Technology and global surgery: Dr Kulber on creating sustainable global partnerships in surgery
This month, Dr Kulber was on his way to Mozambique for his latest mission when he spoke to InterSurgeon. He has been heavily involved in global surgery for his whole career and in 2022, set up Ohana One, a charitable organisation for “establishing long-term sustainable surgical training programs utilizing mentorship relationships and advanced technology”. Ohana One is an active member of InterSurgeon and Dr Kulber is one of our champions for plastic, reconstructive and burns specialties.
Global Surgery experience
Dr Kulber is very passionate about reducing health inequality. It all started when he visited India as a trainee and then in 2012, he went to the Hospital Central de Maputo, Mozambique and met the only plastic surgeon in the country. Mozambique had, at that time, a population of 23 million. He started by performing procedures and providing education with the vision of replicating the system they use in USA with limited resources. However, every year he went back, he saw the same problems; “It occurred to me that there is no follow up. No one asking; “Did you have any complications?”. In the case of Orthopaedics, they might be taught how to do total knee replacements but not know how to deal surgical complications so the patients end up suffering because [the surgeons] cant contact their mentors.”
Ohana One
In 2022, Ohana One was founded. It was developed to address the specific problem of facilitating long term mentorship; “Surgeons in LMIC have mental stressor and there is physician burnout. Keeping in touch by helping with surgery and seeing patients can be really helpful. In Sub-Saharan Africa there is no formal training, we offer year-round help.” For the Mozambique mission, he works with Dr Pedro and Dr Celma Issuf and Dr Kulber provides assistance by working with Dr Pedro, sometimes using Zoom to be present in clinics, to see patients, offering emotional support and expertise using smart glasses technology; “ It’s a collaboration of helping him and working together… helping them deal with problems by asking another doctor/ their peers to help. They often don’t have anyone to talk to so they are on their own. [Often this involves] watching patients die in front of you that you could save if you had the resources so life and death decisions are being made by you. Ohana One aims to provide more year-round collaboration with surgeons using smart glasses. “
Using technology
Ohana One and Dr Kulber have harnessed the advent of internet and technology, to offer real-time help to other doctors; “With smart glasses, you can see what they are seeing. You can understand what they are looking at and help manage it.” The smart glasses work can be worn by the partner and paired with the mentors phone who can see exactly what their partner is looking at. The image can be easily annotated as the technology allows the mentor to point and draw on the live image which is then seen by their partner; “This is not only a teaching method but also a way to communicate” The biggest roadblock they have hit using this technology is connectivity; “The electricity in the operation room can be going in and out. Lighting can also be an issue. This will be solved as we get more satellite connections.” For Mozambique, they had a satellite donated but they are fundraising to activate it.
Ohana One and Dr Kulber have also been involved in helping addressing the issue of lack of resources. “Each year, they [the partners] improved their skill set but sometimes you also need equipment.” They have been working with collaborators in USA to use 3D printing technology that can build microscopes in LMICs for $300 and the clinicals can take microscope courses online.
InterSurgeon
Ohana One and Dr Kulber joined InterSurgeon before the Coronavirus pandemic. A chance meeting between Dr Pedro and InterSurgeon founder, William Harkness, was the beginning of a synergistic partnership; “It’s great that we want to help surgeons but how do you find surgeons? I was very impressed with whole platform and so surprised about how well thought out it was.” Dr Kulber went on to become a champion and members of InterSurgeon were offered help lightning technology free of charge.
Finally…
Dr Kulber still believes in the mission of InterSurgeon as a “space where people reach out and use the platform so that they can connect with each other.”
If you would like to know more about help lightning technology click here.
To read more about Dr Kulbers work in Mozambique click here.
