Abstract
Global surgical collaboration presents opportunities for knowledge exchange, but it also highlights the inequities that influence how surgery is practiced across different contexts. As a Latino surgeon trained in a high-income country, I reflect on my experience at a multidisciplinary, Spanish-language conference in Mexico City that brought together over 600 participants from Mexico and six Latin American countries. The program spanned cholecystectomy, bariatric surgery, hepatology, anesthesia, and interventional radiology, with survey results showing that 87% of attendees reported increased knowledge and 98% intended to apply new practices. Yet, financial constraints, limited time, and lack of institutional support remained significant barriers. For me, the experience was both professional and deeply personal. Teaching exclusively in Spanish affirmed cultural belonging and highlighted language as a tool of equity. At the same time, it underscored the systemic nature of barriers in low- and middle-income countries, where adopting new techniques depends not only on interest or skill but on resources, infrastructure, and institutional support. Standing at the intersection of privilege and solidarity, I felt both pride in contributing and discomfort at the inequities that persist. This reflection suggests that global surgical engagement must move beyond episodic exchanges toward sustained, equitable partnerships that are linguistically accessible, culturally grounded, and structurally supported. Surgery itself exists in two worlds, the technical and the systemic. Embracing that duality can strengthen our collaborations and shift the measure of surgical impact from the number of cases completed to the number of bridges built.
For many years, the operating room has been my safe place; it is where I turn on the reggaeton and strive to find the perfect blend of art and science. A well-performed operation is similar in many ways to dancing; the moves seem flawless, executed with perfect timing, and the team moves in rhythm with the music. The operating room is a true balance of both art and science. Yet, things do not always remain in perfect balance.
The Lancet Commission Global Surgery 2030 calls for accessible, safe, and affordable surgical care for all that emphasizes equity, capacity building, and international collaboration. 1 Our recent multidisciplinary conference in México City embodied these principles: a partnership between Mayo Clinic Arizona and the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, conducted entirely in Spanish and attended by over 600 participants from 6 Latin American countries. This event carried deep personal and professional importance. I was born in the Dominican Republic, and while México is not my birthplace, its rhythms, warmth, and realities felt familiar. I grew up where medical excellence coexisted with scarcity, and ambition was limited by resources. Now, as a surgeon in a high-income country, I reflect on the eager students and residents, and the echoes of my past.
The program covered safe cholecystectomy, bariatric surgery, hepatology, anesthesia, and interventional radiology. Surgeons, residents, and students took notes, snapped pictures, and asked pointed questions. The appetite for knowledge was abundant.
A post-conference survey yielded 509 responses from 660 participants. It confirmed my suspicion—87% reported increased knowledge and 98% planned to apply what they learned. Yet, half lacked financial means, a third lacked time, and a quarter lacked institutional support.
The gap between the desire to provide better patient care and the reality of the resources was more than a statistic; it was a reminder of what it means to practice surgery with significant limitations. In low-middle income countries (LMICs), adopting a new technique is not a matter of interest or knowledge, but of institutional and financial resources.
Standing at the front of that auditorium as a Latino surgeon trained and practicing in a high-resource system, I felt the paradox. I asked myself: “What if I stayed in the Dominican Republic? Would I still be a surgeon? Would I still be me?”
That tension was a mix of pride and guilt: pride in being able to return with knowledge and a sense of solidarity, and guilt that I stood with access to technologies and institutional backing that my colleagues lacked.
Language as a means of equity was central to the experience. Teaching exclusively in Spanish was a deliberate decision that dismantled a barrier and affirmed belonging. For me, it was also personal, reconnecting me to my cultural identity and reminding me that my background is not a distance to overcome but a bridge to be proud of. At the same time, I was reminded that barriers are systemic, not individual. True collaboration is not unidirectional; it is more than knowledge-sharing; it is co-creating solutions, aligning priorities, and ensuring sustainability. Anything less risks reinforcing the disparities we seek to lessen.
Upon returning to Arizona, I entered my own operating room in a different way. I saw the latest laparoscopic tower, the DaVinci robot, and the snack-filled surgical lounge, and I felt the contrast.
The struggle within me persists. I am tremendously grateful for the environment in which I currently practice. Yet, at the same time, I am uncomfortable with its inequities. My colleagues in México struggle with wanting to provide better patient care while balancing the resources they have available. Similarly, I struggle with wanting to give more of my time, but I realize that without systemic change, knowledge alone cannot close the gap.
Surgery lives in two worlds—the technical one of anatomy and instruments, and the broader one of economics, culture, and inequity. As a Latino surgeon, I live in those two worlds daily. My identity allows me to connect, but it also creates an internal conflict—I belong to both, yet I am fully neither.
What, then, is the way forward? First, we should create content in the LMIC native language. We should also seek to develop local surgical community leaders who can help disseminate this knowledge after educational events. Lastly, we should support bi-directional exchanges to foster sustained educational partnerships between institutions committed to advancing global surgical education. The example set by William and Charles Mayo, who traveled the world to learn new surgical techniques and share knowledge, demonstrates the value of such exchanges.
Global surgical collaboration should prioritize building equitable frameworks that value language, culture, and shared growth. HIC academic institutions should strive to bridge these borders; these relationships can provide significant bi-directional growth opportunities. Promoting cultural and linguistic equity enhances patient outcomes, increases surgical capacity, and advances progress toward the Global Surgery 2030 objective of a world where access to safe surgery is no longer a privilege.
Footnotes
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Declaration of Generative AI and AI-Assisted Technologies in the Writing Process
During the preparation of this work, Irving Jorge used Grammarly.com to review and correct any grammatical errors. After using this service, Irving Jorge reviewed and edited the content as needed and takes full responsibility for the content of the publication.