Fellowship in the time of COVID-19
16 September 2020
Two surgeons in Brazil—currently the third-largest global COVID-19 hotspot—found a way to continue AO CMF’s fellowship program even after face-to-face, on-site continuing medical education opportunities had ground to a halt.
With 13 years of experience as a craniomaxillofacial (CMF) surgeon, Dr Raphael Guerra was eager to undertake an AO CMF Fellowship, even in the middle of a global pandemic, proving that “where there is a will, there is a way.” His determination was only matched by the enthusiasm demonstrated by Dr Gabriel Pires Pastore, who oversees AO CMF Fellowships at fellowship center at Vita Care/Beneficencia Portuguesa in São Paulo, Brazil.
“I have known Dr Pastore since 2005: he was my residency coordinator in CMF surgery. After I finished my residency, we went our separate ways, but I continued my medical education with a master’s degree and an AO CMF Fellowship at the University of Basel (Switzerland) in 2017. Then I saw Dr Pastore at a congress in 2018, and we discussed doing something together,” recalls Guerra, who is head of the oral and maxillofacial surgery department at Hospital Leforte in São Paulo. “With the pandemic, I saw the potential to improve myself even more, especially in temporomandibular joint (TMJ) surgery.”
Pastore adds that pandemic presented some challenges—including the closure of many national borders, a situation that left him without a fellow in his center. At the same time, it created an opportunity for Guerra.
“When the pandemic started in Brazil in March, we had a fellow from Colombia here, and then there was news that Brazil’s border was closing. Our fellow was concerned about whether he could get back to Colombia,” recalls Pastore, head of the oral and maxillofacial surgery department of Vita and Hospital Beneficencia Portuguesa de São Paulo. “I told him, ‘You go back to Colombia right now, and you can come back to open arms. He went back to Colombia on Friday, and on Saturday the Brazilian borders closed completely.”
Then Pastore’s hospital decided to receive no additional 2020 fellows—but since Guerra is Brazilian and lives only about 20 minutes from Pastore’s fellowship center, an exception was approved.
“Raphael started right away. Receiving Brazilian fellows was a very nice experience. Maybe Brazilians can refresh their concepts near to home,” he says. “Other than us having fewer surgeries per day during the pandemic and being practically in scuba diving gear in the operating room—a clean room—nothing really changed in our activities.”
Teaching the AO principles
The fact that Guerra and Pastore both live in São Paulo made the fellowship a reality when countries around the world were closing their borders. By June 22, Guerra’s eight-week AO CMF Fellowship with Pastore was underway.
“I didn’t need a stipend for a fellowship in my own city—I just wanted the experience and the certificate,” says Guerra.
Pastore relishes the opportunity to teach the AO principles, emphasizing the key role AO CMF has played in his own career.
“My first AO course as a student was in 1998, and since then I have always used the AO principles to treat my patients,” Pastore explains, adding, “It’s important to pass those principles along to young surgeons. We can see clearly the differences in both the management of surgery and the patient outcomes,” he says.
‘Fear is always present’
Fear is a constant for these two surgeons treating patients in a COVID-19 hotspot, Guerra and Pastore agree.
“Fear is always present: Fear of becoming infected, fear of transmitting the virus to our families. But you can’t do surgery online. We just have to keep an open mind, stay strong, and keep going,” says Guerra.
While they are not on the frontlines of the pandemic in Brazil, Pastore believes that natural fear “keeps us alive.”
“Stopping is not an option, so we take a lot of care about wearing masks and maintaining social distance,” he says. “My responsibility is to be an example to my team. So, I arrive first and I am the last to leave.”
Guerra praises Pastore for creating a professional and trust-based fellowship environment.
“We all have to respect one another and take care of ourselves—and each other. If you want to land together, you have to take off together,” he adds.