The COVID-19 pandemic has highlighted the importance of transnational cooperation. There is a need to improve the education of all healthcare professionals on a global setting.This is especially so, as it is universally acknowledged that low- and middle- income countries are faced with challenging contexts. This is due to reduced resources against a high burden of disease in keeping with the inverse care law. The American Head & Neck Society (AHNS), led by Dr Cherie Ann Nathan has developed a grant to address this and here Dr Cristian Slough and Professor Gregory Randolph interview its latest recipient, Dr Oghogho Braimah.
The mission and goal of the AHNS (www.ahns.info) is to “advance Education, Research, and Quality of Care for the head and neck oncology patient”. This is achieved, not only through patient education and information, but also through societies’ long-standing goal of educating and supporting surgeons at all levels and nationalities with a strong commitment to gender equality.
This has been particularly exemplified by the Endocrine section of the society, whose primary goal is to become the premier organisation for all surgeons with an interest in head and neck endocrine surgery. By elevating one, we elevate all, while improving patient care, research and education in this arena. As part of that commitment to foster education of surgeons of all backgrounds, we wanted to highlight the recent creation of the AHNS Endocrine Section Developing World Female Travel Grant (www.ahns.info/endocrine/developing-world-female-travel-grant), and its 2021 recipient, Oghogho Eloghosa Braimah of Nigeria.
A recent interview with Dr Braimah highlighted some of the challenges and frank obstacles she has experienced during her career, as well as, importantly, her triumphs. Dr Braimah first started in endocrine and head and neck surgery through a combination of chance, and as a matter of necessity. She became interested in general otolaryngology surgery during medical school. Upon entering formal training, she was surprised by the volume of head and neck patients and the complexity of their care. It quickly became clear to her that to be a competent otolaryngologist, she would also have to be a competent head and neck and endocrine surgeon.
“Dr Braimah expressed that in Nigeria, thyroid and endocrine neck surgery is still very much in the purview of general surgeons”
When asked who or what was her inspiration to pursue endocrine surgery, Dr Braimah expressed that in Nigeria, thyroid and endocrine neck surgery is still very much in the purview of general surgeons. Nonetheless, she was lucky that one of her training consultants, Rev Sis Onyeagwara, took interest in thyroid surgeries and began to perform them. She encouraged trainees to do the same. On a global level, Dr Braimah was made familiar with the work of Professor Netterville by another one of her trainers, Dr Okhakhu, and found it very influential. Prof Netterville used to come to Nigeria to perform thyroid and other head and neck surgeries in underserved areas for indigent patients. His dedication to the craft and serving others was inspirational.
Dr Braimah has found that lack of infrastructure, especially in the public healthcare sector, and absence of universal health insurance have been the main barriers for her pursuing her ambitions. There exists an unfortunate healthcare ‘gulf’ in Nigeria and the difference in the quality of care received by wealthy private sector patients differs significantly from that received by indigent ‘public sector’ patients subsidised by the government. For example, in the public sector a nerve monitor for thyroid surgery is hard to find. In addition, indigent patients often have to delay receiving care for long periods of time to raise money for their treatment, resulting in more advanced disease at the time of eventual intervention. This impacts negatively on outcomes and can be highly discouraging for the physicians involved, Oghogho notes.
Dr Braimah with her mentor, Rev Sis (Dr) NC Onyeagwara, and head of department
at her induction as a Fellow of the West African College of Surgeons in Senegal 2019.
Dr Braimah with her mentor, Dr Amina Okhakhu, and the Chief Medical Director
of her training institution at the completion of her training in 2019.
Dr Braimah in the OR.
During our conversations, we also discussed gender equality and parity in her experiences, and she reported that she was lucky to be trained primarily under the departmental leadership of Prof Ogisi. He was intolerant of any form of gender bias and truly encouraged gender equality amongst his surgeons. However, Dr Braimah’s choice to have children during residency training made schedules at times extremely challenging. There were many times when she felt she was neither a good resident nor a good mother. Oghogho notes there is so much more that can be done to support 'doctor-moms’ in Nigeria. Thankfully, she is blessed with a very supportive family. She notes that her husband was happy when residency was finally over! She does report that, as a female consultant who is rather young, she has had to deal with multiple patients looking for the ‘real Dr Braimah’ but this seems to be improving with time.
“Lack of infrastructure, especially in the public healthcare sector, and absence of universal health insurance have been the main barriers for her pursuing her ambitions”
With regard to the AHNS Endocrine Surgery, Dr Braimah feels truly honoured to have received this. She feels the grant will help her improve her surgical expertise. She is particularly looking forward to the hands-on observation portion of the programme. She believed she will be able to make useful connections that can help improve head and neck surgical care for her patients and patients as a whole in Nigeria.
As to where does she see herself in 10 years in the world of head and neck surgery/endocrine surgery, she replied that she hopes to be known for providing care that is state of the art as well as compassionate to otolaryngology head and neck patients. She plans to leverage her degree in Biomedical Engineering in the hopes of developing low-cost technologies to improve access to otolaryngology and head and neck services in low- and middle- income countries. In 10 years, she would like to have the answers to: “Can robotic surgery be done cheaper and just as well?”; “What cost-effective materials or designs could make this procedure easier, faster, more accurate or amenable to task sharing?”
The grant, which is sponsored by the AHNS Endocrine section through generous donations of members of the Endocrine Surgical Section of the society, is intended to support travel, accommodation, and food expenses for a female endocrine surgeon of a developing nation to attend an upcoming AHNS annual meeting. The programme enables the visiting surgeon the opportunity to attend the congress, while meeting and collaborating with experts in their chosen field. The hope is, as underscored above, that this grant will help overcome some of the challenges faced by female endocrine surgeons in their countries.