Surgical healthcare has been prioritised in the Southern African Development Community (SADC), a regional intergovernmental entity promoting equitable and sustainable economic growth and socioeconomic development. However, challenges remain in translating political prioritisation into effective and equitable surgical healthcare. The AfroSurg Collaborative (AfroSurg) includes clinicians, public health professionals and social scientists from six SADC countries; it was created to identify context-specific, critical areas where research is needed to inform evidence-grounded policy and implementation. In January 2020, 38 AfroSurg members participated in a theory of change (ToC) workshop to agree on a vision: ‘An African-led, regional network to enable evidence-based, context-specific, safe surgical care, which is accessible, timely, and affordable for all, capturing the spirit of Ubuntu[1]’ and to identify necessary policy and service-delivery knowledge needs to achieve this vision. A unified ToC map was created, and a Delphi survey was conducted to rank the top five priority knowledge needs. In total, 45 knowledge needs were identified; the top five priority areas included (1) mapping of available surgical services, resources and providers; (2) quantifying the burden of surgical disease; (3) identifying the appropriate number of trainees; (4) identifying the type of information that should be collected to inform service planning; and (5) identifying effective strategies that encourage geographical retention of practitioners. Of the top five knowledge needs, four were policy-related, suggesting a dearth of much-needed information to develop regional, evidenced-based surgical policies. The findings from this workshop provide a roadmap to drive locally led research and create a collaborative network for implementing research and interventions. This process could inform discussions in other low-resource settings and enable more evidenced-based surgical policy and service delivery across the SADC countries and beyond.

To the Editor: Academic conferences collaboratively organised by students and academic staff can be used as a means of increasing interest in undergraduate surgical research, particularly because there is limited time and opportunity to engage with research in a meaningful way in medical school curricula. A study conducted at the University of Cape Town (UCT) in 2014 evaluated medical students' perceptions of research. It found that students perceived research to be important, had a positive attitude towards it, and wanted to become involved in research activities. Despite this, not many had been involved in voluntary research (11% of preclinical students and 12% of clinical students). Some of the barriers cited were perceived lack of training, time and opportunities, and lack of awareness of available research opportunities. [1] The authors concluded that active work must be done to create an environment that fosters passion in clinical research to reverse the worldwide decline of clinician and surgical scientists. [2,3] On 10 -11 October 2020, the Southern African Student Surgical Society (SASSS) and the UCT Division of Global Surgery hosted a symposium entitled 'Reimagining perioperative care in Africa' . In the weeks preceding the symposium, a research competition was held as a means of encouraging undergraduate researchers to display their work. Research has been a major component of the annual SASSS symposium since its inception in 2013. However, because of COVID-19 restrictions in 2020, typical in-person participation could not occur. Instead, a virtual conference was held, which included an online research poster competition.The top 3 research topics were presented by student researchers on an Instagram live feed that delegates and judges were invited to attend. This provided an opportunity for the top 3 researchers to practise their oral presentation skills and for symposium delegates to engage with the research topics by asking questions. Owing to our partnerships with companies, high-quality prizes were awarded to the winners. Internal motivation should be targeted to stimulate research involvement. Therefore, the authors suggest that prizes can act as positive reinforcement for those already interested in research. However, additional efforts need to be made to promote research participation among research-naive students, such as the utilisation of digital structures, mentorship and submission of manuscripts with simple methodologies, e.g. case reports and commentaries. [3,4] Despite the pandemic and international travel restrictions, SASSS and the UCT Division of Global Surgery hosted a successful collaborative conference, including numerous international delegates and speakers.In conclusion, an annual collaborative conference such as the SASSS symposium that showcases advances in surgical care, while promoting research and researchers in surgery, is a definite way of inspiring the next generation of surgical scientists and academic surgeons. [2,3] Medical student participation in research is associa...

Background Little is known about the injury profile of older persons from low‐and‐middle‐income countries, such as South Africa, where violence is prevalent. This study aimed to identify common mechanisms of injury (MOI), severity, complications, and outcomes in elderly patients admitted to a referral trauma centre in Cape Town. Methods A retrospective review was performed of all patients ≥60 years presenting at Tygerberg hospital trauma centre over an eight‐month period. Descriptive statistics were computed for all variables of interest, and the relationship between the MOI, injury severity score (ISS), complications, and outcomes were assessed. Results Of the total 7,635 trauma cases admitted, patients ≥60 years accounted for 4% (n = 275). The most frequent MOI was low falls (58%). Of these 11% of injuries were intentionally inflicted. Among them 35% of the patients experienced complications. The ISS was positively associated with the number of complications (p < 0.01). The mortality rate was 6.5%. An ISS of ≥10 was associated with increased mortality (p < 0.01). The number of complications was positively associated with mortality (p < 0.01). Conclusions In contrast to high‐income countries (HICs), the cohort of elderly patients admitted to the trauma centre made up a relatively small portion of the total admissions. Compared to HICs, intentionally inflicted injuries and preventable MOI were common in our sample, underscoring the importance of addressing causative factors. Notably, the ISS was strongly associated with the number of complications and an ISS ≥10 was associated with mortality, highlighting the utility of the ISS in identifying elderly trauma patients most at risk of negative outcomes.

Global surgery broadly refers to a rapidly expanding multidisciplinary field concerned with providing better and equitable surgical care across international health systems. Global surgery initiatives primarily focus on capacity building, advocacy, education, research, and policy development in low-and middle-income countries (LMICs). The inadequate surgical, anesthetic, and obstetric care currently contributes to 18 million preventable deaths each year. Hence, there is a growing interest in the rapid growth of artificial intelligence (AI) that provides a distinctive opportunity to enhance surgical services in LMICs. AI modalities have been used for personalizing surgical education, automating administrative tasks, and developing realistic and cost-effective simulation-training programs with provisions for people with special needs. Furthermore, AI may assist with providing insights for governance, infrastructure development, and monitoring/predicting stock take or logistics failure that can help in strengthening global surgery pillars. Numerous AI-assisted telemedicine-based platforms have allowed healthcare professionals to virtually assist in complex surgeries that may help to improve surgical accessibility across LMICs. Challenges in implementing AI technology include the misrepresentation of minority populations in the datasets leading to discriminatory bias. Human hesitancy, employment uncertainty, automation bias, and role of confounding factors need to be further studied for equitable utilization of AI. With a focused and evidence-based approach, AI could help several LMICs overcome bureaucratic inefficiency and develop more efficient surgical systems.