Birmingham conference launches groundbreaking global health research

Sixty medical professionals from across the globe converged in Birmingham this month for a two-day conference with the aim of designing the world’s first global trial to combat wound infections following surgery. Amongst the group were 25 surgeons from 12 developing countries including Rwanda, India, Peru and Ghana. The collaborative, known as GlobalSurg, is supporting the development of surgical research in low and middle-income countries whilst benefiting patients worldwide.

Since its foundation in 2014, GlobalSurg has already run two observational studies in surgery, involving patients from over a hundred countries. For its next project, the collaboration will build on these global networks to achieve the more ambitious task of launching a randomised trial.

The trial will aim to reduce wound infections after surgery, one of the most common surgical complications worldwide. A preliminary study run by GlobalSurg found that these affected up to half of patients undergoing gastrointestinal surgery. The impact on patients is significant as infections result in prolonged hospitalisation and delayed recovery, preventing a return to work. Loss of income combined with medical and transport costs adds to the economic burden on patients and their families. For a patient living in a remote village in South Africa, miles from the nearest hospital, a post-surgery infection could be fatal. Clearly the risks for UK patients are less severe, however the impact is by no means negligible in the developed world; Post-op infections cost the NHS over £700 million a year. Despite the severity of the issue, the evidence remains inconclusive as to the best way to tackle post-surgical infections and little research has been conducted in low-income countries.

The meeting was supported by a development grant from the publicly funded Joint Global Health Trials fund, which is supported by the UK Medical Research Council, the Department for International Development and the Wellcome Trust. Should the forthcoming funding application be successful, the trial will be funded by the UK taxpayer. GlobalSurg represents a clear example of the NHS as an outward-looking institution willing to use its resources to drive up standards internationally. This benefits overseas patients, whose hospitals aren’t typically on the cutting edge of medical research, whilst also providing invaluable data that can improve practice here in the UK.

The University of Birmingham, where the project began, has a strong research pedigree and its doctors are helping mobilise the bold ambitions of the collaborators to realise their aims by providing guidance over the funding application. Birmingham’s Clinical Trials Unit, which was founded in the 1980s and today employs over 100 members of staff, will be responsible for processing the data of thousands of patients from dozens of hospitals across the globe. The unit will be on hand to assist with any problems that arise from the trial in all participating hospitals.

GlobalSurg ConferenceDelegates included surgeons from 12 developing countries

Given that implementation of research findings can typically take up to 17 years in the UK, being part of a study that will involve the instant application of improved practice represents a significant opportunity for the participating hospitals and their patients. But the significance of GlobalSurg extends beyond its measurable outcomes; the trial will create new research leaders in countries where they are currently lacking. What’s more, the study will bring these research leaders into a close-knit global network that will strive to create further research opportunities in the future.

Adesoji Ademuyiwa, a surgeon from Nigeria, said that “putting surgery on the public health agenda at a national and international level is my passion. In the 1980s HIV gained international coverage and as a result great progress was made. I want to see the same happen with the application of surgery for trauma victims, as well as in cancer treatment and oncology so that we can improve outcomes for patients.”

Emmy Runigamugabo, a patient representative for GlobalSurg in Rwanda, noted that “patients in Rwanda will be happy to help with research that will help improve hospital care. At home, our patients often have long and difficult journeys to the hospital, and for people to come back if they are sick because of infections is a serious issue that means they will have to rely on the help of others to return for treatment.”

At the conference delegates heard from patient representatives from both the UK and Rwanda, enabling differing experiences across the globe to be compared. Whilst patient involvement in the planning and conducting of clinical trials is common practice in the UK, in low and middle-income countries this is rare. It was agreed that the GlobalSurg trial could provide a unique opportunity to engage patients in developing countries in medical research.

Over the course of the two-day event there was lively discussion between delegates as they ironed out the details of how the trial would be run. From these debates it became clear that a one-size fits all approach would not work and that the use of local knowledge would be crucial to adapting the trial model to realities on the ground. A surgeon working in a fifty-bed hospital in the foothills of the Indian Himalayas spoke of the practical difficulties of a trial participant returning for a follow-up appointment in winter when roads could be impassable. A Rwandan patient representative highlighted how in his country many patients would be unwilling or unable to pay the transport costs to return to hospital. Innovative methods such as using smartphones to send pictures of wounds or outreach visits to the patient’s home were discussed to combat these obstacles.

Going forward, the collaborators have scheduled another meeting for early next year in South Africa. If the funding application, planned for September 2017, is successful, the organisers hope to begin the trial the following year. With the study designed as a starting point to enable further investigation into global surgery, this could be just the beginning for the international research network forged by Birmingham surgeons.