Global Collaborations Help Expand Surgical Workforce Opportunities for Women

In Latin America, women represent approximately 15% of surgeons, in China, women are 6% of the total number of surgeons, and in England, women comprise approximately 17% of practicing surgeons, depending on specialty.^1-3

In the US, there has been a dynamic evolution over the past 50 years as gender balance in the field has shifted from less than 2% women to approximately 25% of all practicing surgeons.⁴

Similarly in Eastern, Central, and Southern Africa, women surgeons a decade ago represented 9%, while today, that number has risen to 27%.⁵

There also has been a seismic shift in gender balance in the cadre of medical students entering medical school in the US (approximately 50% are women),⁶ and surgical trainees in various specialties are showing similar patterns. While true gender parity has yet to be attained, progress is exemplified by metrics such as these, and it is likely that these trends may continue in the future. This growth is a result of the multidecade, multifaceted effort by individual women surgeon pioneers and surgical leadership, as well as society as a whole.

Founded in 1913, the ACS has focused on building a surgical workforce based on inclusive excellence. The Association of Women Surgeons (AWS) was created in 1981 to champion gender-related challenges for women surgeons. The AWS Foundation also was created for the advancement of equity for women in the surgical profession. These organizations are making an impact on the profession by recognizing, supporting, and fostering collaboration on a global scale.

Surgeon Workforce Shortage in Sub-Saharan Africa

In low- and middle-income countries, and particularly on the African continent, the global surgeon workforce shortage is a major issue. The need to recruit and train surgeons is imperative in sub-Saharan Africa, where the surgeon-to-population ratio is approximately 1 per 100,000—well below the requisite minimum of 20 per 100,000 to adequately serve a population.^7,8

Central to the solution for this crisis has been the establishment of the College of Surgeons of East, Central, and Southern Africa (COSECSA). A primary goal of COSECSA is to grow the number of practicing surgeons on the African continent, while ensuring quality training standards. COSECSA has also been a champion for growth and innovation, as its members are considered to be thought leaders for the region, as well as ambassadors for international collaboration.

Officially inaugurated in 1999, COSECSA represents 14 member sub-Saharan countries and eight partner countries, unifying a diversity of nationalities under a single professional umbrella and providing a central accreditation body.⁹ The visibility and validation of the newer surgical society supported by established societies was an important component to building international credibility.

In 2008, the Royal College of Surgeons in Ireland (RCSI)/COSECSA Collaboration Programme began, which is a pivotal partnership that continues to this day. The ACS and AWS Foundation (AWSF) built a supportive and reciprocal collaboration with COSECSA to help the organization expand its own global presence and impact on surgeons and surgical practice in Africa. The Pan-African Academy of Christian Surgeons also provided mentorship and sponsorship for, and endorsement of, COSECSA.

Professional Societies, Gender Equity Initiatives

Investing in the education and empowerment of women surgeons has been a focal point for sub-Saharan Africa. Women in Surgery Africa (WiSA) was formed in 2015 to provide peer-to-peer mentorship and support for women surgeons, surgeons in training, and medical students in the COSECSA region.¹⁰ Historically, traditional gender roles in Africa have had priority, which can lead to significant barriers for women pursuing careers in medicine and surgery. This history reflects a complex interplay of cultural, social, and economic factors that have shaped the landscape for women surgeons.

With data-based tracking of gender-based metrics within COSECSA, the organization developed an initiative to increase the enrollment of women in surgical training programs and increase the number of women successfully completing those programs in the region. Figure 1 (below) shows the growth of women surgical trainees entering COSECSA training programs during the last 20 years, and Figure 2 (below) shows the number of women surgeon graduates.

The ACS-COSECSA Women Scholars Program, which began in 2017, provides funding toward the women trainees’ examination and travel fees to enter into an accredited COSECSA surgical training program and then to become certified surgeons as fellows of COSECSA (FCS). In 2018, the ACS Foundation and AWSF joined together to financially support this program.

Figure 3 (below) shows the number of women graduates of COSECSA supported by the scholarship as compared to the gender ratio and total number of graduates from 2019 to 2023.

Past Recipients

Past recipients of the ACS-COSECSA Women Scholars Program have recognized it as deeply meaningful, validating, and hugely impactful for them early on in their careers. Some African women who have trained to be surgeons find the final hurdle to become a certified COSECSA fellow insurmountable as they balance their career, motherhood, and finances in emerging and fragile economies. The award provides financial benefits to offset these challenges, and it raises the visibility of the trainees into a cohort of individuals who remain connected to the ACS, AWS, and COSECSA.

Past recipients have gone on to have highly successful careers and have grown into leaders of their specialties in their countries. The following profiles highlight an inspiring award recipient from each year.

2017

Nardos Worku, MD, is one of the few pediatric orthopaedic surgeons in Ethiopia. She has both specialty (orthopaedics) and subspeciality (pediatric orthopaedics) certifications from COSECSA and has received a master’s degree in public health from Jimma University. Her outstanding performance led to being recognized by the Women Scholars Program and attending the qualifying exams in Maputo, Mozambique.

After becoming a fellow of COSECSA, she was able to complete her pediatric orthopaedic fellowship at CURE Children’s Hospital of Ethiopia in Addis Ababa and help many children with deformities and fractures since that time. Dr. Worku also held leadership roles as an executive member for the Ethiopian Society of Orthopedics & Traumatology. She currently works at Lancet General Hospital in Addis Ababa, Ethiopia, as a pediatric orthopaedic surgeon, leading the pediatric orthopaedic unit.

2018

Mumba Chalwe, MD, was selected for the ACS/AWSF COSECSA Women Scholars Program Award in 2018, which facilitated her accreditation by COSECSA. As Zambia's first woman urologist, she has actively mentored and trained emerging female surgeons in her field. In her capacity as chairperson of WiSA, Dr. Chalwe has led various research grant initiatives and surgical leadership programs aimed at supporting women surgeons across the COSECSA region. Currently serving as the head of urology at Ndola Teaching Hospital, an academic institution in Zambia's Copperbelt region, Dr. Chalwe is at the forefront of enhancing prostate cancer care. She also is engaged in cancer research within the same facility. Her commitment to advocating for the surgical profession extends both locally and regionally, actively contributing to national surgical society efforts in formulating perioperative care policies. Dr. Chalwe’s career trajectory is a testament to the significant impact women surgeons can have in their communities when provided with the necessary support and resources. Through her leadership and advocacy, she continues to inspire and empower future generations of women in surgery.

2019

Lieutenant Colonel Takondwa Itaye-Kamangira, MBBS, MMed,
worked for the Malawi Ministry of Health at Queen Elizabeth Central Hospital in Blantyre, Malawi, following training. In the subsequent months after she became a COSECSA fellow, Dr. Itaye-Kamangira was employed as a surgeon for the Malawi Defense Force (MDF) and has risen to the rank of lieutenant colonel. Since working at the MDF, Dr. Itaye-Kamangira has been deployed twice on United Nations (UN) missions to the Democratic Republic of Congo (DRC). On her second deployment with MDF, she was the commanding officer for her team tasked with setting up and running a surgical unit (Light Mobile Surgical Module) in the DRC to support the troops and other UN employees. She also volunteers her time in the district hospital near her home when she is available. Her commitment to these roles has led to her appointment as the medical advisor to the Southern African Development Community Mission in the DRC. Receiving the Women Scholars Program Award provided the opportunity for Dr. Itaye-Kamangira to progress professionally. Today, as a fully accredited surgeon, she is able to serve her community in Malawi as well as internationally.

2020

Tracern Mugodo, MD, was selected for the ACS/AWSF COSECSA Women Scholars Program Award in 2020 and became an orthopaedic fellow of COSECSA. She stated that “the scholarship enabled me to register for my exams, covered my travel expenses to write exams and many opportunities as an Associate Fellow of the ACS to advance my career in various ways from reading materials, leadership skills programs to scholarship opportunities. Gratitude fills my heart as I reflect on the outcomes of this scholarship opportunity.” In 2021, The Royal College of Surgeons of Edinburgh granted Dr. Mugodo the Faculty of Remote, Rural and Humanitarian Healthcare Fellowship Fund. She has become the clinical manager for Zimbabwe’s clubfoot program, an opportunity that she says has empowered her as a leader due to the role’s impact on the many lives of children born with this condition. Dr. Mugodo currently is a consultant orthopaedic surgeon at Parirenyatwa Hospital in Harare, Zimbabwe, and is pursuing new directions as an orthopaedic spine surgeon following an AO Spine Fellowship in Cape Town, South Africa.

2021

Shikuria Lemma, MD, attributes her ability to become a COSECSA fellow and taking the necessary exams to the opportunities provided by the Women Scholars Program Award. Since passing the COSECSA exams, her certification has led to more job opportunities in her region as well as attaining subspecialty fellowship training. She is an orthopaedic and trauma surgeon in the Black Lion Specialized Hospital, in Addis Ababa, Ethiopia, and was able to pursue subspecialty training in foot and ankle surgery beginning in January 2025 in Egypt.

“I just want to say thank you for your support. Being selected as one of the recipients of the ACS scholarship award was a great moment for me. I felt recognized by something bigger,” said Dr. Lemma, who plans to return to Ethiopia to practice after training in Egypt.

2022

Rovine Naluyimbazi, MBBS, MMed, said:
“I received life-changing news. I had been awarded a scholarship from the American College of Surgeons. This timely support arrived just before my final exams, providing the much-needed motivation to succeed. The scholarship covered all examination expenses, including registration, travel, and accommodations, which would have been insurmountable following the recent loss of my father.”

Dr. Naluyimbazi then qualified as a pediatric surgeon, and she has gone on to acquire minimally invasive surgical skills, with the goal to further refine these techniques. Her clinical interests include neonatal, urological, and oncological conditions. She currently is a pediatric surgeon at Mulago National Referral Hospital in Kampala, Uganda.

2023

Tinotenda Masenda, MD, is currently practicing as an orthopaedic and trauma surgeon in her home country of Zimbabwe, where women surgeons are a minority. Estimates suggest that she is one of four practicing women orthopaedic surgeons in the region.

“Receiving the ACS award was very beneficial because it went a long way toward helping me get through my COSECSA orthopaedic exams,” said Dr. Masenda. “The financial support enabled me to achieve my dream of becoming a surgeon. This goal would not have been possible without the support from the ACS Women Scholars Program Award. There are many doors that have been opened, which I hope to use for my professional development.”

Dr. Masenda is currently working toward completing subspecialty training in foot and ankle surgery as well as limb reconstruction. She has established a network of colleagues through the ACS, and as a result, has been able to find supportive mentorship opportunities.

2024

Nakavizya Janet Nshinka, MD, is currently a urology registrar at Ndola Teaching Hospital in Zambia. The scholarship enabled her to pursue the fellowship in urology under COSECSA, where she received the honor of best-performing student in urologic surgery. The ACS scholarship has affected her career and professional aspirations. Her mentor, Dr. Chalwe, a 2018 awardee profiled earlier in this article, was one of the earliest recipients of the scholarship and was her inspiration. She shared her commitment to continuing the legacy of mentoring young women doctors and encouraging them to pursue careers in surgery. Dr. Nshinka has contributed to Zambia’s urology workforce where access to specialized care is extremely limited. She is passionate about prostate cancer research and management as well as the field of andrology, especially since male reproductive health is not well-studied in her country. She said she looks forward to future opportunities for advanced training and research to improve urologic care and outcomes in Zambia and beyond.

Future Directions

The AWSF is working to grow the Women Scholars Program and provide ongoing support to past recipients as well as to future grant awardees. Mentorship is a crucial component of professional development, and these professional organizations aim to initiate a program that connects aspiring female surgeons with experienced mentors.

Surgeon role models not only demonstrate the possibilities within the field but also provide practical insights and advice on overcoming barriers. Supporting African women surgeons so they can attain successful practices and visible leadership roles promotes the value of women in surgery and will make positive inroads into the severe surgeon workforce shortages in the region.

Dr. Melanie Sion is a surgeon for Yale Medicine General Surgery, Trauma & Surgical Critical Care in New Haven, CT. She also is the leader for global surgery at Yale with special interests in developing surgical services in Southern and Eastern Africa and educating the medical community on health disparities in surgical care due to global inequity.

References

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