Department of Surgery

Medical School

Our Work

Honduras

hondurasSurgeons, anesthesiologists, residents, and medical students from the University of Minnesota have engaged in all four objectives of academic global surgery in Honduras. Dr. Peter and Lulu Daly from St. Paul, Minnesota built a modern surgery center on an orphanage about an hour from Tegucigulpa, Honduras. Initially, this surgery center functioned only a few times a year and was primarily limited to orthopedic and general surgery brigades.  The surgery center partnered with Surgical Centers of America to create an international organization called One World Surgery. Now, this modern surgery center functions continuously and is led by Dr. Merlin Antunez a Honduran orthopedic surgeon who grew up on the orphanage. Specialists in urology, orthopedic surgery, general surgery, gynecology, anesthesiology, surgical oncology, otolaryngology, dermatology, and ophthalmology provide clinical care at this site. Physicians from the University of Minnesota have provided clinical care at One World Surgery since 2012. More than 20 surgical residents and 20 medical students have received educational and training opportunities in Honduras. The University of Minnesota is hosting a 2-day educational event in February 2020 at One World Surgery to enhance breast cancer early detection and treatment in Honduras. Additionally, investigators from the University of Minnesota have partnered with local investigators in Honduras to identify obstacles to early breast cancer detection and to understand the genetic mutations of breast cancer in Central America (Photo: Tuttle Honduras). Students and residents at the University of Minnesota have established a monthly global surgery journal club.

Uganda

rwandaSurgeons from the UMSGD program are partnering in two areas in Kampala. We have a long-running series of USAID and NIH-funded grants evaluating the lymphatic system in clearance of viral and other infections. We partner with Infectious Disease experts at the University of Minnesota and the NIH to evaluate lymph node trafficking in East African subjects. Additionally, we have a growing relationship with Makarere University Department of Surgery and the Ruth Gaylord Hospital to grow surgical capacity in Uganda. Our efforts include surgical camps at the Ruth Gaylord hospital, student and resident rotations at Mulago Hospital, and resident exchanges between surgical trainees at the University of Minnesota and Makarere University. This work includes collaborative research efforts with Makarere University.

Rwanda

gs rawandaEstablished in 2012, the Rwanda Human Resources for Health (HRH) is a collaborative initiative between US academic institutions and Rwanda (University of Rwanda) to build a strong, independent health care delivery system based on the training of next generation health care providers in Rwanda. Starting in 2013, the University of Minnesota joined forces with the Rwanda HRH in the Department of Surgery and the Department of Obstetrics and Gynecology to support medical student, resident, and faculty education. As a product of the Rwanda HRH work, the total number of obstetrics/gynecologist and surgeons has grown exponentially and the number of hospitals with highly trained medical staff has increased. The surgical residency program has expanded from a general surgery training program to include specialist training in orthopedics, neurosurgery, and urology.

Dr. Rahel Ghebre (Associate Professor in the Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota) served as in-country teaching faculty in the Department of Obstetrics and Gynecology at the University of Rwanda transferring skills in advanced gynecology surgery and gynecologist oncology. Dr. Ghebre also collaborated on research and the development of educational material with University of Rwanda faculty. Outputs of research include increasing knowledge and awareness of cervical cancer screening and diagnosis (see publication list below). In the next phase of Rwanda HRH, Dr. Ghebre is partnering on specialist training for gynecologic oncology.

Dr. Jennifer Rickard (Assistant Professor in the Department of Surgery, Division of Critical Care/Acute Care Surgery, University of Minnesota) is an active teaching faculty in the Department of Surgery at the University of Rwanda. Dr. Rickard has ongoing educational and clinical research in acute surgery and surgical site infections.

In addition to strengthening clinical training, research capacity within Rwanda is continually growing as local researchers are stimulated to understand local disease processes and management opportunities. University of Minnesota residents and students have the opportunity to engage in both clinical and research activities in Rwanda.

Publications

Dr. Rahel Ghebre Publications

  1. Small M, Magriples U, Ghebre R, Bazzett-Matabele L, Nitrushwa D, Kitessa D, Ntasumbumuyange D, Lantos P, Hill W, Bagambe P, Brown H, Rulisa S. Increased Nation-wide Access to OB/GYNs through a US-Rwanda Training Partnership. Obstetrics & Gynecology. Obstet Gynecol. 2019 Jun 11. [Epub ahead of print] PMID: 31188322

  2. Rwabizi D, Bazzett-Matabele L, Ghebre R, Stephen R, Dtasumumuyange D, Nitrushwa D, Nkubito V, Small M. The "Honeycomb Sign": Gestational Trophoblastic Disease Case Series from the largest Tertiary Center in Rwanda. Int J Preg & Chi Birth. 2019 March; 5(2): 45-46. DOI: 10.15406.
      
  3. Martin AN, Kaneza KM, Kalkarni A, Mugenzi P, Ghebre R, Nitrushwa D, Ilbawi AM, Pace LE, Costas-Chavarri A. Cancer Control at the District Hospital Level in sub-Saharan Africa—an Educational and Resource Needs Assessment of General Practitioners? Journal of Global Oncology. 2019 Jan; 5: 1-8. PMID 30668270

  4. Ghebre RG, Grover S, Xu MJ, Chuang LT, Simonds H. Cervical Cancer Control in HIV-infected Women: Past, Present and Future. Gynecologic Oncology Reports. 2017 Jul 21; 21:101-8. PMID: 28819634.

  5. Ruzigana G, Bazzet-Matabele L, Rulisa S, Martin AN, Ghebre RG. “Cervical Cancer Screening at a Tertiary Care Center in Rwanda.” Gynecologic Oncology Report. 2017 May 26; 21: 13-16. PMID: 28616457

  6. Randall TC, Ghebre R. Challenges in prevention and care delivery for women with cervical cancer in Sub-Saharan Africa. Frontiers in Oncology. 2016 Jun 28; 6:160. PMID: 27446806

  7. Randall TC, Goodman AK, Schmeler K, Durfee J, Pareja R, Munkarah A, Rulisa S, Ghebre R, Trimble EL, Chuang L. Cancer and the world’s poor: What’s a gynecologic cancer specialist to do? Gynecologic Oncology. 2016 Jul; 142(1):6-8. PMID: 27210817

  8. Nzayisenga I, Segal R, Pritchett N, Xu M J, Park PH, Mpanumusingo VE, Umuhizi DG, Goldstein DP, Berkowitz RS, Hategekimana V, Muhayimana C, Rubagumya F, Fadelu T, Tapela N, Mpunga T, Ghebre RG. Gestational Trophoblastic Neoplasia at the Butaro Cancer Center of Excellence in Rwanda. Journal of Global Oncology. 2016, 2(6), 365-374. PMID: 28717722


Dr. Jennifer Rickard Publications

  1. Skube ME, Alexander BH, Beilman GJ, and Tuttle TM. Impact of patients’ primary language on stage of cancer at diagnosis. Minnesota Medicine 2019.

  2. Bunogerane GJ*, Rickard J. A Cross Sectional Survey of Factors Influencing Mortality in Rwandan Surgical Patients in the Intensive care unit. Surgery. Accepted for publication.

  3. Mpirimbanyi C, Abahuje E, Hirwa AD, Gasakure M*, Rwagahirima E*, Niyinzima C*, Hakizimana AN*, Ishimwe E*, Ntirenganya F, Rickard J. Defining the Three Delays in Referral of Surgical Emergencies from District Hospitals to University Teaching Hospital of Kigali, Rwanda. 2019. World J Surg. Accepted for publication.

  4. Mutabazi E*, Bonane A, Ndibanje AJ, Rickard J. Epidemiological study of peritonitis among children and factors predicting mortality at a tertiary referral hospital in Rwanda. East Cent Afr J Surg. Accepted for publication.

  5. Christie SA, Nwomeh BC, Krishnaswami S, Yang GP, Holterman AL, Charles A, Jayaraman S, Jawa RS, Rickard J, Swaroop M, Sifri ZC, Etoundi Mballa GA, Monono ME, Chichom Mefire A, Juillard C. Strengthening Surgery Strengthens Health Systems: A New Paradigm and Potential Pathway for Horizontal Development in Low- and Middle-Income Countries. World J Surg. 2019 Feb 26. doi: 10.1007/s00268-019-04958-4. [Epub ahead of print]

  6. Rickard J, Onwuka E, Joseph S, Ozgediz D, Krishnaswami S, Oyetunji TA, Sharma J, Ginwalla RF, Nwomeh BC, Jayaraman S; Academic Global Surgery Taskforce. Value of Global Surgical Activities for US Academic Health Centers: A Position Paper by the Association for Academic Surgery Global Affairs Committee, Society of University Surgeons Committee on Global Academic Surgery, and American College of Surgeons' Operation Giving Back. J Am Coll Surg. 2018 Oct;227(4):455-466.e6. doi: 10.1016/j.jamcollsurg.2018.07.661. Epub 2018 Aug 20.

  7. Rickard J, Ntirenganya F, Ntakiyiruta G, Chu K. Global Health in the 21st Century: Equity in Surgical Training Partnerships. J Surg Educ. 2018 Aug 6. pii: S1931-7204(18)30160-0. doi: 10.1016/j.jsurg.2018.07.010.

  8. Mpirimbanyi C*, Rickard J, Furaha C, Ntirenganya F, Necrotizing soft tissue infections at a tertiary referral hospital in Rwanda: epidemiology and risk factors for mortality. World J Surg. 2018 Aug;42(8):2314-2320. doi: 10.1007/s00268-018-4515-z.

  9. Rickard JL, Ngarambe C*, Ndayizeye L*, Smart B*, Majyambere JP, Riviello R. Risk of catastrophic health expenditure in Rwandan surgical patients with peritonitis. World J Surg. 2018 Jun;42(6):1603-1609. doi: 10.1007/s00268-017-4368-x.

  10. Rickard, J, Ngarambe C*, Ndayizeye L*, Smart B*, Riviello R, Majyambere JP, Ghebre RG. Antibiotic use and antimicrobial resistance of surgical patients with peritonitis at a tertiary referral hospital in Rwanda. Surg Infect. 2018 May/Jun;19(4):382-387.

  11. Rickard J, Ngarambe C*, Ndayizeye L*, Smart B*, Riviello R, Majyambere JP. Critical care management of peritonitis in a low-resource setting. World J Surg. 2018 Oct;42(10):3075-3080. doi: 10.1007/s00268-018-4598-6.

  12. Saluja S, Nwomeh B, Finlayson SRG, Holterman AL, Jawa RS, Jayaraman S, Juillard C, Krishnaswami S, Mukhopadhyay S, Rickard J, Weiser TG, Yang GP, Shrime MG; Society of University Surgeons Global Academic Surgery Committee. Guide to research in academic global surgery: A statement of the Society of University Surgeons Global Academic Surgery Committee. Surgery. 2018 Feb;163(2):463-466. doi: 10.1016/j.surg.2017.10.013. Epub 2017 Dec 6.

  13. Ngarambe C*, Smart BJ*, Nagarajan N, Rickard J. Validation of the surgical apgar score after laparotomy at a tertiary referral hospital in Rwanda.World J Surg. 2017 Jul;41(7):1734-1742.

  14. Yi S*, Rickard J. Specialization in acute care surgery in low-income and middle-income countries. Trauma Surg Acute Care Open. 2017 May 22;2(1):e000095.

  15. Abahuge E*, Nzeyimana I*, Rickard JL. Introducing a morbidity and mortality conference in Rwanda. J Surg Educ. 2017 Jul-Aug;74(4):621-629. Epub 2017 Feb 7.

  16. Ndayizeye L*, Ngarambe C*, Smart B*, Riviello R, Majyambere JP, Rickard J. Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality. Surgery. 2016 Dec;160(6):1645-1656. Epub 2016 Oct 4.

  17. Rickard J, Ntirenganya F, Kyamanywa P, Ntakiyiruta G. Utilizing the American Board of Surgery In-Training Exam in a Rwandan surgical residency program: alignment of exam topics with the University of Rwanda general surgery curriculum. East Cent Afr J Surg. 2016;21(1): 24-352016.

  18. Rickard J, Ssebuufu R, Kyamanywa P, Ntakiyiruta G. Scaling up a surgical residency program in Rwanda. East Cent Afr J Surg. 2016;21(1):11-23.

South Dakota – Native American Population

The UMSGD Program is partnering with tribal and Indian Health Service leaders at the Rosebud Indian Reservation in South Dakota to enhance surgical capabilities at this hospital. Additionally, the University of Minnesota is developing an elective general surgery rotation at the Northern Navajo Medical Center in Shiprock, NM to provide unique training opportunities in Native American health care. Investigators from the University of Minnesota are also studying surgical disparities among Native American/Alaska Native women with breast cancer and investigating genomic characteristics of breast cancer in this population.

Children’s Surgery International

global surgeryDr. Brianne Barnett Roby is a Pediatric Otolaryngologist at the University of Minnesota Department of Otolaryngology. She serves on the Board of Directors for Children’s Surgery International (CSI) which is a Minnesota-based, nonprofit volunteer organization that provides specialized medical and surgical services to children and professional training to in-country partners around the world.  The vision of CSI is a world where communities have access to the needed skills, tools, and knowledge to provide essential and life-changing surgical and medical care to their children. Dr. Roby trains local surgeons in partner countries to provide cleft lip and palate repair.

Volunteers for CSI provide life-changing surgeries, in-country education and medical supplies for children, their families and medical professionals in Bangladesh, Ethiopia, Ghana, Haiti, Liberia, Mexico, Peru, Tanzania and Vietnam. The goal is sustainability. CSI partners with host communities to provide professional training, education and support to surgeons, nurses and other caregivers so they can perform the procedures independently and eventually no longer require services from surgeons from high-income countries. In-county education includes intensive hands-on training for local surgeons and nurses.

To learn more about their work, the upcoming trips, and possible volunteer opportunities, visit the CSI website at www.childrenssurgeryintl.org or contact the office at 612.746.4082 or info@childrenssurgeryintl.org.

India

Cancer risks associated with the use of smokeless tobacco (SLT) products worldwide vary drastically. There is a critical need to better understand SLT carcinogenesis, and which chemical constituents and/or product characteristics drive the risk of cancer development in SLT users. India has a unique tobacco burden profile and represents both an area of critical need and unique setting for such studies. Nearly one third of the population in India is using various forms of SLT, exceeding the prevalence of smoking. This is accompanied by high rates of oral and head and neck cancer (OHNC), which is strongly associated with SLT use and is a leading cause of cancer-related death in India. Our work addresses the tobacco burden and tobacco research capacity in India, where the widespread smokeless tobacco (SLT) use results in significant morbidity and mortality. The goal of our work is to investigate the relationship between carcinogen content in SLT products and relevant exposures and oral/head and neck cancer risk in users of these products, while concurrently building capacity for a sustainable tobacco carcinogenesis research program in India. The study is being conducted in collaboration with the Tata Memorial Centre and the Healis-Sekhsaria Institute for Public Health in Mumbai.

The goal of our research is to investigate the relationship between carcinogen content in SLT products and relevant exposures as well as OHNC risk in users of these products, while concurrently building capacity for a sustainable tobacco carcinogenesis research program in India. We will focus on the tobacco-specific nitrosamines N'-nitrosonornicotine (NNN) and 4- (methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Our first aim is to determine the variation of NNN and NNK in SLT products currently available in Mumbai including a wide range of both manufactured and cottage-made products. Our second aim examines the relationship between NNN and NNK levels in SLT products and the levels of corresponding biomarkers in users of these products. In this aim, we will assess biomarkers of exposure in 300 users of SLT products with differing NNN and NNK content, as established in Aim 1. In our third aim, we are comparing levels of urinary NNN and NNK biomarkers between SLT users with and without OHNC. Together, these studies we will generate important insights into the role of NNN and NNK in SLT carcinogenesis in India. While substantial work has been carried out by the Indian public health research and advocacy community to generate valuable knowledge on SLT use, perceptions, and epidemiology, biomarker-based studies of tobacco carcinogen exposure and cancer risk have never been conducted in India. Our research team is uniquely positioned to initiate this research, as it will leverage our collaborative partnership with clinicians and scientists at Tata Memorial Hospital and its affiliated Advanced Center for Training, Research and Education in Cancer in Mumbai. In addition to generating novel scientific data, this study will incorporate capacity building activities that are closely linked to the Specific Aims and include the development of analytical laboratory capacity, training of young investigators from Mumbai in tobacco research procedures, and establishment of tobacco product and biospecimen repositories for future research.

Publications

  1. Debas H, Alatise OI, Balch CM, Brennan M, Cusack J, Donkor P, Jaffe BM, Mazariegos GV, Mock C, Mutiibwa D, Numann P, Nyagatuba JKM, O'Neill JA Jr, Tarpley JL, Tesfaye S, Tefera G, Tuttle TM. Academic Partnerships in Global Surgery: An Overview American Surgical Association Working Group on Academic Global Surgery. Ann Surg. 2019 Oct 4

  2. Mock C, Debas H, Balch CM, Brennan M, Buyske J, Cusack J, DeMeester S, Herndon D, Le Holterman AX, Jaffe B, Kandil E, Kauffman G, Mazariegos G, Merchant N, Numann P, Oleynikov D, Olutoye O, O'Neill J, Shackford S, Stock P, Tarpley JL, Tuttle T, Wolf S, Wren SM, Yang GP. Global Surgery: Effective Involvement of US Academic Surgery: Report of the American Surgical Association Working Group on Global Surgery. Ann Surg. 2018 Jul 12

  3. Debas H, Alatise OI, Balch CM, Brennan M, Cusack J, Donkor P, Jaffe BM, Mazariegos GV, Mock C, Mutiibwa D, Numann P, Nyagatuba JKM, O'Neill JA Jr, Tarpley JL, Tesfaye S, Tefera G, Tuttle TM. Academic Partnerships in Global Surgery: An Overview American Surgical Association Working Group on Academic Global Surgery. Ann Surg. 2019 Oct 4