In a world where five billion people lack access to safe, affordable surgical care, the work of RCSI’s Institute of Global Surgery is not just academic, it is lifesaving.
Over the past decade, since the publication of the landmark Lancet Commission on Global Surgery, RCSI’s Institute of Global Surgery has emerged as a global leader in the movement to transform healthcare systems in low- and middle-income countries through sustainable, impactful, and locally driven surgical care interventions.
From innovative training models to sustainable partnerships, it has supported the training, retention, upskilling and career development of surgery, anaesthesia, nursing and obstetric non-specialist and specialist caregivers.
Today, its efforts continue to foster long-term, sustainable research and training interventions, and increase access to high-quality surgical care for those who need it most.
Transforming lives by building capacity
In sub-Saharan Africa, 93% of people lack access to safe surgical care when needed. A significant contributing factor in this is the acute lack of surgical care providers.
The RCSI/COSECSA Collaboration Programme, supported by Irish Aid, continues its deep and wide-ranging collaboration with the College of Surgeons of East, Central and Southern Africa, expanding quality-assured surgical training in the region. COSECSA has grown to be the largest single contributor to the surgical workforce in sub-Saharan Africa with over 1,507 surgical trainees enrolled in training programmes across 20 African countries (as of December 2024).
The collaboration is managed for RCSI by Lucia Brocato, Programme Manager, Lawa Shaban and a group of RCSI volunteers. The collaboration programme has expanded to support training in anaesthesiology, peri-operative nursing, and obstetrics, bringing in three new partner organisations from east, central and southern Africa, and three from Ireland.
Scaling surgical solutions
Access to surgery isn’t just about training, it’s about systems. Dr Jakub Gajewski, Director of Research at the Institute of Global Surgery, has been instrumental in building evidence-based surgical systems for local communities in sub-Saharan Africa.
Through initiatives such as COST and SURG-Africa, he helped pioneer a scalable model of surgical, training, supervision and mentorship across Malawi, Zambia, and Tanzania, grounded in rigorous data collection and implementation research.
This work has led to a doubling of surgical procedures performed at the district level and an estimated 30% reduction in unnecessary referrals. District hospitals benefiting from these interventions are now better equipped to provide timely, safer surgical care, enabling faster referrals when needed and significantly improving outcomes for rural patients who previously had limited or no access to essential surgical services.
In collaboration with local surgeons and international partners, he launched KidSURG, an ambitious paediatric surgical project, providing access to safe surgery for neglected populations.
Fighting breast cancer with knowledge
Currently nine of out of ten Malawian women with breast cancer die in the first year after receiving the diagnosis. Akazi, led by Dr Gajewski, Dr Chiara Pittalis, Antonio Jaen Osuna and Zsofia Torok, and funded by Research Ireland, promotes a systematic approach to breast cancer control in Malawi and facilitates efficient utilisation of available resources in the country.
Thanks to the Akazi project, the Ministry of Health in Malawi now has its first practical guide for the early detection of breast pathologies, and two years later, those clinicians who completed the first breast-health course ever done in Malawi have become the cornerstone of breast services for rural dwellers.
Voices from the OR
Dr Emanuela Parotto, a PhD scholar at the RCSI Institute of Global Surgery, is leading a unique comparative study that explores the power dynamics within operating theatres and how these shape the professional identity of anaesthesia providers.
Comparing low-income countries with a high-income country, Italy, the project is uncovering how interpersonal relationships, perceptions of hierarchy, and everyday interactions influence career choices, job satisfaction, and the broader appeal of anaesthesia as a profession – particularly in low and middle-income countries, where uptake remains low.
The environmental causes of a congenital defect
Gastroschisis is a congenital birth defect where the abdominal wall fails to close completely.
Dr Phyllis Kisa, a PhD Scholar at the RCSI Institute of Global Surgery and paediatric surgeon and urologist working at Makerere University College of Health Sciences and Mulago National Referral Hospital in Uganda, is currently carrying out a mixed methods study into environmental and maternal risk factors for gastroschisis among Ugandan infants.
Standing up for unsalaried health workers
Unsalaried health workers make up 50% of all health workers in Sierra Leone’s public system, which undermines health outcomes in the country. Dr Pieternella Pieterse, Research Fellow, and Federico Saracini, PhD Scholar, have been carrying out a four-year Research Ireland PATHWAY funded study on unsalaried health workers in Sierra Leone.
They have recently shared their findings in Sierra Leone with research participants, aid donors, NGO stakeholders and government representatives, hoping to influence policy on the recruitment, without pay, of nursing graduates.
Clean water, safer births
Unpredictable rainfall patterns and water scarcity – both intensified by climate change – undermine healthcare delivery and increase the risk of infection, particularly during childbirth and surgery. The SURG-Water project which won the Research Ireland SDG Challenge (SDG 13 – Climate Action), uses innovative solar water disinfection technology (SODIS) to purify harvested rainwater. in Malawi.
By increasing the supply of clean water in rural health settings, the project is helping to tackle the growing health burden posed by climate change, which disproportionately affects rural communities in sub-Saharan Africa
The interdisciplinary team, which includes Professor Kevin McGuigan who is Director of the RCSI Solar Disinfection Research Group, Dr Kuba Gajewski, Dr Chiara Pittalis, Antonio Jaen Osuna, and Zsofia Torok, demonstrates how research innovation, climate-conscious design, and global health priorities can align to deliver real-world impact
E-learning without borders
Eric O'Flynn, the Institute’s Programme Director (Education, Training and Advocacy) and Dr Ines Peric who is Education Project Manager, lead the RCSI team in The United Nations Global Surgery Learning Hub (SURGhub), a collaboration between The Global Surgery Foundation, the United Nations Institute for Training and Research and the RCSI Institute of Global Surgery, supported by J&J.
This open access UN-based platform provides easy access to a wide range of trusted, quality global surgery educational resources to all cadres involved in the delivery of surgical care. SURGhub now has more than 100 free courses, and more than 17,000 enrolled surgical learners from 196 countries. It won the Times Higher Education award for Technological Innovation of the Year in 2024.
The team hosts the e-learning platforms of three African training colleges and two NGOs and manage the creation of numerous partner e-learning courses, many of which are managed by Méabh Hennelly, Education Programme Officer.
Building a global network for the future
With support from the Erasmus+ programme, Professor Juan Carlos Puyana has engaged with partners in Universidad ICESI in Cali (Colombia), University of Medicine, Tirana (Albania) and Kenyatta University to create new educational opportunities into the future.
In collaboration with Stellenbosch University, the Institute has launched a pioneering course' titled 'Essential Research Skills: A Global Surgery Perspective'.
This is the first cross-border student-academic initiative in global surgery education. By equipping emerging healthcare professionals with essential research competencies and fostering international collaboration, this initiative significantly advances the global surgery agenda, training new generations of experts in this field.
RCSI is committed to achieving a better and more sustainable future through the UN Sustainable Development Goals.
