007/s00268-022-06640-8
  14. Velin L, Lantz A, Ameh EA, Roy N, Jumbam DT, Williams O, Elobu A, Seyi-Olajide J, Hagander L. Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries. BMJ Global Health. 2022 Apr 1;7(4):e0087
  15. Kumar N, Sawhney R, Roy N, et alRapid diagnostic testing: the key to ensuring sufficient supply and safe access to blood in emergenciesBMJ Global Health 2024;9:e014613. 
  16. Rohini Dutta, Shagun Tuli, Minal Shukla, Priti Patil, Alex J van Duinen, Neil Thivalapill, Rakhi Ghoshal, Anusha Jayaram, Nobhojit Roy & Anita Gadgil (2023) Geographic and socioeconomic inequities in caesarean delivery rates at the district level in Madhya Pradesh, India: A secondary analysis of the national family health survey-5, Global Health Action, 16:1, DOI: 10.1080/16549716.2023.2203544
  17. Patil, Priti1,; Mishra, Satish2; Gadgil, Anita2; Bhandarkar, Prashant 1,3; Roy, Nobhojit4,5; Dwivedi, Laxmi Kant6. The Burden of Diabetic Foot Ulcers in Urban India: A Community Healthcare Setup-Based Study. Indian Journal of Endocrinology and Metabolism ():, June 30, 2023. | DOI: 10.4103/ijem.ijem_346_22
  18. Raykar NP, Raguveer V, Abdella YE, Ali-Awadh A, Arora H, Asamoah-Akuoko L, Barnes LS, Cap AP, Chowdhury A, Cooper Z, Delaney M. Innovative blood transfusion strategies to address global blood deserts: a consensus statement from the Blood Delivery via Emerging Strategies for Emergency Remote Transfusion (Blood DESERT) Coalition. The Lancet Global Health. 2024 Mar 1;12(3):e522-9.

Cancer care: 

  1. Patil P, Sarang B, Bhandarkar P, Ghoshal R, Roy N, Gadgil A. Does women's empowerment and their socioeconomic condition affect the uptake of breast cancer screening? Findings from NFHS-5, India. BMC Womens Health. 2023 Jan 7;23(1):7. Doi: 10.1186/s12905-022-02147-5. PMID: 36611149; PMCID: PMC9824936.
  2. Dutta, R., Mahajan, A., Patil, P. Et al. Breast Conservative Surgery for Breast Cancer: Indian Surgeon’s Preferences and Factors Influencing Them. Indian J Surg Oncol 14, 11–17 (2023). https://doi.org/10.1007/s13193-022-01601-y
  3. Sawhney, R., Nathani, P., Patil, P. et al. Recognising socio-cultural barriers while seeking early detection services for breast cancer: a study from a Universal Health Coverage setting in India. BMC Cancer 23, 881 (2023). https://doi.org/10.1186/s12885-023-11359-3

 

  • Anita Gadgil

    Senior Research Fellow, Global Surgery and Trauma