Dr. Ronald Lett, BMSc, MSc, MD, FRCSC, FCS (ECSA): 2018 Recipient of the Royal College Teasdale-Corti Humanitarian Award
Dr. Lett crossing the Gulf of Mwanza to meet the Minister of Health, Tanzania
Dr. Ronald Lett BMSc MSc MD FRCSC FCS (ECSA)
Injury Epidemiologist and General Surgeon
- CEO and Director of Curriculum Development, Canadian Network for International Surgery
- Adjunct Professor of Surgery, McGill & University British Columbia
Dr. Lett has been involved in global health for over 40 years and has dedicated his career to improving the quality of surgical services in developing countries.
When he started out in the late 1970s in Africa, Dr. Lett was first a student, then a general practitioner who performed surgery and subsequently a qualified surgeon. Over this period, he recognized that the contributions of individual physicians like himself would have only limited and local impact. What was needed was a workforce of well-trained local health care providers.
Switching gears in the early 1990s to focus on medical education and training, his vision was as simple as it was complex: build a practical education and training program that would help develop a stable and sustainable training model for countries with limited resources.
His perseverance has paid off. To date some 35,000 health professionals have been trained using the techniques developed by Dr. Lett. These trained professionals in turn have helped countless patients and many have also trained more colleagues.
Improving frontline skills and confidence
As the founder and principle program developer for the Canadian Network for International Surgery (CNIS), Dr. Lett has driven development of many surgical skills programs that have improved the skills and the confidence of frontline providers of surgical and obstetrical services in Africa.
Since its establishment in 1995 the aim of CNIS is to create a system of practical education and training programs. To date, CNIS has tailored 12 specific courses and qualified more than 760 instructors in their own countries. These hands-on programs have been delivered hundreds of times over in Uganda, Tanzania, Mozambique, Rwanda, Mali and Ethiopia.
Dr. Lett with Essential Surgical Skills students in Mekele, Ethiopia
Dr. Lett with Surgery and Obstetrics colleagues in Uganda
Hundreds of CNIS-trained Canadian and African specialists have gone on to train 35,000 healthcare practitioners in a variety of lifesaving surgical skills. Many programs are developed and delivered jointly with university departments and colleges in target countries. Programs cover basic surgical techniques, trauma care, burn management, obstetrics, osteomyelitis, head and spine injury and clinical skills for physicians, nurses, and paramedics.
Dr. Lett has created a truly multidisciplinary organization through enlisting midwives, nurses, teachers and obstetricians, anesthesiologists and surgeons of various specialties. In recent months, CNIS has started conversion of courses to digital formats to expand the reach of these valuable teaching tools through mobile app technology.
A “legendary” and pragmatic teacher
Dr. Lett’s colleagues say perhaps his greatest strength is his pedagogical skill, and his ability to create courses to teach a given skill is “legendary.” Students learn thinking and management skills as well as each step of an operative procedure. Each skill is first practiced and perfected using low fidelity simulation. Students hone skills suturing on animal materials such as goat’s feet or beef hearts, under strict supervision to assure that knots are pristine and strong, and hemostatic technique is perfected.
Programs have extensive evaluation components. The long-term goal is lower surgical complication rates and ultimately reduce mortality.
Recognizing the importance of the social determinants of health, including the impact of conflict and violence, Dr. Lett teamed up with Ethiopian and Ugandan primary school educators. Together they developed a course for life skills and conflict resolution that was delivered in schools to tens of thousands of grade five students.
Engaging the Canadian Medical Community
“Canadians have a global responsibility to share our skills and our good fortune with those that need it most,” says Dr. Ronald Lett.
At a time when most Canadian physicians who are involved with global health work, spend a few weeks away from Canada, Dr. Lett has spent most of his career living and working in West and East Africa. He has immersed himself in the cultures, learned to speak Swahili and has gained tremendous respect from the many colleagues working on CNIS courses.
Work such as this demands not only pedagogic skill, but effective management skills. CNIS is a small registered Canadian charity with a Board of Directors and annual fundraising goals. Dr. Lett is responsible for overseeing both Canadian and international activities, including management of all activities in Africa and the Caribbean. Over the years, CNIS projects have been based in 14 departments of surgery, nine departments of obstetrics and eight paramedical training centers, and involves coordination of surgeons, obstetricians, anesthesiologists and nurses from across Canada volunteering in Africa.
Working with CNIS as the national organizer, Dr. Lett is also responsible for sustaining the Bethune Round Table, which is an annual meeting of Canadian surgical personnel involved in global work. The Bethune Round Table is hosted and organized by different universities throughout Canada.
In addition to extensive curriculum development, Dr. Lett has an extensive list of peer review articles, book chapters, editorials and letters-to-the-editor. He has taken tens of thousands of photos in Africa and is working on a book about his experiences. In addition to the critical contributions of hundreds of African and Canadian colleagues, he has depended on the love and support of his mother Audrey, late father Glen, wife Elizabeth and children Robyn, Ryan, Tara, Lana and Lawrence. Dr Lett would like to thank the Royal College for this recognition that would not be possible without the support of these colleagues and his family.
Going forward, Dr. Lett suggests ambitious future directions for the Royal College’s international work, including proactive support for its Fellows in all specialties, who work or volunteer internationally, development of a Global Fund for Surgery, Obstetrics and Anesthesia Human Resource Development for low and middle income populations, financed as compensation for their countries’ augmentation of the Canadian medical workforce, and appointing a Royal College International regional director for Africa.