International Student Surgical Network

Katayoun Madani is a global surgery research fellow at Northwestern Trauma and Surgical Initiative and Co-Chair of InciSioN, the International Student Surgical Network. She was born and raised in Iran, witnessing challenges in an overwhelmed surgical healthcare system, survived by an ongoing, decade long war. She then moved to the United States where she completed her undergraduate and Master's of Science in tissue engineering at Arizona State University. Katayoun attended St. George’s University School of Medicine in Grenada West Indies, where she was co-founder and first Chair of InciSioN Grenada. She co-led a large-scale advocacy effort with the Ministry of Health Grenada and Grenada General Hospital to deliver medical devices and supplies to furnish an operating room and intensive care unit. Katayoun led InciSioN’s Research Team from 2017 to 2020. She founded the Students4COVID bringing together multidisciplinary members from over 40 countries to provide global relief during the pandemic.

InciSioN advocates for timely and affordable access to safe surgery and anaesthesia for everyone, everywhere, when needed. Our efforts are built on three pillars of education, advocacy and research with the aim of training the surgical workforce of the future. We work to educate ourselves and others on Global Surgery and the current status of surgical care around the world, so that we understand the gaps better. Through advocacy campaigns we raise awareness for the neglected surgical patients globally. Our research is focused on developing studies and gathering ethically obtained sound scientific data on the current status of surgical healthcare systems. The results of our studies can inform the wider public about global surgery, its barriers and possible interventions.  By bridging the gap between students, residents, early career physicians and other healthcare professionals we hope to create a community that will build a better surgical tomorrow for the world.

Five billion people do not have access to safe, affordable surgical and anaesthesia care when needed, and 143 million additional surgical procedures are needed in Low Middle Income Countries (LMICs) each year to save lives and prevent disability. Only 6% of total operations occur in the poorest countries, where over a third of the world’s population lives. Thirty three million people face catastrophic health expenditure due to surgery and anaesthesia care annually. An additional 48 million cases of catastrophic expenditure are attributable to the non- medical costs of accessing surgical care. Investing in surgical services in LMICs is affordable, saves lives, and promotes economic growth. To meet present and projected population demands, urgent investment in human and physical resources for surgical healthcare is needed. In 2010, an estimated 16·9 million lives were lost from conditions needing surgical care. This well surpassed the number of deaths from HIV/AIDS (1·46 million), tuberculosis (1·20 million), and malaria (1·17 million) combined. Each year, at least 77·2 million disability-adjusted life-years could be averted by basic, life-saving surgical care.

Reference: Meara, John G., et al. "Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development." The Lancet 386.9993 (2015): 569-624.

InciSioN the International Student Surgical Network is a student run non profit organization representing over 5000 students, trainees, and early career physicians who are passionate about Global Surgery. On a local level InciSioN has established National Working Groups (NWGs) in 50 countries spanning all world regions. InciSioN International Team (IT) sets the tone for global activities of the organization. Our efforts are built on three pillars of education, advocacy and research.

Education team is active in five areas; education for professional, internal capacity building, public education, content developing, and opportunity providing. Additionally the team is developing an open access course on Global Surgery. InciSioN advocacy team works on annual campaigns for; Universal Health Coverage Day, Global Surgery Day, International Day for Maternal Health and Rights, World Anaesthesia Day, and World Trauma Day. The team creates graphics and audio-visual contents for social media campaigns, host twitter chats, and screening of documentaries such as the Checklist Effect. InciSioN research team has fostered the development of research projects and collaborations and created opportunities for research-education, and mentorship for members across the globe through: the Research Proposal Program; Research Mentorship Program; Research Capacity Building program; Global Surgery Journal Club; and External Collaborations.

5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. InciSioN brings together students, trainees, and early career physicians to work towards providing safe, timely and affordable surgical care for all who need it. Most of the disparities in access to surgical health care are in low and middle income countries (LIMICs). LMICs compose the majority of our network of National Working Groups (NWGs). We are intentional in ensuring an active presence and involvement of our LMIC members in all activities. Our educational efforts are focused not only on internal capacity building but also on understanding the disparities and gaps in global surgery. Our advocacy campaigns work closely with NWG leaders to bring light to local level issues and raise awareness for neglected surgical patients. InciSioN research focuses on studies that collect data to form a better understanding of infrastructural factors needed for building robust and sustainable surgical healthcare systems. Moreover we form equitable, multidirectional collaborations to provide growth opportunities for our LMIC members, and have developed a travel scholars program for our LMIC members to attend our annual Global Surgery Symposium to empower the future human resource of the Global Surgical ecosystem.

Incision relates to all aspects of the Elevate Prize. Majority of our membership is from Low Middle Income Countries (LMICs) which are also most impacted by the disparities in surgical care delivery. We are dedicated to ensuring equitable involvement of our LMIC members in all projects and leadership of our organization. 

We have taken upon ourselves to be the voice for the 5 billion neglected surgical patients across the globe. Our educational and research efforts not only contribute to policy development and impact today but also are building blocks for the future of the world’s surgical healthcare ecosystem.

In 2014 the International Federation of Medical Student Associations (IFMSA),  released a policy statement on access to safe surgery and anesthesia for all, and a call for formation of small working groups (SWGs) on global surgery. From this call six SWGs on Global Surgery, one of which was St. George’s University SWG on Global Surgery ( later named InciSioN Grenada), were formed and began working together. By late 2015 IFMSA decided to remove SWGs on Global Surgery from the list of its activities due to a shift in priorities. The SWGs on Global Surgery came together and soon gathered support from newly developed working groups in other countries and formally established InciSioN as a non profit organization in March 2016. I joined the International Team of InciSioN in 2017 while I was the chair of InciSioN Grenada.  Over the last 3 years my colleagues and I have worked tirelessly to build InciSioN to an organization of 50 National Working Groups, representing over 5000 students, trainees and early career physicians. Today InciSioN is a recognized force in advocacy, education, and research in Global Surgery and its members are often referred to as the future of the operating room.

I was born and raised in Iran during the post revolution war with Iraq that lasted eight years. My family were all healthcare providers and through their work I witnessed the disparities in healthcare and surgical care in my home country firsthand. I became familiar with Global Surgery as a medical student in Grenada. When I learned that the island of Grenada had four surgeons and one functional operating room for 100,000 people with severe shortage of instruments, I had to do something. I dedicate two years to working closely with my colleagues, Grenadian surgeons and Ministry of Health in Granada to bring in a cargo to furnish an operating room and an intensive care unit tailored to the needs of the community. The cargo while necessary was only a temporary fix, and to truly address gaps in surgical care we need to find sustainable solutions. I am passionate about Global Surgery because no child should die because of a reused central line, no mother should perish from lack of access to c-section, and no one should be pushed into poverty because they needed a life saving surgery. This is the calling that I am dedicating my career to.

Throughout my career I have led many student initiatives and organizations as I find working together with colleagues on projects we are passionate about very satisfying. As an undergraduate student I led the Arizona State University chapter of Biomedical Engineering Society and my initiatives led to a 600$ award to our organization. As a medical student I co-led an initiative called Hope for Nepal that united our entire campus and community and raised over $15,000 USD for earthquake relief leading to delivery of medical supplies, rebuilding of three villages and an orphanage. Later I co-founded InciSioN Grenada, and became its first chair and led the largest philanthropic effort in history of the Grenada Ministry of Health valued at $400,000 USD.

From 2017-2020 I led the InciSioN Research Team, during which I created the research infrastructure of our network. I currently serve as the co-chair of InciSioN. In this capacity I lead our executive board and international team and set the tone for the global activities of a network spanning 50 countries and counting. Throughout the years I have created close working relationships with colleagues and NWG leaders. These connections paired with my leadership experiences, and passion for global surgery allow me to have a better understanding of the needs of our members and their communities and to set a strong foundation for training of the future of global surgery and harnessing the power of youth in this field.

In March 2020 COVID-19 pandemic swept across the globe leading to high infection rates and mortality, quarantine, social distancing, and halt of medical education as we knew it. The InciSioN executive board (EB) and I had many plans for the 2020 term, including InciSioN Global Surgery Symposium (IGSS) set to take place on May1st in Colombia. It became apparent quickly that our plans and priorities had to shift and adapt. First we gathered information about our National Working Groups (NWGs) and their local conditions. Simultaneously I founded a multidisciplinary initiative called Students4COVID, and InciSioN placed a call for formation of COVID Committees. Next COVID Committees for Public Education, Multi-lingual Q and A, Social Media, and Webinar formed and some merged with Students4COVID to provide support for pandemic. In early March I sought the expertise of our board of advisors, held discussions with the EB and InciSioN Colombia, to make the difficult decision of postponing IGSS after a year of planning, to protect the wellbeing of everyone. COVID-19 pandemic completely changed 2020, yet I am proud that we have been able to support our NWGs, provided relief globally for the pandemic, and we are planning to host IGSS virtually in winter.

In spring 2015 a deadly earthquake shook Kathmandu, the capital of Nepal. I was a medical student in Grenada and the education coordinator of the St. George’s University Surgery Club. I received an email from the American College of Surgeons; Operation Giving Back asking for medical supplies. I reached out to the executive board of Surgery Club and asked for support. The president told me “if students donate, then we will match their donation”. I sent posts and messages immediately to student communities, and within minutes the president of International Federation of Medical Students Grenada contacted me and shared that he had received a request for help from his counterpart in Nepal.

 Together we launched an initiative called Hope for Nepal, and through class announcements, going door to door at dormitories and local business, in 12 days we united 17 student organizations, the local community and administration. We raised over $15,000 USD which helped rebuild 3 villages and an orphanage named Orchid Garden, in addition to donating two medical supply kits. To this day, I receive photos from the Orchid Garden Nepal which remind me of how close humanity can be, no matter how far physical distances may seem.

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InciSioN is a grassroots movement involving youth, going from the level of students to trainees, and early career physicians coming together from across the globe, aiming to change the landscape of surgical care delivery. Never before a youth movement has been associated with surgery, as the field itself is a postgraduate training in medicine. InciSioN represents an awakening of youth and the future generations of the surgical healthcare ecosystem, in understanding their role and responsibility in building the future of surgery. InciSioN is the future generation taking ownership of their responsibility. Our work is passion driven, an idea from one corner of the world can catch on in the morning  and by evening you have a team joining forces working around that idea. The organization itself has an extraordinary growth curve, going from 12 to 50 National Working Groups in 3 years, rendering it the largest medically focused student run organization in the world after the 70 year old International Federation of Medical Student Associations. Our work in advocacy, education and research is not only capacity building and training of the future generations but has been recognized as a major force in Global Surgery today.

Five billion people lack access to safe, timely, and affordable surgical care. InciSioN works to change this statistic through capacity building and training of the future generation of the global surgical ecosystem. Our efforts have local and global impacts that are both effective short term and also will echo through the upcoming generations.

In 2015, in the light of the passing of the WHO Resolution WHA68.15 “Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage”, InciSioN started Global Surgery Day, which raises awareness for neglected surgical patients. InciSioN members were involved in advocacy efforts that led to adoption of Resolution 72.31 “Emergency and trauma care” by the 72nd WHA in 2019. InciSioN Somaliland has been working on changing the laws to allow for maternal consent for C-Sections, and InciSioN Egypt members have provided medical device donations to local hospitals. We have empowered our members to effect global and local level advocacy and policy today. The longterm effect of these policies is how resources are allocated to surgical patients and how they are treated.

Our surgical safety checklist workshops train the surgical staff. Whilst our e-learning course and capacity building modules teach long term skills. Our Travel Scholars Program provides the opportunity of attending InciSioN Global Surgery Symposium for Low Middle Income Country (LMIC) members. One of our travel scholars had never seen a train prior to attending IGSS, and he went on to create a NWG in his own country and hosted an IGSS few years later. These scholars have not only already given back to the community and led to change, they will continue to do so throughout their careers.

Our research collaboration with Lifebox and Ariadne showed the views of the new generation on surgical safety checklist and set plans in motion for modification to the checklist. While our internal research studies are opportunities for developing and honing research skills. Providing research education especially for our LMIC members enables them to develop and lead research projects that will change delivery of surgical care in their country for many years to come.

Current Outreach :

National Working Groups/Countries : 50

Individual doctors, medical students, trainees, nurses : 5,000

Patients/General Population : 2,500

Next 1 Year Outreach :

National Working Groups/Countries : 60

Individual doctors, medical students, trainees, nurses : 7,500

Patients/General Population : 10,000

Next 5 Years Outreach :

National Working Groups/Countries : 100

Individual doctors, medical students, trainees, nurses : 20,000

Patients/General Population : 50,000

Over the next year we plan to continue our efforts towards:

• Releasing an open access e-learning course on fundamentals of global surgery

• Provide capacity building sessions on effective advocacy for global surgery in landscape of COVID-19 pandemic as a follow up to our call to action from May 2020

• Collect data on knowledge and attitudes of students towards Global surgery as part of the InciSioN ISOMERs study

• Host IGSS2020 virtually as the single largest global surgery focused conference in the world

Our 5 year goals are:

• To have an impact at the local level by investing in infrastructure and equipment for LMIC countries. 

• To advocate for timely and affordable access to safe surgery and anaesthesia for everyone, everywhere, when needed

• To connect students, residents and young doctors interested in surgery, anaesthesia and obstetrics around the world

• To bridge the gap between students and residents, young doctors and other healthcare professionals

• To raise the voices of students and residents and their influence in improving global access to surgical and anaesthesia care

• To inform the wider public around the world about global surgery, its barriers and possible interventions

• To contribute to and advance research in Global Surgery

• To produce the future generations of surgeons, anaesthesiologists and obstetricians

We will ensure that we are on track through both short term and project based, and annual organization wide internal reviews and evaluations.

Barriers for the next year -

• Financial : Most of the activities of the organisation are currently limited to advocacy, research and education using the online platforms which require minimal financial investment. With our goals as we wish to scale up our activities and start on ground action as elaborated in the sections ahead. This will require substantial financial support. 

• Technical : Global Surgery is a new concept and not many individuals are aware about the intensity of the problems we have in hand. Moreover for providing safe and accessible surgery, we would require equipments and infrastructure. 

• Cultural : An international organisation brings together people from different parts of the world with varied cultural backgrounds. 

Barriers for the next 5 years -

• Financial : As we further scale up our projects, the need for monetary support will directly increase.

• Cultural : An international organisation brings together people from different parts of the world with varied cultural backgrounds. As we hope to involve most of the countries after five years, it would bring new challenges. Political, social, cultural differences are not always favorable.

• Legal : Currently a very few of our NWGs are registered as NGOs in their countries. We wish to ensure that the registration of most of our NWGs is complete in order to assure the sustainability of each NWG.

Overcoming Barriers :

• Financial : We wish to have a sustainable revenue to ensure that finances don't prevent us from achieving our goals. We regularly apply for grants and plan to approach companies to collaborate with and receive CSR funds. 

• Cultural : We have tackled this with various training sessions about personal and soft skills. This has equipped the youth with the soft skills to interact effectively with other members. We have created a space which is free of cultural, racial, social and geographical disparities. Every youth has a voice and opportunity to work in the organisation. 

• Technical : We organise webinars, advocacy campaigns, educational webinars and also conduct research on global surgery. We have come a long way in the past five years and raised a lot of awareness about global surgery and hopefully with our continued efforts, Global surgery problems will be actively tackled by governments and other organisations as well.

• Legal : We plan to have mentors in our Board of Trustees who can actively help us with the registration process of NGOs in the countries that we function in. 

Incision works closely with other medical student organisations- namely the International Federation of Medical Students Association (IFMSA). Our partnership was based on the overlap in the work that we do in global health as a whole. After signing our MOU last year, we have worked with IFMSA on social media projects for UHC day, global surgery day and at their annual conference, where a session on Global Surgery was delivered to medical students outside of our organisation. 

Incision is also part of the G4 alliance, a group of organisations working on Surgical Obstetric Trauma and Anesthetic care. Our organisation engages with the global surgery world through our relationship with the other members in the G4 Alliance. At the present moment, we do not have working relationships with these organisations, but in the past have worked on data collection for the world surgical indicators. Incision provides a global network of students and trainees who are equally passionate about making global surgery equitable.

Key Resources:

InciSioN International Platform

National Working Groups of InciSioN 

Donor Network

Partners + Key Stakeholders:

Lifebox

Sadanah Foundation

G4 Alliance

IFMSA (International Federation of Medical Students Association) 

CSurgeries 

National governments 

Key Activities: 

Network - Connecting global surgery enthusiasts across the world

Education - Providing relevant educational content on Global Surgery

Advocacy - Advocating for Global Surgery and UHC

Research - Conducting and supporting valuable research projects

Type of Interventions:

Workshops/Sessions

Annual Conference

Valuable Research

Campaigns

Channels:

Social Media

www.incisionetwork.org 

National Working Groups

Direct Beneficiaries:

Future surgical healthcare workforce including medical, public health and paramedical students, trainees, nurses.

Indirect Beneficiaries: 

Patients requiring surgical care across the world

Pregnant women

Direct Value Proposition:

50National Working Groups (Countries)

All 6 WHO Regions 

5000+ medical students, trainees, nurses and junior doctors

3 Annual Conferences

50+ Sessions/Workshops/Webinars

10+ Research Publications

10+ Policy Statements

Indirect Value Proposition:

Surgical outcome 

Access to surgery in resource limited places

Reducing mortality by essential and emergency surgeries 

Cost Structure:

Virtual meeting tools

G4 Alliance Membership

Online Platform

On ground action projects

Revenue:

Event Sponsorships

Optional Donations 

Grants

Currently we are ensuring our financial sustainability via sustained sponsorships, grants and donations. We receive sponsorships every year for our annual conference IGSS. These funds are also used to provide travel scholarships for individuals to get a chance to attend the conference. 

Majority of our revenue is spent in equipping our network with knowledge and skills in the field of global surgery. But with the exponential increase of our network, we wish to broaden our outreach by directly impacting the lives of patients. We wish to train and support the healthcare workforce in our network to take action at a local level. We believe that the knowledge and skills imparted to our members will support the patients but at the same time we also require to assist them with various amenities and infrastructure. We strongly believe that the Elevate Prize will provide us with a capital to bring these plans to life.

Revenue 

University of Edinburgh Sponsorship for IGSS2019 (568.10 euros)

• $ 640 

• Sponsorship for IGSS 2019

• Date Received : 18 - 04 - 2019

• The amount was used to support the travel scholars and the event. 

Lifebox Foundation 

• $ 500

• Sponsorship for IGSS 2019

• Date Received : 09 - 05 - 2019

• The amount was used to support the travel scholars and the event. 

Gradian Health Systems Sponsorship for IGSS 2019 (648.63 euros)

• $ 750

• Sponsorship for IGSS 2019

• Date Received : 22 - 02 - 2019

• The amount was used to support the travel scholars and the event. 

We seek $ 200,000 for the FY 2020-2021 and $ 250,000 for the FY 2021-2022 by grants. We wish to raise the money by December of each year. We are operating in 50 countries, and the health system of each country has been devastated by the pandemic. We plan to support the LMICs with infrastructure and equipment with the raised money. There are 5 billion individuals who lack access to safe and accessible surgery globally according to the Lancet Global Surgery, the number will only have risen now. The number essential and emergency surgeries have dropped drastically which will in turn increase the burden on the surgical health systems in the near future. The efforts made by the members of our NWGs will make surgical care accessible to the rural, district and all the other inaccessible areas. 

We wish to support 8 LMIC countries in FY 2020-2021 and 10 in the next FY. $23,000 will be invested in each country. The amount will be used to build 1-2 OTs, providing PPE equipment, ventilators or equipment sterilizing setup based on the needs of the country. Thus we believe that the amount invested in each country will save thousands of lives in the upcoming 10 years. The financial support along with the voluntary efforts of junior doctors and trainees will substantially help the efforts. 

Our estimated expenses are mentioned below :

Supporting 6 LMICs

• $138,000 ($23,000 * 4) 

• The money will be used to build infrastructure and provide equipment based on the requirement of the country. 

• This amount will ensure sustainable efforts in those countries for a long term and surely save thousands of lives. 

• $46,000 ($23,000 * 2) would be used in the beginning of 2021 in two other countries.

• This entirely depends on the revenue generated and the work shall be upscaled/downscaled depending on the condition. 

G4 Alliance membership fees (in 2021)

• $5,000  

IGSS 2021 

• $5,000

• Supporting 7-10 travel scholars, i.e 7-10 deserving individuals will get a chance to travel and attended our annual conference and thus get a chance to learn more about Global Surgery

• A similar amount was reserved for IGSS 2020 but since it will be held online, the cost would not be realised. 

Internal Management and Administration

• $2,000

• Zoom Account, G Suite, Canva Pro, etc. 

The Elevate Prize can help us overcome two of the biggest barriers:

Financial : The prize money will help us scale up and work on the on ground projects that we have planned. With these projects we would be able to make an impact on various individuals across the globe. It will also serve as a case study for the projects that we take up further, thus assisting us in collaborating with national organisations to receive sustainable CSR funds, grants and sponsorships. Thus this prize can change the trajectory of our organisation and help us scale up to a level where we could make a global impact in making surgical care safer and more accessible to all. 

Technical : The prize can also further help us to increase our outreach and advocate for Global Surgery. Moreover it could help us get in touch with various corporate companies and the MIT lab itself to source surgical equipment which can be utilised in LMICs. 

InciSioN is an organisation that was started by a group of like-minded medical students who were passionate about global surgery. This group has now grown to include more than 5000 members across the world in over 30 different countries. Our organisation is led by students and trainees worldwide and over the past 5 years, and as our organisation grows annually, the expertise required by the executive board grows with it.

We currently rely on the expertise of our board of trustees and board of advisors to help guide our organisation, this paired with a board of students who are non-experts in the fields outside of medicine mean that we require advise and assistance to continue to expand our organisation in a sustainable fashion allowing our network of students to contribute to the issue of global surgery as best as they can.

We hope to partner with other student organisations: the world of global surgery is not limited to medical students, trainee, and surgeons; surgery is a field that involves more than just the surgeon that is operating. Especially in low-resource settings, the need for innovation and low-cost alternatives is more apparent. We hope to work with other non-healthcare student organisations to create early career connections between healthcare and non-healthcare professionals interested in the surgical field. The creation of these links will help our organisation and our members understand the multidisciplinary nature of what we do. 

Additionally, we hope to work with organisations that will be able to guide us on our journey as an NGO in areas such as fundraising and public engagement. Our advocacy team has been successful in generating general infographics pertaining to global surgery facts, but we hope to engage a wider audience and to garner more attention to the issue of global surgery. We hope that with better advocacy work within our networks, that our members are able to change the narrative around surgical care within their countries respectively. 

With passionate young global surgery advocates amongst our midst, we also hope to inspire and equip them with the relevant skills to function. This could be through capacity building projects that may help build the soft skills to help create better communication networks between the different levels within Incision. We hope that, after their terms, our members develop the soft skills needed to then work in other teams.