Willieford Moses, M.D.
General Surgery Residency Program
UCSF Department of Surgery
Background and Education
- Hometown: San Francisco, CA
- Education: Duke University, Durham, NC: BS, Psychology
- UCSF School of Medicine: MD
What made you want to become a surgeon?
One of my goals has always been to do global health work. Early in medical school, I saw that you could do this through surgery. There are plenty of countries and communities in desperate need of surgeons – not just trauma surgeons, but surgical oncologists, endocrine surgeons, pediatric surgeons. Particularly in the global health arena, device development and innovation are critical to helping fill this need via low-cost economic solutions. I’m hoping to gather a tool set to allow me to do that.
What sparks your passion for global health?
My dad is from Nigeria. I recognized how fortunate I was to be born in the US in terms of the health care that I received. My cousins who are still in Nigeria will face many hurdles just to maintain their health. The majority of the world has very few resources, and small bits of change can have dramatic impacts. Obviously, there are health metrics such as vaccinations that still need attention, but we can’t underestimate the role that a surgeon can play in significantly improving the lives of the underserved and under-resourced.
Interestingly, there are parts of the US, even in San Francisco where I grew up, that are forced to function at levels very similar to the developing world due to lack of resources. I would love to take some medical device or intervention that’s extremely complex and expensive, and whittle it down back to its basic units to make it affordable and widely applicable.
Would that be analogous to providing a flip phone that could make calls and send texts? It’s not the latest smartphone, but could address needs that are the low-hanging fruit.
Yeah, that’s a great analogy. I’d like to work in areas within medicine that could benefit from that sort of paradigm shift in how we approach and develop new technology. For example, when I was a medical student I spent a summer in Uganda working on a research project. One of my classmate’s projects was to develop a protocol to teach the basics of first responder care to police officers and taxi drivers, since they were most likely to be the first to interact with traumatic injuries that occurred regularly in the streets. Did they need a bells-and-whistles, auto-adjustable splint to stabilize a fracture for transport? No. They could probably just use a piece of cardboard with some rope, and that’s exactly what they taught them.... Thinking of ways to fabricate a splint like that from readily available, everyday equipment would be a game-changer for countries in which trauma is one of the biggest health care concerns.
Tell me about your work with Dr. Shuvo Roy on the bioartificial kidney.
Dr. Roy has spent more than a decade working on silicon membranes and their use for kidney filtration. His lab has come to the point now where it’s ready for preclinical animal studies to test the efficacy of the membranes, which was perfect timing for me to come in as a surgery resident.
The technology revolves around flat plates of silicon nanopore membranes, as opposed to the more traditional hollow fiber dialysis membranes, which are tubular structures that appear similar to a bundle of straws. Nanopore membranes are more efficient and can function in a smaller surface area than hollow fiber membranes, allowing us to potentially implant these devices.
My understanding is that it’s a two-step process. First it’s like using a large-holed sieve to pull out quite a bit of things from the bloodstream, but then you run it through a second layer of filtration where you put back most of the good stuff, but retain the stuff that you want to discard?
That’s exactly it. On one side, there’s this silicon sheet with a lot of nanopore holes that can filter liters of blood to produce what we call an ultrafiltrate, which includes toxins and small molecules like urea and creatinine, but excludes larger molecules like nutrients and red and white blood cells that cannot make it through the pores. However, the majority of this ultrafiltrate consists of water that needs to be reabsorbed. That is where the second process comes in, with the bioreactor – a membrane lined with kidney cells responsible for water reabsorption from the ultrafiltrate. It functions similar to the way your kidney works to reabsorb water. Half of our lab is working on the filter side, and the other half is working on the bioreactor side of the project.
Using the same silicon membranes, our lab has developed a concurrent focus around characterizing their gas exchange properties. In this case we have the High-efficiency External Ambulatory Lung (HEAL) project, where the membranes serve as a barrier for gas exchange similar to ECMO [extracorporeal membrane oxygenation], except at a more efficient rate and potentially with less anticoagulation because of the geometry of the membranes. Another project that I’m working with our lab is an artificial pancreas device, which uses nanopore membranes to serve as an immune-isolating barrier to prevent white blood cells and various inflammatory markers from injuring transplanted islet cells for Type I Diabetes.
What is your role in these projects?
All these devices will require blood to run through them, and our lab needed someone with some technical know-how [in surgery]. For the bioartificial kidney, I am developing and running the large animal studies to prove their effectiveness before we can implant the device in humans. We’re trying to figure out how we can best optimize our device to be bio- and hemo-compatible, answering questions such as: How we will we connect it to a blood vessel? What is the appropriate level of anticoagulation? What effects will our device have on the animal, and ultimately our human patient? Our goal is to anticipate as many problems as possible, and come up with solutions that will help us make a safe, reliable and effective device.
Any highlights of your Surgical Innovations experience so far?
The opportunity to work directly with Dr. Michael Harrison, one of the truly groundbreaking individuals in device innovation and pediatric surgery, has been a particular highlight for me. He essentially developed fetal surgery here at UCSF, and there are many devices and instruments that are testaments to his career as an innovator. Having the opportunity to sit across from him during our weekly Pediatric Device Consortium meetings allows one to recognize the genius that is his mind, as well as to develop an appreciation for someone who’s willing to continually ask questions and be driven to come up with solutions.
Learning is a life-long process, and I think it’s the same for innovation. Dr. Harrison has never been one for accepting the status quo, and that’s why he’s still closely involved with device innovation well after his retirement from operating. Getting to interact with him is a true blessing, and you could only have this sort of resource at UCSF.
Are there specific skills that enable successful collaboration for device innovation?
Interpersonal skills are essential. To communicate effectively, you need some level of understanding regarding what the other person does, whether it’s an engineer, clinician or someone from industry.
True innovation happens when team members develop relationships with one another. Engineers bring their know-how, explaining different ways a problem could be approached. They ask, “Would this work?” And you as a clinician have the opportunity to say, “That’s sounds great, but realistically, you can’t bring that equipment into a clinical setting.” From there you have this continuously iterative process, whether it’s for a device, an idea regarding digital health, or a software application.
For example, one of our transplant surgeons heard about a new optical technology and thought we could use it to gauge tissue perfusion, which is important for ensuring that a new anastomosis that you create will have adequate blood supply to heal and not fall apart due to ischemia. When we approached one of the engineers with this idea, he immediately recognized the limitations of that technology and was able to provide us with an alternative that we are currently investigating. Our original idea could have concluded in a dead end months down the line, but we were fortunate to receive the engineer’s opinion early in the process to help us go down a more technically feasible route.
Anything else you’d like to say?
There is a growing understanding that becoming an academic surgeon doesn’t necessarily require that you do basic science research. Surgical innovation is just one of these [other] pathways. I feel fortunate to be at an institution that is willing to engage my interests and develop them further. UCSF respects the need for this pathway, providing us with the necessary coursework and training that will allow us to take an idea and move it forward.
– Elizabeth Chur