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funding criteria is not stipulated by HIC partners
but directed by the LMICs and domestic resourceconstrained research sites and partners, who are
integral to the project conception and execution
[46]. Ideally, the partnering LMIC and domestic
resource-constrained sites could jointly contribute
resources to increase the likelihood of long-term
ownership [47]. Furthermore, academic global
surgical centers are well positioned within an
academic institution to provide the research
support needed to disseminate the research
ndings. Technical assistance, such as grant
writing workshops, scientic writing consultation,
and library services, are made available to CHESA
fellows under the purview of the university. This
nurturing environment is the key to success for
any aspiring researcher, regardless of his/her
background.
Equity in global surgery research extends into
project responsibility and recognition. Sensitivity
to LMIC and local partner inclusivity in joint
scholarly work is paramount. By providing a platform of afliation, an equitable academic global
surgery center is well poised to bolster ownership
from LMIC and domestic community partners to
ensure they steer the research agenda. CHESA
seed funding has also helped to promote these
research collaborative partnerships. An upfront
memorandum of understanding (MOU) that a center can broker establishes the expectations for
involved partners, such that there is minimal confusion over roles and recognition as the project
progresses. This is especially important during the
reporting of scholarly work. Domineering HIC
authorship of LMIC and domestic vulnerable
community projects has come under increasing
scrutiny, as non-HIC authors get left in the middle
of the author list or pushed into the acknowledgments section [48]. A designated academic global
surgery center with preexisting connections with
its partner sites can leverage its status to empower
LMIC and domestic community partner authors to
take on rst and senior authorship roles.
Scholarship activity remains a major
benchmark to evaluate the productivity of an
academic center. Global surgery initiatives focus
primarily on improving surgical care in lowresource systems, so that global surgical research
typically has an activist agenda. Scholarly
projects in global surgery are therefore not
limited to the classic disciplines of basic science,
translational, and clinical research. To adapt,
academic global surgery centers can incorporate
multifactorial research capabilities into its
repertoire, including but not limited to economic
evaluation, implementation science, qualitative
analysis, and quality improvement. Other ways to
disseminate global surgical initiatives can be in
the form of opinion pieces and traditional media
forums such as newspapers or magazine outlets,
to engage a broader readership. Academic
discoveries are most effective when creatively
presented in a way that galvanizes or justies
some form of surgical capacity building.
Global surgery researchers can also risk
working in silos as global surgery is diffuse and
occasionally disjointed. Work may be duplicated,
and the wheel is reinvented when multiple groups
try to address the same issue without knowledge
of the others’ efforts, while synchronized efforts
from several angles can more effectively and efciently push the global surgical agenda forward.
Furthermore, solutions for one site should be
shared in a multidisciplinary forum, as they may
be able to be adapted, repackaged, and reimplemented elsewhere. To streamline activity, global
surgical organizations such as the Global Surgery
Student Alliance (GSSA), the Association for
Academic Global Surgery (AAGS), and CHESA
have created centralized databases of ongoing
academic projects [49, 50]. These repositories
can connect like-minded investigators or groups
to help synergize similar ideas and research
methods, as well as to provide opportunities for
involvement. A network of content experts can
also be built within the Center, such that the discourse of global surgical research initiatives
becomes routine. This communication can be
facilitated by center-wide touchpoints or WIP
meetings where representatives from different
disciplines can present and discuss their work.
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Partnerships
Partnership among LMIC, HIC, and domestic
community stakeholders is at the Center’s core.
This can span many levels within the academic
global surgery center, from faculty to trainee, and
helps foster the intermingling of innovative ideas.
The American Surgical Association Working
Group for Global Surgery outlined successful
characteristics of LMIC and HIC collaborations,
which include a predetermined memorandum of
understanding, needs assessment methodology,
and identication of strategies to address priority
needs [51]. However, many barriers prevent such
partnerships from forming that stem from individual problems (e.g., insufcient income, family
and clinical responsibilities, skepticism of global
surgery efforts, ethical and safety concerns), difculties with the community (e.g., lack of mentorship and colleagues), and immature systems
(e.g., inadequate time, limited recognition, and
poor administrative, political and nancial support) [52].
Effective circumvention of these potential
barriers requires a multilateral approach.
Surgical subspecialties should be part of the core
administrative team, such as orthopedics, urology, and gynecology, as international surgical
delivery frequently does not differentiate subspecialties as the general surgeon (or even nonsurgical clinician) is tasked to treat every surgical
problem. In order to improve surgical care in
LMICs it is important to include surgical subspecialty training and subspecialty surgical care
as a fundamental pillar of global surgery programs. Collaboration with other essential perioperative workforce members, including nursing
and pharmacy, is also vital for a multilateral
effort to enhance systematic surgical capacity, as
is interface with nonclinician specialists such as
epidemiologists, policy makers, and economists
[53]. CHESA co-leadsthe UCSFWorld Health
Organization Collaborating Center for
Emergency, Critical and Operative Care, and
is active in advancing the implementation of
itsemergency care program and providing technical input into the World Health Academy
teaching modules. CHESA members work closely with their professional associations and non- government organizations to
advance the global surgery and health equity
agenda.
Prior to the establishment of CHESA in 2020, GPAS
functioned with leads from UCSF and MU and
focused on faculty and trainee exchange. During its
tenure from 2010 to 2016, GPAS had 17 scholars. Two
summarized experiences with the GPAS program are
described by previous trainees below.
Dr. Naomi Kebba (2014 GPAS Scholar): Within the
Department of Surgery at Mulago Hospital in Uganda,
Naomi was able to pursue her passion in surgery and
built her condence as an academic leader. Enrolling
in the GPAS program, she received extensive
mentorship regarding her project: building an
advanced trauma training curriculum designed for
resource-constrained settings. Bolstered by a team
composed of GPAS Scholars and UCSF faculty, this
course was renamed the Kampala Advanced Trauma
Course and still runs today.
Dr. Alex Elobu (2011 GPAS Scholar): Working within
the Department of Surgery at Mulago Hospital, Alex
joined GPAS with the aim of professional growth and
mentorship. The uncertainty of job security after
residency washed away once Alex was involved with
GPAS, receiving further research training, publishing
opportunities, collaboration with other hospitals, and
having an opportunity to travel for an international
conference. Using GPAS as a stepping stone toward a
career in global and academic surgery, Alex continues
to advocate for trainees who were in his same position
years ago.
Advocacy, Allyship, andPolicy
Center cohesion is evident in CHESA’s response
to recent civil and natural upheavals. Advocacy
and allyship through the Center does not solely
attend to domestic or international issues.
Examples range from striking a united stance on
stricter gun control after continued mass shootings in the USA to rapid mobilization of Center
resources to address the immediate needs of victims from the COVID-19 pandemic, Haiti earthquake, and the war in Ukraine. In fact, the
anesthesia arm of CHESA partnered with the US
Agency for International Development (USAID)
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and the Public Health Institute Sustaining
Technical and Analytic Resources Programduring the height of the COVID-19 pandemic to
assist with the COVID-19 response in LMICs.
Together, they developed OpenCriticalCare, an
open-source anesthesia educational platform
with courses and other learning resources to help
alleviate the critical care workforce shortage that
occurred during the COVID-19 pandemic.
During the 2021 Haiti earthquake, CHESA collaborated expediently with the charity MedShare,
an international medical supply and personal
protective equipment redistributor, to redirect
critical medical equipment and supplies to the
hardest hit areas. This was championed byDr.
Ernest Barthlemy, aCHESA fellow alumclosely
connected to the Haiti earthquake
response.CHESA has been working on the early
stages of development of a workforce strategy
with the Ugandan Ministry of Health, to accompany a Surgery, Anesthesia, and Obstetrics
National Plan. In addition, CHESA Advocacy
and Policy lead Dr. Adrian Gelb has been advancing consensus metrics for global surgery post the
Lancet Commission through the Utstein
Consensus Group. Advocacy and allyship are
critical and powerful components of a successful
academic global surgery center. The ability to
band together to coalesce diverse, like-minded
groups allows for swift action especially in times
of hardship.
The purpose of this section is to share
CHESA’s experience in building its operating
model to support its programming. It will offer
generalized “how to” advice, describing what
works for the Center at this point in its organizational history and noting some areas that need
improvement to help the Center achieve better
results over time. CHESA is a work in progress,
and its operating model should and will evolve
over time as it collaborates with a constellation of
stakeholders including UCSF leadership, CHESA
members, donors, and community-based partners
in the USA and globally.
There are many existing resources that offer
detailed technical guidance and recommendations for setting up a nonprot organization or
academic center’s operating model. Few, however, focus on the intricacies of an academic
global surgery center, let alone one like CHESA
which focuses on advancing health equity in surgical, anesthesia, and perioperative care.
Simultaneously, the generalized “how to’s” presented in this section are not one-size-ts-all.
CHESA does not have solutions to all the questions, nor does this section intend to give the
impression that it does. However, CHESA’s
experience and lessons learned may prove useful
to others in the process of conceptualizing or
establishing their own academic global surgery
centers or seeking to expand or bolster their existing programs.
Generalized “How To”
The effectiveness of an academic global surgery
center’s programming hinges on a well-dened
operating model. Encompassing several domains
including, but not limited to, leadership, nance,
and governance, the purpose of the operating
model is to translate strategy into results and provide a plan and structure for deploying people
and resources to carry out the Center’s mission.
Each academic global surgery center’s operating
model is uniquely designed based on available
resources and their strategic plan.
How toSecure Funding
1. Secure endorsement from an institution that
can nancially support the center.
2. Develop a budget to inform funding goals.
3. Implement a resource mobilization strategy.
As with many mission-oriented organizations,
securing funding to support the work while moving toward a sustainable nancial model remains
an ongoing challenge for CHESA.The Center is
extremely fortunate to have the endorsement and
backing of UCSF to provide startup funds for the
rst few years of operations. There is strong strategic alignment between CHESA and UCSF as a
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leading university dedicated exclusively to the
health sciences and a pioneer in the eld of academic global surgery. Before CHESA launched,
various perioperative departments at UCSF had
some support and interested faculty and trainees to
advance global health and health equity priorities.
Siloed, each department had too few resources to
build a program, support trainees and carve out
faculty roles for program directors. CHESA
brought these departments together, bridging the
divide among groups with shared goals. The
Center enabled the pooling of resources in order to
amplify the collective impact of these groups by
sharing operational costs, leadership and fellowship support, mentorship resources and enabling
joint projects. This is a distinguishing feature of
CHESA’s nancial model.
The organization is partially funded by surplus
from the surgery and anesthesia departments, as
well as contributions from other departments like
urology, orthopedics, and otolaryngology, who
have agreed to dedicate faculty time and/or direct
nancial contributions to support CHESA activities, including the fellowship program, research,
education, and advocacy and policy projects. This
ensures that everyone has a vested interest in
CHESA’s success while further highlighting the
critical, multidisciplinary nature of the Center.
To gain buy-in from internal UCSF decisionmakers, CHESA’s leadership leveraged existing
university relationships and years of experience in
global surgery, anesthesia, and perioperative care
to highlight the imperative of the mission and to
demonstrate the potential for greater impact by
establishing the Center. To ask for this investment,
CHESA needed clarity on what it sought to accomplish and how much these activities were expected
to cost. With a history of previous global surgery
partnerships and initiatives, the two main departments that came together to form CHESA– surgery and anesthesia – drew on previous project
experience to develop a budget that included all
components and activities that require funding
(e.g., fellowships, event planning, stafng, etc.). A
well-formulated operating budget facilitates the
best use of limited nancial resources by focusing
on what is needed to achieve the primary goals and
objectives of the Center. CHESA continues to
monitor, oversee, and rene its budget, making
course corrections as needs and priorities shift.
Securing an initial nancial commitment
enabled CHESA to hire a small team to establish
and grow the Center. The UCSF departments and
leadership backing CHESA seek a return on their
seed investment, including the Center’s ability to
bring in more external funding from philanthropy, government, and other institutions. To
accomplish this task, the Center is designing and
delivering a resource mobilization strategy
focused on harnessing and increasing existing
university support, communicating impact, and
pursuing external funding and strategic partnerships. As CHESA secures additional grants, it
engages and offers the opportunity for other
CHESA members to get involved and be
supported.
Global surgery receives a much smaller
proportion of funding from US government and
nongovernmental sources compared to other
areas in global health, such as infectious diseases
[54]. CHESA is cultivating relationships with
other teams and organizations internal and
external to UCSF to pursue business development
opportunities that support shared outcomes. For
example, a maternal and child health initiative
that incorporates access to global surgery,
anesthesia, and perioperative care as a key
component to achieving the overall project
outcome.
How toRecruit andDeploy
Committed Faculty andSta
1. Recruit faculty across all associated
disciplines.
2. Bring in faculty and staff committed to center
values.
3. Identify core staff who can adapt to diverse
roles to support the center’s management and
growth.
In CHESA’s experience, recruiting and
retaining committed faculty and champions across
multiple disciplines is critical to the Center’s
success. Under its current investment model,
CHESA advocates to UCSF department chairs to
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protect varying levels of faculty time for center
activities. This frees staff to do health equity work
and to support the mission of CHESA while
maintaining clinical commitments. CHESA
invites representatives from across disciplinesfrom
UCSF and non-UCSF collaborating institutions in
LMICs to be part of the Center’s Leadership
Committee (see next section). Furthermore, for
some faculty recruits and prospective trainees at
UCSF, a selling point for joining UCSF is the
opportunity to participate in global surgery
initiatives. CHESA facilitates opportunities for
colleagues to get involved in this work, build
networks, and collaborate with other faculty, staff,
and partners. Access to faculty from various
disciplines means CHESA can leverage diverse
technical expertise when pursuing and
collaborating on new projects and donor opportunities. Building these relationships expands
CHESA’s network of professionals involved in
related health equity work, enhancing CHESA’s
visibility and potentially attracting new partners
and donors.
CHESA engages faculty and staff aligned with
its values of social justice, diversity, equity, and
inclusion. These values are core to CHESA’s programmatic approach and guide interactions and
engagement with community stakeholders and
partners from all settings, including domestic
community partners and LMICs. CHESA prioritizes continuous learning and improvement in
applying these values to the work as it pursues
more equitable academic engagement in the global
surgery, anesthesia, and theperioperative space.
Given the current size of the organization and
limited resources, CHESA has hired full-time staff
who can adapt and shift their support between
multiple priorities related to nance, operations,
business development, and project management,
in collaboration with many stakeholders and partners internal and external to UCSF. Staff bring
experience in global health and development and
an interest in academia. As CHESA expands its
programming and budget, the organization will
plan to recruit professionals in dedicated roles
such as communications and operations.
How toSet uptheGovernance
1. Test different organizational structures until
you nd what works.
2. Bring in diverse leadership to advise.
3. Clarify decision-making processes.
CHESA has gone through a few iterations in
its organizational structure. For the rst year,
CHESA had multiple co-directors overseeing the
Center’s management and strategic direction.
The Center opened participation to all members
in technical working groups focused on education, research, and advocacy and policy. Setting
up to promote inclusivity and collaboration, the
structure unfortunately led to inefcient and
unclear decision-making and accountability.
CHESA shifted its model so one director
oversees the Center’s overall strategic direction
and management with multiple associate directors to facilitate the executive-level decisions and
tasks for the Center. Administratively, there are currently two full-time staff (deputy director and
program coordinator) and other faculty and staff of varying levels of effort up to 50% who help lead
and implement center activities.CHESA’s organizational structure is a work in progress being shaped
by the Center’s diverse leadership team who will periodically reect on the effectiveness of the
structure and make adjustments as necessary.
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Executive Committe
Leadership committee
Director Advisory Board
Deputy Director
CHESA has set up three bodies to provide
technical and strategic advice and help deliver
center programming.
• Executive committee: Oversees the strategic
direction of the Center. Chaired by the
Director, the Executive Committee meets
monthly for programmatic and operational
updates and to engage in strategic decision-
making at the organizational level.
• Leadership committee: Provides essential
linkages between various perioperative
specialties and departments at UCSF,
CHESA, and our non-UCSF and
international partners and works together
to advance CHESA’s mission. Included on
the leadership committee are key leadership
roles: directors and associate directors who
oversee four focus areas for the center,
namely, thefellowship program, education,
research, and advocacy and policy. This is
a shift away from the original working
group approach, so specific leads are held
accountable for direction and progress on
Center priorities. The leadership committee
invites participation from international
collaborators from LMICs for their
essential input and feedback on Center
initiatives and provides a stipend for their
participation. Each leadership committee
member serves as a champion and liaison
for CHESA with their home department or
Project
Coordinators
Work Study
Students / Interns
institution and provides technical input on
CHESA’s programming.
• Advisory board: Advises and counsels the
CHESA director and executive committee on
the strategic direction of the center. CHESA
is grateful to have a diverse and highly
accomplished board who guides the Center
on its technical programing, as well as
organizational strategies related to resource
mobilization, partnerships, and
communications. The advisory board
members are connectors and thought partners
to CHESA, providing vast experience in
health care, philanthropy, and technology
across the public, private, and
nongovernmental organization sectors.
The CHESA structure sits within a large
university system, which brings its own benets
and drawbacks. CHESA has access to ofce
space and operational capabilities like
communications, nance, supply chain, and legal
departments. However, the university system is
strictly administered by its own rules and
regulations. It can be challenging for the Center
to operate as nimbly as it would like when the
umbrella administrative processes lack clarity or
must move through multiple approval channels
before a task is initiated or completed.
The organizational structure reects CHESA’s
commitment to inclusivity, collaboration, and
diverse perspectives. Clear decision-making
processes are important for the Center to leverage
the separate groups under its structure, as well as
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the many faculty, partners, and advisors who
comprise these committees. This is an area that
CHESA continues to improve as it balances the
need to make timely decisions but in a way that
encourages and leaves space for feedback and
diverse input.
How toPromote Opportunities
forLearning andCollaboration
1. Employ a social media strategy.
2. Act as a shared resource and bridge for
collaboration at a local and global level.
3. Communicate the impact of your center’s
work.
CHESA employs a social media strategy
through monthly newsletters, website updates,
and social media channels (Twitter, Instagram,
YouTube) to increase awareness of the challenges
for achieving health equity in surgery and what
the Center and its members and collaborators are
doing to address this. CHESA shares regular
opportunities for members to build bridges and
connect with one another around shared interests
and programs. This includes events like the WIP
meetings for members to get immediate feedback
and support from other experts and implementers
to improve their health equity research projects.
CHESA seeks to break down silos and enhance
collaboration and learning across its community.
The WIP meetings are also used as a platform to
share Center-wide updates.
CHESA has hosted open-access virtual Grand
Rounds to discuss health equity topics related to
surgery, anesthesia, and perioperative care, highlighting research and project experience in the
USA and internationally. Health equity journal
club is another avenue for members to connect
and discuss literature and implications for members’ ongoing projects or research and professional interests.
COVID-19 has made it challenging to organize
in-person meetings and events to facilitate
networking and learning across members.
CHESA is exploring ways to strengthen the
member community, including those who reside
outside of the Bay Area and other countries.
Communicating impact is an area for
improvement for CHESA, not only sharing data
but improving CHESA’s story-telling. Illustrating
the organization’s support and inuence across
system levels and geographies and its impact on a
wide range of individuals from healthcare practitioners to patients is an important goal that has
many important implications for the stakeholders. A strong communications strategy can help
galvanize members and partners around the
Center’s mission and advance parallel efforts to
build partnerships and cultivate new donor
relationships.
Reections
What Works
Although each academic global surgery center
will be unique, we believe there are core principles for success that are universal.
Lead with Inclusion and Belonging From the
beginning, CHESA set out to positively disrupt
the global surgery space, with the rst step being
inclusion and a focus on the people as our most
valuable asset. This led to the removal of “global”
from the Center’s name and inclusion of “anesthesia” to expand beyond surgery. These actions
were aimed at promoting representation of all
disciplines within the perioperative ecosystem,
from nursing to dermatology, and ensuring those
engaged in domestic health equity work felt
included. We intentionally created minimal
requirements for membership to encourage broad
participation from our external collaborators
across the globe, and we offered Center leadership roles with compensation to non-UCSF partners to ensure broad stakeholder representation.
We also sought participation from people with
diverse backgrounds to enrich the perspectives
within CHESA.
Focus on Decolonization and Reduction of
Implicit Bias We have placed decolonization
and the reduction of implicit bias at the forefront
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of all our work, with an initial emphasis on
awareness in order to identify and eliminate any
bias. We acknowledge that an HIC academic center may historically represent a potential power
imbalance to both local and global communities
and partners. To address this potential conict,
we have sought to identify and address past injustices in order to rewrite the narrative and shift the
center of gravity. It is not acceptable to proceed
with work that is “about them, without them.” It
is essential to recognize partners as local experts
and support them with our platform, resources,
knowledge, experience, and advocacy, with a
truly bidirectional exchange of ideas. We also
sought to create a culture of listening and safety
to encourage people who are vulnerable to be
honest when raising possible issues or conicts,
as we consistently strive to optimize and equalize
our work.
Engage from the Top-Down and
Bottom-Up As many who are involved in health
equity work can relate, diverse and creative
approaches are frequently required for success.
While support, recognition, and inclusion of our
Center at the highest level was essential, including from the institution, relevant departments,
divisions, and related centers, the importance of
each individual Center member cannot be understated. These methods can be applied to all Center
activities, including the fellowship, education,
research, advocacy, allyship, and policy, partnerships, funding, and governance. Similarly, CHESA tackles projects
from both levels – incremental at the point of
education and research, and also at a higher level
of policy and advocacy, as action
viabothapproachesis needed to make progress.
Build on Long-Term Partnerships As
highlighted previously, CHESA is founded on
many longstanding relationships with local and
international partners. Longitudinal engagement
and investment show a commitment to and
solidarity with the people, place, and work and
build a level of trust that strengthens the
relationship and enhances potential impacts.
While exploring new sites and collaborations are
also essential for the Center as we work to expand
our work’s footprint, this activity cannot come at
the cost of existing, ongoing partnerships.
Stay Flexible and Adaptable It is critical to
recognize the fragility of our work and the many
factors that must align to allow for success, as
well as how close many activities are to stagnancy
or failure. Accepting this reality encourages us to
remain exible and open-minded and to routinely
consider multiple avenues for an initiative’s
success, enabling us to pivot, adapt, and innovate
when we need to take a different path. We have
also realized timetables and priorities may not
always align, and when this conict arises, we
must defer to our local partner’s agenda and not
force an issue for our own benet. Occurrences
will occasionally require a shift in the balance of
effort and time in partnerships and will call upon
everyone to remain malleable and to potentially
let go of noncritical or unfeasible items while
always keeping the end goal and purpose of our
work in mind.
Conclusion andChallenges
Multiple obstacles have presented themselves
during the development of our academic global
surgery center. Many of our challenges are likely
common across centers, and we continue to
explore solutions.
How to Measure our Impact and Ensure the
Center Has Value for its Members, Partners,
Institution, Funders, and the Communities it
Aims to Serve? We have consistently been
confronted with how best to measure the value
and impact of our Center and to constantly
evaluate whether the work we are doing or
considering engaging in aligns with our Center’s
mission and vision. Possible metrics for impact
include sustained external funding and grants,
membership roster, project tally, total research
output (publications, presentations), courses
taught, and fellows trained. Given our focus on
people, our Center will gather stories from those
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who engage with CHESA to understand at a
more granular level our Center’s overall purpose
and meaning for those who work and study with
us and areas for improvement. There do
notappear to be any agreed-upon metrics for an
academic global surgery center based on review
of existing center websites nor in the literature.
This therefore remains an area in need of future
exploration in an effort to hold all of us more
accountable.
How to Sustain the Center? As discussed
previously, at CHESA we developed a clear
organizational structure which requires sustained
engagement from multiple parties. We have
struggled with staff retention, adequate protected
time from clinical work for leaders to meaningfully participate, and with accountability. Many
healthcare professionals engaged in global surgery work share this struggle due to competing
clinical and academic responsibilities. To combat
this, we have strived to conrm protected time
from department chairs and/or provide compensation for time invested in the Center. We have
also focused on hiring non-clinical staff and have
involved work-study students to support the dayto-day functions of the Center and ensure continuity and sustained engagement. Furthermore,
centers require longitudinal funding. While
CHESA’s initial support is largely from institutional funds, our goal is to transition to a larger
proportion of grant and philanthropic support. Besides the inherent competitiveness of
grants, an added challenge is the required academic institution indirect structure, which can
range from 40 to 60% for indirect costs depending on the donor or funding agency, signicantly
decreasing the actual funds that can be used by
the Center.
How to Achieve an Equitable Balance of
Activities (e.g., Domestic Vs International, by
Specialty)? While historically the eld of global
surgery was a synonym for international surgery,
and frequently focused on surgery over other disciplines, at CHESA we have strived to dispel this
misperception to include all health equity work in
perioperative and anesthesia care, surgical diseases, and related disciplines under our Center’s
umbrella. Although many of our activities are
focused in LMICs, we seek to increase participation and membership from individuals and groups
doing both local and global perioperative health
equity work, including domestic community
organizations and members of vulnerable populations and underrepresented groups. CHESA’s
scope is intentionally broad, which we view as
necessary to adequately represent the complex
perioperative health equity landscape, and is in
agreement with our inclusive mission, vision, and
guiding principles.A broader alignment and use
ofaccess to care modelsand social determinant
of health that are implemented in both domestic
and international settings may catalyzecross-talk
between these spaces and unify efforts.
How to Break Silos and Increase Awareness of
the Center across Multiple Levels
(Institutional, Local, Regional, National, and
International)? Most individuals active in the
global surgery space are unfortunately all-toofamiliar with siloed activities. Without an ability
to know what activities are occurring where and
with whom, we are unable to avoid recreating the
wheel and duplicating efforts, and therefore,
opportunities for collaboration are stymied. We
created and are maintaining a database of CHESA
member perioperative health equity projects to
catalog our Center’s work and explore ways for
members to collaborate to strengthen their activities. As part of our bigger global health community through UCSF’s IGHS, we created a method
of adding tags regarding one’s relevant institutional center membership(s), research focus
areas, and project locations that are listed on
one’s institutional prole webpage. This then
links to an open-access database of IGHS professionals that can be searched by any of the above
criteria [55].
Despite reaching out to meet with leaders and
others engaged in a similar workspace, we continue to struggle at UCSF with limited institutional knowledge about our existence, purpose,
and potential, not to mention global awareness.
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A. Yap et al.
Albeit slower than desired, we have made progress and we realize this is not a unique problem
for new organizations within much larger institutions. This has prompted us to continue and build
on our activities in this space: direct outreach and
meetings with stakeholders within UCSF, across
University of California campuses, and externally; publicity and promotion of the Center’s
activities via a monthly newsletter to our members and CHESA social media channels (Twitter,
Instagram, YouTube); brainstorming our branding; developing an informative, accessible website; open-access grand rounds programming;
trainee-organized journal clubs; monthly member WIP meetings; and member representation of
the Center via participation in various educational and academic activities locally, nationally,
and globally. We also encourage members to list
CHESA as an institutional afliation on research
conference abstracts, presentations, and
publications.
How to Build and Sustain a Center during
Massive Global Disruptions (e.g., COVID-19
Pandemic, Geopolitical Distress, War, Etc.)
and Competing Interests? While
“unprecedented” has been used to describe many
world events since 2020, just as CHESA was
coming into existence, our initial in-person
retreat pivoted to virtual, our Center’s community
has come together to support each other in
unparalleled ways. As highlighted previously, we
raised our voices in support of various pivotal
social justice movements and world events and
sponsored fundraising activities for partners.
While these unforeseen events may have
temporarily diverted our attention from previous
priorities, we relied on our Center’s strengths,
exibility, and adaptability to respond to member,
partner, and global societal needs. We did not
face funding constraints during these times,
which would be an added barrier some centers
may face. This could severely limit a center’s
ability to continue even basic operations and
activities due to inadequate stafng and resources.
In addition, COVID related disruptions placed an
additional emphasis on the need for close
evaluation of surgical and anesthesia systems and
perioperative infrastructure, and the oxygen
ecosystem.CHESA was asked to work in these
areas that will ideally translate to sustainable
initiatives. Likewise, the social justice movement
that has galvanized in the USA over the last
several years put a focus on structural racism as a
public health issue, and highlighted the need of
our Centers to address this in concert with other
partners.
Remote work impacted our ability to build our
community in-person and contributed to difculties with staff retention, yet it has also created
opportunities to innovate and support broader
digital engagement for CHESA members across
the globe. We routinely reect on what worked
and what did not in order to change and grow. We
recognize many within our Center’s community
are overburdened and underappreciated and inadequately supported, which were long standing
challenges worsened by the COVID-19 pandemic
and other local and global events. CHESA’s goal
is not to be an additional task or responsibility, but
to be a supporter, facilitator, and advocate, with
our member’s wellness and prevention of burnout
at our Center’s core. There will always be competing priorities and inadequate time and
resources to accomplish all our goals, but CHESA
will continue to use our mission, vision, and
member engagement to guide our activities. We
aim for everyone within the CHESA community
to thrive as we engage in this necessary and meaningful work together and move closer to achieving
global perioperative health equity and justice.
Acknowledgments This chapter would not have been
possible without the support of UCSFCHESA's leadership, including Director and Professor of Surgery Dr.
Doruk Ozgediz. We are grateful to Dr. Kathryn Chu,
Director of the Stellenbosch University Centre for Global
Surgery and Professor of Global Surgery, for her criticalinsights and feedbackon early chapterdrafts.
References
1. Dare AJ, Grimes CE, Gillies R, Greenberg SLM,
Hagander L, Meara JG, et al. Global surgery:
dening an emerging global health eld. Lancet.
2014;384(9961):2245–7.
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