Center for Health Equity in Surgery and Anesthesia Expands Its Influence

Written by Andrew Schwartz.

In the past year, the UCSF Center for Health Equity in Surgery and Anesthesia (CHESA) has grown to more than 100 members from 10 different UCSF departments, while also welcoming new Deputy Director Patti Orozco and new Projects Manager Zayna Tommalieh. The growth exemplifies CHESA’s determination to advance equity in surgery, anesthesia and perioperative care through projects that span the globe.

“CHESA is the evolution of numerous global health initiatives at UCSF,” says Michael Lipnick, MD, an associate director at CHESA and faculty in the UCSF Department of Anesthesia and Perioperative Care. The group came together in 2020 when the UCSF Anesthesia Division of Global Health Equity merged with the UCSF Center for Global Surgical Studies and numerous other UCSF departments, while also partnering with institutions from around the world.

“It’s an exciting time for CHESA,” says Orozco. “Health equity is a much better understood and prioritized concept and there’s more interest from diverse stakeholders to support this work, including donors.”

Addressing Equity at Home and Abroad

“One of CHESA’s primary educational goals is to dispel this notion that global health is either charity work or research in a poor country outside the United States,” says Lipnick. “We intentionally did not use the word ‘global’ because people’s first response to ‘global’ is to think ‘international,’ but health equity is a challenge everywhere, including here in the Bay Area.”

With that in mind, the center’s research, education, and advocacy efforts build collaborations across multiple communities. For example, an epidemiological study of pediatric surgical conditions in Uganda collaborates with one aimed at understanding barriers to accessing surgical care in San Francisco. Similarly, CHESA fellows – future leaders of health equity efforts in perioperative care – share curriculum, projects and mentors to build a community of like-minded colleagues.

The expanded fellowship program speaks to the extraordinary synergy that CHESA creates. “When we were one division in Anesthesia, we had one fellow per year,” says Lipnick. “Now we have the resources for 15 fellows, about half from low and middle-income countries.”

Major Contributions from Anesthesia

The UCSF Department of Anesthesia and Perioperative Care has proven to be a major contributor to CHESA’s work. Current projects with department involvement include:

• Collaboration between CHESA and the Anesthesia Hypoxia Lab, which aims to solve the problem that pulse oximetry doesn’t work as well for people with darker skin. OpenOximetry.org includes lab and clinical research with the intent to publicly disseminate data that can help consumers, manufacturers and agencies improve access to safe devices. The FDA's Centers of Excellence in Regulatory Science and Innovation funds the clinical study.
• CHESA is working with the UCSF Department of Emergency Medicine to co-lead the UCSF World Health Organization Collaborating Centre for Emergency, Critical and Operative Care. Lipnick and Carol Chen, MD, will co-direct the center, with additional leadership from CHESA Associate Director Marissa Boeck, MD, MPH and multiple others.
• The Open Critical Care project, which began as a response to the COVID-19 pandemic, continues to create tools to support clinicians taking care of critically ill patients, including creation of a new oxygen encyclopedia and new oxygen calculators.
• Tyler Law, MD, leads the Global Anesthesia Workforce Study for the World Federation of Societies of Anesthesiologists (WFSA). The department’s Adrian Gelb, MD, is the immediate past president of WFSA.
• Odi Ehie, MD, Rondall Lane, MD, Erica Langnas, MD, MPH, Maytinee Lilaonitkul MBBS, and Mervyn Maze, MB, CHB, coordinate and lead implementation of the department’s health equity curriculum and are working with CHESA to digitize and share the curriculum more broadly.
• Department faculty members are also assuming key programmatic roles at CHESA, including Gelb as director of Advocacy and Policy, Lilaonitkul as associate director of Education and Law and Langnas as associate directors of Research.
• Former CHESA fellows include:
  • Beti Asnake, MS, MD, who recently started a new position to help lead global health initiatives in anesthesia at UCLA.
  • Bunmi Okunlola, MD, who did her fellowship at Zuckerberg San Francisco General Hospital and led a research project focusing on equity in pulse oximetry. “An editorial she wrote has gained the attention of regulatory authorities around the world,” says Lipnick. 

Continued Expansion Inside and Outside of UCSF

CHESA has also collaborated with the department to bring Visiting Professor Gunisha Kaur, MD, MA, to UCSF from Weill Cornell Medicine where she directs the Human Rights Impact Lab and co-directs the Weill Cornell Center for Human Rights. Her research focuses on displaced populations and she conducts clinical research on issues such as chronic pain in torture survivors, the mental health of children who are displaced, and trafficking of young women and girls in refugee camps. CHESA and Kaur are actively exploring ways to expand the partnership between the two institutions.

“We are always open to engaging new stakeholders from within and outside UCSF interested in building connections, supporting health equity work and providing mentorship to our fellows and interns,” says Orozco. “CHESA is focused on supporting partners on locally-driven priorities. This work requires deep listening, building trust and doing our best to engage intentionally and equitably. It takes time but is critical to creating sustainable change where it’s needed most.”