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Alice U, Kanmounye US, Jumbam DT, Ayala R. Global Surgery Speaker Series: An Education and Advocacy Resource for the Advancement of Global Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6144. [PMID: 39258279 PMCID: PMC11387043 DOI: 10.1097/gox.0000000000006144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/24/2024] [Indexed: 09/12/2024]
Affiliation(s)
- Umutoni Alice
- From the Department of Policy and Advocacy, Operation Smile, Norfolk, Va
| | | | - Desmond T Jumbam
- From the Department of Policy and Advocacy, Operation Smile, Norfolk, Va
| | - Ruben Ayala
- From the Department of Policy and Advocacy, Operation Smile, Norfolk, Va
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Johnston PF, Bloom L, Sifri ZC. Insight Into the Clinical Practices of US-based Surgical Nongovernmental Organizations. J Surg Res 2024; 301:578-583. [PMID: 39053172 DOI: 10.1016/j.jss.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 04/18/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION A growing sector of humanitarian surgical nongovernmental organizations (NGOs) is providing care in low- and middle-income countries. Minimal data exists regarding this extremely heterogeneous community. This study aims to describe the demographics and clinical practices of surgical NGOs. We hypothesize there are identifiable attributes of such organizations which correlate with success. METHODS A survey was sent to 83 US-based surgical NGOs directly providing general or subspecialty surgical care in low- and middle-income countries. Further information was obtained from organizations' websites. Descriptive statistics were performed to analyze organizational attributes and define protocol-driven practices. RESULTS Thirty NGOs (36%) responded, averaging 20 ± 11 y of operation. Annually, US humanitarian surgical organizations performed a wide range of operations (10-15,000) with 52% performing fewer than 200 operations per year. Sixty-seven percent of responders were classified as strongly protocol-driven. Only twenty percent reported deviation from standard US practice occurs often or very often, most commonly in pain management (18%), preoperative workup (16%), and operative technique (16%). CONCLUSIONS To our knowledge, this is the first effort to describe the characteristics and clinical practices of the humanitarian surgical sector. There exists a wide scope of clinical practice among responding surgical NGOs, however mostly consistent with US standards, with a prevalance of protocol-driven clinical approach. Developing consensus-based protocols may help standardize and improve quality of care for surgical NGOs.
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Affiliation(s)
| | - Laura Bloom
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Richard K, Sanchez R, Amado B, Lubner R, Niconchuk J, Chen H, Phillips J, Kynes M, Belcher RH. Pediatric Otolaryngology Short-Term Mission Outcomes at a Surgical Mission Hospital in Guatemala. Otolaryngol Head Neck Surg 2024; 170:252-259. [PMID: 37466003 DOI: 10.1002/ohn.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes. STUDY DESIGN Retrospective cohort study. SETTING Guatemalan surgery center is called the Moore Center. METHODS Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. RESULTS A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. CONCLUSION This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.
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Affiliation(s)
- Kelsey Richard
- Medical Doctorate Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Barbara Amado
- Centro Quirugico Pediatrico Moore, Guatemala City, Guatemala
| | - Rory Lubner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Niconchuk
- Department of Anesthesia, Pediatric Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Phillips
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
| | - Matthew Kynes
- Department of Anesthesia, Pediatric Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan H Belcher
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
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Yan A, Castellanos SL, Chao AH. Plastic Surgical Outreach to Low- and Middle-income Countries and Global Health Priorities: An Analysis of 96 Nongovernmental Organizations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5477. [PMID: 38148941 PMCID: PMC10749701 DOI: 10.1097/gox.0000000000005477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023]
Abstract
Background Conditions that are treated by surgery constitute a significant portion of the global burden of disease. In low- and middle-income countries (LMICs), allocation of resources toward the most cost-effective surgical procedures (essential surgery) and care delivery platforms is critical. Nongovernmental organizations (NGOs) and the plastic surgeons who work with them play a significant role in plastic surgical outreach to LMICs. However, it is unknown whether their work aligns with existing global public health recommendations. Methods A previously established internet-based methodology was used to identify plastic surgical NGOs. Through direct correspondence with NGOs and publicly available data, plastic surgical NGOs were cataloged with respect to the subspecialty areas of plastic surgery performed, care delivery platforms, and geographic sites. These results were then compared with the existing global public health recommendations. Results A total of 96 NGOs met inclusion criteria. The most common subspecialty area was cleft surgery (80.3%), followed by pediatric plastic surgery (46.9%). No NGOs used a continuous care delivery platform. Instead, all NGOs used an intermittent model through short-term surgical missions, of which 62.8% used a nonrotating care model and returned to the same site(s) annually, whereas 37.2% used a rotating care model. Conclusions Most NGOs perform cleft surgery, an area considered essential surgery, and thus, collectively, the work of NGOs largely aligns with global public health priorities. However, there is room for improvement for both the types of procedures performed and the care delivery platforms to provide the most cost-effective and sustainable care.
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Affiliation(s)
- Allison Yan
- From Ohio State University College of Medicine, Columbus, Ohio
| | | | - Albert H. Chao
- Department of Plastic and Reconstructive Surgery, Ohio State University, Columbus, Ohio
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Shapiro LM, Welch J, Leversedge C, Katarincic JA, Leversedge FJ, Dyer GSM, Kozin SH, Fox PM, McCullough M, Agins B, Kamal RN. Capacity Assessment Tool to Promote Capacity Building in Global Orthopaedic Surgical Outreach. J Bone Joint Surg Am 2023; 105:1295-1300. [PMID: 37319177 DOI: 10.2106/jbjs.23.00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND A growing number of nongovernmental organizations from high-income countries aim to provide surgical outreach for patients in low- and middle-income countries in a manner that builds capacity. There remains, however, a paucity of measurable steps to benchmark and evaluate capacity-building efforts. Based on a framework for capacity building, the present study aimed to develop a Capacity Assessment Tool for orthopaedic surgery (CAT-os) that could be utilized to evaluate and promote capacity building. METHODS To develop the CAT-os tool, we utilized methodological triangulation-an approach that incorporates multiple different types of data. We utilized (1) the results of a systematic review of capacity-building best practices in surgical outreach, (2) the HEALTHQUAL National Organizational Assessment Tool, and (3) 20 semistructured interviews to develop a draft of the CAT-os. We subsequently iteratively used a modified nominal group technique with a consortium of 8 globally experienced surgeons to build consensus, which was followed by validation through member-checking. RESULTS The CAT-os was developed and validated as a formal instrument with actionable steps in each of 7 domains of capacity building. Each domain includes items that are scaled for scoring. For example, in the domain of partnership, items range from no formalized plans for sustainable, bidirectional relationships (no capacity) to local surgeons and other health-care workers independently participating in annual meetings of surgical professional societies and independently creating partnership with third party organizations (optimal capacity). CONCLUSIONS The CAT-os details steps to assess capacity of a local facility, guide capacity-improvement efforts during surgical outreach, and measure the impact of capacity-building efforts. Capacity building is a frequently cited and commendable approach to surgical outreach, and this tool provides objective measurement to aid in improving the capacity in low and middle-income countries through surgical outreach.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
| | - Jessica Welch
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
| | - Chelsea Leversedge
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
| | | | | | - George S M Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Scott H Kozin
- Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | | | - Bruce Agins
- Department of Epidemiology & Biostatistics, University of California-San Francisco, San Francisco California
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
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Henry JC, Wong LY, Reyes AM, Jin JZ, Ferguson MK, Yip CH, Hill A. Achieving global surgical excellence: an evidence-based framework to guide surgical quality improvement programs in low and middle income countries. FRONTIERS IN HEALTH SERVICES 2023; 3:1096144. [PMID: 37609518 PMCID: PMC10441221 DOI: 10.3389/frhs.2023.1096144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
Objectives There is a lack of evidence-based guidelines for enhancing global surgical care delivery. We propose a set of recommendations to serve as a framework to guide surgical quality improvement and scale-up initiatives in low and middle income countries (LMICs). Methods From January-December 2019, we reviewed the available literature and their application toward LMIC settings. The first initiative was the establishment of Best Practices Recommendations intended to summarize best-level evidence around quality improvement processes that have shown to decrease morbidity and mortality in LMICs. The GRADE level of evidence and strength of the recommendation were assigned in accordance with the WHO handbook for guidelines development. The second initiative was the scale-up of principles and practices by establishing international expert consensus on the optimal organization of surgical services in LMICs using a modified Delphi methodology. Results Recommendations for three topic areas were established: reducing surgical site infections, improving quality of trauma systems, and interventions to reduce maternal and perinatal mortality. 27 studies were included in a quantitative synthesis and meta-analysis for interventions reducing surgical site infections, 27 studies for interventions improving the quality of trauma systems, and 14 studies for interventions reducing maternal and perinatal mortality. Using Delphi methodology, an international expert panel established consensus that district hospitals should place the highest priority on developing surgical services for low complexity, high volume conditions. At the national level, emergency and essential surgical care should be integrated within national Universal Health Coverage frameworks. Conclusions This project fills a critical cap in the rapidly developing field of global surgery: gathering evidence-based, practical, and cost-effective solutions that will serve as a guide for the efficient planning and allocation of resources necessary to promote quality and safe essential surgical services in LMICs.
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Affiliation(s)
- Jaymie Claire Henry
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, United States
| | - Ana M. Reyes
- Department of Surgery, University of Miami/Jackson Health System, Miami, FL, United States
| | - James Z. Jin
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Mark K. Ferguson
- Department of Cardiothoracic Surgery, University of Chicago, Chicago, IL, United States
| | - Cheng Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Andrew Hill
- Department of Surgery, University of Miami/Jackson Health System, Miami, FL, United States
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
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Welch JM, Kamal RN, Chatterjee M, Shapiro LM. Rates, Barriers, and Facilitators of Outcome Collection on Hand Surgery Outreach to Low- and Middle-Income Countries. Hand (N Y) 2023; 18:875-884. [PMID: 35048744 PMCID: PMC10336811 DOI: 10.1177/15589447211072200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Global outreach to low- and middle-income countries (LMICs) continues to grow in an effort to improve global health. The practice of quality measurement is empirically lacking from surgical outreach trips to LMICs, which may limit the safety and quality of care provided. Using convergent mixed-methods, we aimed to: (1) identify and evaluate barriers and facilitators to outcome measure collection; and (2) report the sample rate of such collection on hand surgery outreach trips to LMICs. METHODS Surgeons and administrators involved in hand surgery outreach trips completed a survey regarding rates of outcome measure collection and a semi-structured interview to explore barriers and facilitators of outcome collection. Survey data were reported descriptively. Interviews were recorded and transcribed, and excerpts were categorized according to the Pettigrew framework for strategic change (content, process, and context). Results were combined through convergent mixed-methods analysis. RESULTS Thirty-three participants completed the survey, and 21 participated in interviews. Rates of collection were the most common for total case number (83%) and patient mortality (65%). Longitudinal outcomes (eg, patient follow-up or time away from work) were less frequently recorded (9% and 4%, respectively). Content analysis revealed barriers related to each domain of the Pettigrew framework. CONCLUSIONS This analysis demonstrates low levels of outcome collection on outreach trips and identifies priority areas for improvement. Developing context-specific solutions aimed at addressing barriers (eg, resource/database availability) and promoting facilitators (eg, collaborative relationships) may encourage higher rates of collection, which stands to improve patient safety, quality of care, and accountability when conducting outreach trips to LMICs.
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Argaw S, Genetu A, Vervoort D, Agwar FD. The state of cardiac surgery in Ethiopia. JTCVS OPEN 2023; 14:261-269. [PMID: 37425461 PMCID: PMC10328795 DOI: 10.1016/j.xjon.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 07/11/2023]
Abstract
Objectives Six billion people globally do not have access to cardiac surgical care. In this study, we aimed to describe state of cardiac surgery in Ethiopia. Methods Data on status of local cardiac surgery collected from surgeons and cardiac centers. Medical travel agents were interviewed about number of cardiac patients who were assisted to travel abroad for surgery. Historical data and number of patients treated by non-governmental organizations were collected via interviews and by accessing existing databases. Results Patients access cardiac care via 3 avenues: mission-based, abroad referral, and care at local centers. Traditionally, the first 2 have been the main mode of access; however, since 2017, an entirely local team has begun performing heart surgery in the country. Currently, surgical cardiac care is provided at 4 local centers: a charity organization, a tertiary public hospital, and 2 for-profit centers. Procedures at the charity center are provided for free, whereas in others, patients mostly pay out of pocket. There are only 5 cardiac surgeons for 120 million people. More than 15,000 patients are on waitlist for surgery, mainly because of lack of consumables and limited numbers of centers and workforce. Conclusions There is a change in the trend from non-governmental mission- and referral-based care toward care in local centers in Ethiopia. The local cardiac surgery workforce is growing but still insufficient. The number of procedures is limited with long wait lists due to limited workforce, infrastructure, and resources. All stakeholders should work on training more workforce, providing consumables, and creating feasible financing schemes.
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Affiliation(s)
- Salem Argaw
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Abraham Genetu
- Department of Surgery, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dominique Vervoort
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
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Shapiro LM, Welch JM, Chatterjee M, Katarincic JA, Leversedge FJ, Dyer GSM, Fufa DT, Kozin SH, Chung KC, Fox PM, Chang J, Kamal RN. A Framework and Blueprint for Building Capacity in Global Orthopaedic Surgical Outreach. J Bone Joint Surg Am 2023; 105:e10. [PMID: 35984012 PMCID: PMC10760412 DOI: 10.2106/jbjs.22.00353] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nongovernmental organizations (NGOs) from high-income countries provide surgical outreach for patients in low and middle-income countries (LMICs); however, these efforts lack a coordinated measurement of their ability to build capacity. While the World Health Organization and others recommend outreach trips that aim to build the capacity of the local health-care system, no guidance exists on how to accomplish this. The objective of this paper is to establish a framework and a blueprint to guide the operations of NGOs that provide outreach to build orthopaedic surgical capacity in LMICs. METHODS We conducted a qualitative analysis of semistructured interviews with 16 orthopaedic surgeons and administrators located in 7 countries (6 LMICs) on the necessary domains for capacity-building; the analysis was guided by a literature review of capacity-building frameworks. We subsequently conducted a modified nominal group technique with a consortium of 10 U.S.-based surgeons with expertise in global surgical outreach, which was member-checked with 8 new stakeholders from 4 LMICs. RESULTS A framework with 7 domains for capacity-building in global surgical outreach was identified. The domains included professional development, finance, partnerships, governance, community impact, culture, and coordination. These domains were tiered in a hierarchical system to stratify the level of capacity for each domain. A blueprint was developed to guide the operations of an organization seeking to build capacity. CONCLUSIONS The developed framework identified 7 domains to address when building capacity during global orthopaedic surgical outreach. The framework and its tiered system can be used to assess capacity and guide capacity-building efforts in LMICs. The developed blueprint can inform the operations of NGOs toward activities that focus on building capacity in order to ensure a measured and sustained impact.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Jessica M Welch
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Maya Chatterjee
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | | | | | - George S M Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Duretti T Fufa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Scott H Kozin
- Shriners Hospitals for Children–Philadelphia, Philadelphia, Pennsylvania
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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Leversedge C, Castro S, Appiani LMC, Kamal R, Shapiro L. Patient Follow-up After Orthopaedic Outreach Trips - Do We Know Whether Patients are Improving? World J Surg 2022; 46:2299-2309. [PMID: 35764890 PMCID: PMC9436850 DOI: 10.1007/s00268-022-06630-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 12/21/2022]
Abstract
Background The burden of traumatic musculoskeletal injuries falls greatest on low- and middle-income countries (LMICs). To help address this burden, organizations host over 6,000 outreach trips annually, 20% of which are orthopaedic. Monitoring post-surgical outcomes is critical to ensuring care quality; however, the implementation of such monitoring is unknown. The purpose of this review is to identify published follow-up practices of short-term orthopaedic surgery outreach trips to LMICs.
Methods We completed a systematic review of Pubmed, Web of Science, EMBASE, and ProQuest following PRISMA guidelines. Follow-up method, rate, duration, and types of outcomes measured along with barriers to follow-up were collected and reported. Results The initial search yielded 1,452 articles, 18 of which were eligible. The mean follow-up time was 5.4 months (range: 15 days-7 years). The mean follow-up rate was 65.8% (range: 22%-100%), the weighted rate was 57.5%. Fifteen studies reported follow-up at or after 3 months while eight studies reported follow-up at or after 9 months. Fifteen studies reported follow-up in person, three reported follow-up via phone call or SMS. Outcome reporting varied among mortality, complications, and patient-reported outcomes. The majority (75%) outlined barriers to follow-up, most commonly noting transportation and costs of follow-up to the patient. Conclusions There is minimal and heterogeneous public reporting of patient outcomes and follow-up after outreach trips to LMICs, limiting quality assessment and improvement. Future work should address the design and implementation of tools and guidelines to improve follow-up as well as outcome measurement to ensure provision of high-quality care. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06630-w.
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Affiliation(s)
- Chelsea Leversedge
- Stanford School of Medicine Department of Orthopaedic Surgery, VOICES Health Policy Research Center, 450 Broadway St, Redwood City, CA 94306 USA
| | - Samuel Castro
- Stanford School of Medicine, 291 Campus Drive, Palo Alto, CA 94305 USA
| | - Luis Miguel Castro Appiani
- Department of Orthopaedic Surgery, Hospital Clinica Biblica Aveinda, 14 Calle 1 Y Central, San José, Costa Rica USA
| | - Robin Kamal
- Stanford School of Medicine Department of Orthopaedic Surgery, VOICES Health Policy Research Center, 450 Broadway St, Redwood City, CA 94306 USA
| | - Lauren Shapiro
- School of Medicine Department of Orthopaedics, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
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Paratz E, Maurays J, Flavio R, Appelbe A, Bayley N. Doctors with borders: the impact of international border closures on Timorese people who need cardiac procedures. Med J Aust 2022; 216:583-584. [DOI: 10.5694/mja2.51491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022]
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Lyons S, Xu AL, Durand WM, Patel S, Oni JK, Babu JM. The Impact of the COVID-19 Pandemic on the Functionality of International Surgical Volunteer Organizations. Front Surg 2022; 9:868023. [PMID: 35465436 PMCID: PMC9019131 DOI: 10.3389/fsurg.2022.868023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSurgical volunteer organizations have been severely limited during the ongoing coronavirus disease pandemic. Our purpose was to identify obstacles to surgical volunteer organizations secondary to COVID-19 and their responses.MethodsForty-one surgical volunteer organizations participated in a web-based survey (156 invited, 26% response rate). Respondents were separated into two groups: low donations surgical volunteer organizations (≤50% donations of previous year; n = 17) and high donations surgical volunteer organizations (≥75%; n = 24). Univariate analyses were used to compare the two cohorts.ResultsOf responding surgical volunteer organizations, 34 (83%) were unable to maintain full functionality due to COVID-19; 27% of high donations vs. 0% of low donations surgical volunteer organizations (p = 0.02). The three leading obstacles were finances/donations (78%), fewer volunteers (38%), and inadequate personal protective equipment (30%). In response, 39% of surgical volunteer organizations developed novel E-volunteering opportunities. For support, 85% of surgical volunteer organizations suggested monetary donations, 78% promotion through social media platforms, and 54% donation of personal protective equipment.ConclusionThe majority of surgical volunteer organizations were unable to maintain full functionality due to stressors caused by COVID-19, including limitations on finances, volunteers, and personal protective equipment.
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Affiliation(s)
- Spencer Lyons
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Amy L. Xu
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Amy L. Xu
| | - Wesley M. Durand
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, United States
| | - Shyam Patel
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Julius K. Oni
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, United States
| | - Jacob M. Babu
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, United States
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Chao AH, McAllister JR. Reconstructive surgery outreach to low- and middle-income countries: An interdisciplinary analysis of 131 non-governmental organizations. J Glob Health 2022; 12:04002. [PMID: 35186281 PMCID: PMC8822145 DOI: 10.7189/jogh.12.04002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A significant portion of surgical aid to low- and middle-income countries (LMICs) is provided by non-governmental organizations (NGOs) in concert with surgeons, but little is known about the overall scope of this work or how it corresponds to indicators typically used to guide developmental aid distribution. The objective of this study was to characterize and investigate the collective efforts of NGOs providing reconstructive surgical aid to LMICs. Methods An interdisciplinary approach was taken drawing from political science to examine this issue in reconstructive surgery. NGOs providing reconstructive surgical aid were identified, and then catalogued with respect to the LMICs they serve. LMICs were characterized using 28 variables in 6 domains based on contemporary developmental theory. Univariate and multivariate regression analyses were performed. Results A total of 131 reconstructive surgery NGOs were identified serving 718 sites in 136 LMICs. Univariate analysis found that LMICs that were more frequent recipients of aid were more populous (P < 0.001), had lower ‘Hospital Beds Density’ (P = 0.001), and had higher rates of ‘Mortality by Injury’ (P = 0.001). Multivariate regression analysis identified population as the sole predictor among all indicators analyzed (95% confidence interval (CI) = 1.154 to 1.469; P = 0.001). Conclusions The distribution of reconstructive surgical aid by NGOs is guided most by population, but not other characteristics traditionally used to guide aid distribution. Greater coordination and data-sharing among NGOs is recommended to optimize outreach efforts.
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Affiliation(s)
- Albert H Chao
- Ohio State University, Department of Reconstructive Surgery, Columbus, Ohio, USA
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Corbally MT. The role of registered charities in the delivery of global surgery in low- and middle-income countries - a personal experience. Surgeon 2021; 20:41-47. [PMID: 34930698 DOI: 10.1016/j.surge.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
The world's resources are unequally divided. Investment in healthcare in Low- and Middle-Income Countries (LMICs) has traditionally involved vertical public health strategies with little emphasis on the delivery of safe and effective surgery and anesthesia. The past 20 years has witnessed greater awareness of the numbers of people who have no access to surgery, the morbidity and mortality of such limited access, and the cost to the individual and society if a solution is not found. Global surgery has become a hot topic and The Millennium Development Goals (MDG) and the Sustainable Development Goals (SDG) have underlined the importance of surgery in national health care plans. The harsh metrics reported by the Lancet Commission has framed the problem in more concrete terms and as of today, over 5 billion people lack access to safe surgery, over 143 million extra surgeries are needed annually to affect the imbalance and more than 15,000 children die each day in Sub Saharan Africa and Southeast Asia from preventable disease, including the lack of access to safe surgery. Horizontal integrated healthcare that includes surgical provision is the new norm, but its introduction is expensive and will need time. The ambition of universal healthcare access for all people (SDG) with a corresponding reduction in child and maternal mortality will be difficult for most governments. Altruistic, Non-Governmental Organizations (NGOs) are ideally placed to assist this goal but must introduce changes in practice to include onsite and off-site training, broad partnerships with other NGOs and academic bodies and greater advocacy with governments to ensure sustainability. NGOs should work in concert with local agencies, hospitals and governments to meet local needs.
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Affiliation(s)
- Martin T Corbally
- Royal College of Surgeons - Medical University Bahrain, King Hamad University Hospital, Kingdom of Bahrain.
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15
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Goettke E, Coultas C, White M, Leather AJM. Conceptualising sustainability in the surgical work of non-governmental organisations in low and middle-income countries : a scoping review protocol. BMJ Open 2021; 11:e048046. [PMID: 34911707 PMCID: PMC8679068 DOI: 10.1136/bmjopen-2020-048046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sustainability remains poorly defined in global surgery, yet is, nevertheless, crucial to the work of non-governmental organisations (NGOs) in low- and middle-income countries (LMICs) aimed at strengthening access to, and quality of, surgical and anaesthesia care. The objective of this protocol is to outline a scoping review that maps what is known in the literature about sustainability in NGO surgical work in LMICs. METHODS The application of Arksey and O'Malley's six-stage methodological framework is described: identifying research questions; identifying relevant publications; selecting publications; charting the data; reporting results; and stakeholder consultation. The review will include all study designs, as well as editorials, commentaries, sources of unpublished studies and grey literature. Three electronic databases will be searched. Two reviewers will use predefined and iteratively refined selection criteria based on the 'Population-Concept-Context' framework to independently screen titles and abstracts of citations from the search. Disagreements will be resolved together by the reviewers. Full-text screening will also be carried out independently by two reviewers. Disagreements at this stage will be resolved with a third party. The search strategy for grey literature will include searching in ProQuest Dissertations and Theses and the websites listed in a surgical NGO database. Further relevant citations will be identified by screening the reference lists of the included papers. ETHICS AND DISSEMINATION This review will undertake a secondary analysis of data already collected and does not require ethical approval. The results will be disseminated through journals and conferences targeting surgical NGO stakeholders and global health academics.
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Affiliation(s)
- Emma Goettke
- Population Health Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Clare Coultas
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michelle White
- Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew J M Leather
- Population Health Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
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16
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Dawson S, Jackson D, Elliott D. Understanding the motivation of nurses volunteering for non-disaster humanitarian service. Collegian 2021. [DOI: 10.1016/j.colegn.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Hubbard RM, Buchbinder LB, Tobias JD, Zabala LM, Latham GJ, Gautam NK. The Anesthesiologist's Perspective and Experience in Global Congenital Cardiac Surgery: Results of a Survey of the Congenital Cardiac Anesthesia Society Membership. Semin Cardiothorac Vasc Anesth 2021; 26:27-31. [PMID: 34743642 DOI: 10.1177/10892532211047641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anesthesiologists are important components of volunteer teams which perform congenital cardiac surgery in low-resource settings throughout the world, but limited data exist to characterize the nature and breadth of their work. A survey of Congenital Cardiac Anesthesia Society (CCAS) members was conducted with the objective of understanding the type of voluntary care being provided, its geographic reach, the frequency of volunteer activities, and factors which may encourage or limit anesthesiologists' involvement in this work. The survey was completed by 108 participants. Respondents reported a total of 115 volunteer trips during the study period, including work in 41 countries on 5 continents. Frequent motivating factors to begin volunteering included invitations from charitable groups, encouragement from senior colleagues, and direct connections to individual locations. Discouraging factors included familial responsibilities, the need to use vacation time, and a lack of support from home institutions. The year 2020 saw a marked decrease in reported volunteer activity, and respondents reported multiple pandemic-related factors which might discourage future volunteer activities. The results of this study demonstrate the global reach of anesthesiologists in providing care for children having cardiac surgery. It also offers insights into the challenges faced by interested individuals, many of which are related to a lack of institutional support. These challenges have only mounted under the COVID-pandemic, leading to a dramatic downturn in volunteer activities. Finally, the survey reinforces the need for better coordination of volunteer activities to optimize clinical impact.
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Affiliation(s)
- Richard M Hubbard
- 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Joseph D Tobias
- 550012Nationwide Children's Hospital & Ohio State University, Columbus, OH, USA
| | - Luis M Zabala
- 2755University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX, USA
| | - Gregory J Latham
- Seattle Children's Hospital & University of Washington Medical Center, Seattle, WA, USA
| | - Nischal K Gautam
- 12340University of Texas Health Science Center at Houston, Houston, TX, USA
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18
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Philanthropy in Plastic Surgery: Best Practices and Measuring Impact. Plast Reconstr Surg 2021; 148:687-694. [PMID: 34432708 DOI: 10.1097/prs.0000000000008280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Philanthropy in plastic surgery supports research, clinical care, academic infrastructure, and education in the United States and internationally. Plastic surgeons have opportunities to innovatively address unmet needs in their local and global communities by forming philanthropic nonprofit organizations. METHODS The authors queried three national philanthropic databases (Charity Navigator, Guidestar, and ProPublica) for Internal Revenue Service 990 form tax return information related to philanthropic plastic surgery organizations. The authors analyzed the financial information publicly available about current plastic surgery philanthropic organizations and their funding sources. RESULTS Seventy-three federally tax-exempt groups identified plastic surgery as their primary area of work to the Internal Revenue Service in 2019, and 52 of those organizations said they engaged in clinical and/or educational philanthropy.3 In 2017, a total of $158.5 million was donated to these groups in cash and noncash donations including equipment and time. Analyses of 6 years (2013 to 2018) of tax records from groups that provide plastic surgery clinical, research, or educational philanthropy reveal that government grants provide very little funding for this work. Eighty-six percent of money raised for these groups in 2017 was collected by means of direct donations. Money obtained from fundraising events contributed 2 percent to their total monies raised in 2017 on average and 8 percent came from noncash gifts. CONCLUSIONS A broad body of academic research is reviewed here that guides best practices and measuring a group's impact and outcomes. The details of a philanthropic group's organization and finances directly influence the impact of their work and, as such, are worthy of our sustained attention.
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Vervoort D, Guetter CR, Munyaneza F, Trager LE, Argaw ST, Abraham PJ, Dayan V. Non-Governmental Organizations Delivering Global Cardiac Surgical Care: A Quantitative Impact Assessment. Semin Thorac Cardiovasc Surg 2021; 34:1160-1165. [PMID: 34407434 DOI: 10.1053/j.semtcvs.2021.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Abstract
In low- and middle-income countries (LMICs), 93% of the population lacks safe, timely, and affordable access to cardiac surgical care when needed. As countries slowly build or expand local, independent cardiac centers, non-governmental organizations (NGOs) partially bridge the gap in cardiac surgical care delivery in LMICs. However, little is known about the current scope of cardiac NGOs. Here, we perform an analysis of active NGOs involved with the delivery of cardiac surgical services in LMICs or for patients from LMICs. Cardiac surgery NGOs were identified from medical literature, established NGO databases, and Google Scholar searches. The search was performed between December 2019 and May 2020. NGOs whose websites were not updated or described missions or projects taking place no later than 2015 were considered inactive. Eighty-six NGOs are actively providing cardiac surgery services in LMICs or treating patients from LMICs. Five NGOs performed adult cardiac surgery only, 56 performed pediatric cardiac surgery only, and 25 performed both adult and pediatric cardiac surgery. NGOs originated from 23 different countries and were operational in a total of 111 countries, 96 of them being LMICs. Fifty-three NGOs reported data on annual surgical volume, of which half performed less than 50 operations per year. NGOs effectively address the burden of cardiac surgical disease in LMICs and contribute to local capacity-building. Increased, more detailed, and standardized reporting of the impact and outcomes of NGOs is necessary to better understand annual cardiac surgical volume and to support local centers working towards independent services.
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Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Camila R Guetter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Faustin Munyaneza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lena E Trager
- School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Salem T Argaw
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Peter J Abraham
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victor Dayan
- Centro Cardiovascular Universitario, Hospital de Clinicas, Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
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20
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Global Volunteering in Orthopaedics: Availability and Implementation Considerations. J Am Acad Orthop Surg 2021; 29:139-147. [PMID: 33252550 DOI: 10.5435/jaaos-d-20-00740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/10/2020] [Indexed: 02/01/2023] Open
Abstract
The World Health Organization describes traumatic injuries as a "neglected epidemic" in developing countries, accounting for more deaths annually than HIV/AIDS, malaria, and tuberculosis combined. Low- and middle-income countries rely on volunteer assistance to address the growing surgical disease burden of traumatic injuries. Efforts to increase the availability of international electives for orthopaedic trainees can help with the short-term need for surgical personnel abroad and facilitate sustainability through capacity building, maximizing long-term benefits for all parties. The volunteer invariably benefits from this cross-cultural experience with many citing improved skills in communication, clinical diagnostics, appreciation of equality and diversity, and cost-consciousness. A consolidated discussion regarding barriers and implementation strategies can assist interested individuals and institutions plan for future volunteering endeavors.
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21
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Botman M, Hendriks T, Keetelaar A, Smit F, Terwee C, Hamer M, Nuwass E, Jaspers M, Winters H, Corlew S. From short-term surgical missions towards sustainable partnerships. A survey among members of foreign teams. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Commander SJ, Ellis D, Williamson H, Grabski D, Sallah AY, Derbew M, Fitzgerald TN. Predictors of Burnout and Depression in Surgeons Practicing in East, Central, and Southern Africa. J Surg Res 2020; 255:536-548. [PMID: 32640405 DOI: 10.1016/j.jss.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgeons are at risk of burnout and depression, which can lead to medical errors, inefficiency, exhaustion, conflicts, and suicide. Significant challenges exist in sub-Saharan Africa that may increase the prevalence of burnout and depression, but no formal evaluation has identified stressors specific to this environment. METHODS A survey was distributed to all members of the College of Surgeons of East, Central, and Southern Africa (COSECSA). Burnout, depression, and stressors were assessed with validated measures: Maslach Burnout Inventory for Medical Personnel, Patient Health Questionnaire (PHQ) 9, and Holmes-Rahe Life Stress Inventory. RESULTS There were 131 participants (98 African and 33 non-African surgeons). The incidence of moderate to severe depression was 48% (n = 63), and the incidence of burnout was as high as 38% (n = 48). There were no significant differences between African and non-African surgeons in marital status, number of children, partners in practice, or distribution of time. More African surgeons experienced birth of a child (18% versus 3%, P = 0.04) but had less workplace conflict (7.1% versus 10.7%, P = 0.045) than non-African surgeons. African surgeons more consistently felt they were positively influencing others (P = 0.008), enjoyed working with patients (P = 0.009), and were more satisfied (P = 0.04). For all surgeons, predictors of increased PHQ-9 depression were serious professional conflict (P = 0.02), difficulty accessing childcare (P = 0.04), and racial discrimination (P = 0.003). In the Maslach model, predictors of burnout were difficulty accessing childcare (P = 0.05) and denial of promotion based on gender (P = 0.006). CONCLUSIONS Burnout and depression in surgeons practicing in East, Central, and Southern Africa are substantial. Despite significant challenges, African surgeons tended to have a more positive outlook on their work. Improvements can be made to reduce burnout and depression by focusing on work conditions, equality of promotion opportunities, workplace conflict management, childcare support, and increasing the numbers of surgeons in practice.
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Affiliation(s)
| | - Danielle Ellis
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Hannah Williamson
- Duke Cancer Institute Biostatistics Shared Resource, Durham, North Carolina
| | - Dave Grabski
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Milliard Derbew
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina.
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23
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The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2907. [PMID: 32802643 PMCID: PMC7413812 DOI: 10.1097/gox.0000000000002907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Worldwide, many scar contracture release surgeries are performed to improve range of motion (ROM) after a burn injury. There is a particular need in low- and middle-income countries (LMICs) for such procedures. However, well-designed longitudinal studies on this topic are lacking globally. The present study therefore aimed to evaluate the long-term effectiveness of contracture release surgery performed in an LMIC.
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24
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Kudsk-Iversen S, Krouch S, Chu K. The Contribution of Surgical Nongovernmental Organizations to Global Surgical Care: An Estimate of Annual Caseload. JAMA Surg 2020; 155:664-665. [PMID: 32374372 DOI: 10.1001/jamasurg.2020.0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Sophallyda Krouch
- Kampot Provincial Referral Hospital, Sangkat Kampong Bay, Krong Kampot, Kampot Province, Cambodia
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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25
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Kassam SN, Perry JL, Ayala R, Stieber E, Davies G, Hudson N, Hamdan US. World Cleft Coalition International Treatment Program Standards. Cleft Palate Craniofac J 2020; 57:1171-1181. [PMID: 32573279 DOI: 10.1177/1055665620928779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To present preliminary efforts to establish an internationally agreed set of minimum core practice and best practice guidelines, along with overarching principles to promote safe and comprehensive cleft care globally. DESIGN Representatives from 6 national and international organizations collaborated to form a World Cleft Coalition. Representatives met monthly/bimonthly to compile standards for safe, comprehensive, and sustainable cleft care. Outcomes were circulated within each organization and to a small subset of external constituents for feedback. RESULTS A series of overarching principles were established for those involved in International Cleft Treatment Programs, based on the experience of participating organizations. The overarching principles are followed by a structured and detailed Recommended Practice for Ensuring Safe, Comprehensive and Sustainable Cleft Care, which includes minimum core and best practice for the following areas: surgical safety, quality control, patient education, patient selection, patient follow-up, comprehensive care, partnership with the host nations and professionals, training and exchanges for sustainability, and local capacity building. CONCLUSIONS Outcomes aimed to provide a working document to define core principles for safe comprehensive cleft care, while balancing various levels of resources, geographic locations, appropriately trained health care professional specialists, and training limitations. The study highlights the process and benefits to a collaborative international working group not only to establish best practice but also to solicit and engage others in discussion of their experiences with building and supporting safe, high-quality, comprehensive, sustainable, worldwide cleft care.
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Affiliation(s)
- Serena N Kassam
- Dental and Pre-Surgical Division, Global Smile Foundation, Norwood, MA, USA.,Department of Pediatric Dentistry, New York University College of Dentistry, New York, NY, USA.,Clinical Assistant Professor, Division of Pediatric Dentistry, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.,Clinical Attending, Department of Pediatric Dentistry, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, CA, USA
| | - Ruben Ayala
- Operation Smile, Virginia Beach, VA, USA.,The Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (the G4 Alliance), Chicago, IL, USA
| | | | - Gareth Davies
- European Cleft Organisation, Rijswijk ZH, the Netherlands
| | - Nan Hudson
- Transforming Faces, Toronto, Ontario, Canada
| | - Usama S Hamdan
- Global Smile Foundation, Norwood, MA, USA.,Tufts University School of Medicine, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
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Masefield SC, Megaw A, Barlow M, White PCL, Altink H, Grugel J. Repurposing NGO data for better research outcomes: a scoping review of the use and secondary analysis of NGO data in health policy and systems research. Health Res Policy Syst 2020; 18:63. [PMID: 32513183 PMCID: PMC7278191 DOI: 10.1186/s12961-020-00577-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Non-governmental organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas, including the evaluation of health policy and programmes. Methods A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytical approach provided a comprehensive overview and descriptive analyses of the studies that (1) used data produced or collected by or about NGOs; (2) performed secondary analysis of the NGO data (beyond the use of an NGO report as a supporting reference); and (3) analysed NGO-collected clinical data. Results Of the 156 studies that performed secondary analysis of NGO-produced or collected data, 64% (n = 100) used NGO-produced reports (mostly to a limited extent, as a contextual reference or to critique NGO activities) and 8% (n = 13) analysed NGO-collected clinical data. Of these studies, 55% (n = 86) investigated service delivery research topics and 48% (n = 51) were undertaken in developing countries and 17% (n = 27) in both developing and developed countries. NGOs were authors or co-authors of 26% of the studies. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), albeit with some limitations such as inconsistent and missing data. Conclusion We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics such as conflict-affected areas. NGO–academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. The use of NGO data use could enable relevant and timely research in the areas of programme evaluation and health policy and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries.
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Affiliation(s)
- Sarah C Masefield
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom. .,Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.
| | - Alice Megaw
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom
| | - Matt Barlow
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
| | - Piran C L White
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Environment and Geography, University of York, York, YO10 5NG, United Kingdom
| | - Henrice Altink
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of History, University of York, York, YO10 5NH, United Kingdom
| | - Jean Grugel
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
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27
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Čebron U, Honeyman C, Berhane M, Patel V, Martin D, McGurk M. Barriers to Obtaining Informed Consent on Shortterm Surgical Missions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2823. [PMID: 33133898 PMCID: PMC7571941 DOI: 10.1097/gox.0000000000002823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
Short-term surgical missions (STSMs) enable visiting surgeons to help address inequalities in the provision of surgical care in resource-limited settings. One criticism of STSMs is a failure to obtain informed consent from patients before major surgical interventions. We aim to use collective evidence to establish the barriers to obtaining informed consent on STSMs and in resource-limited settings and suggest practical solutions to overcome them. METHODS A systematic review was performed using PubMed and Web of Science databases and following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. In addition to the data synthesized from the systematic review, we also include pertinent data from a recent long-term follow-up study in Ethiopia. RESULTS Of the 72 records screened, 11 studies were included in our review. The most common barrier to obtaining informed consent was a paternalistic approach to medicine and patient education. Other common barriers were a lack of ethics education among surgeons in low-income and middle-income countries, cultural beliefs toward healthcare, and language barriers between the surgeons and patients. Our experience of a decade of reconstructive surgery missions in Ethiopia corroborates this. In a long-term follow-up study of our head-and-neck patients, informed consent was obtained for 85% (n = 68) of patients over a 14-year period. CONCLUSIONS This study highlights the main barriers to obtaining informed consent on STSMs and in the resource-limited setting. We propose a checklist that incorporates practical solutions to the most common barriers surgeons will experience, aimed to improve the process of informed consent on STSMs.
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Affiliation(s)
- Urška Čebron
- From the Department of Hand, Plastic, Reconstructive and Burn Surgery, University of Tübingen, Tübingen, Germany
| | - Calum Honeyman
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Meklit Berhane
- Department of Plastic and Reconstructive Surgery, ALERT Hospital, Addis Ababa, Ethiopia
| | - Vinod Patel
- Department of Oral Surgery, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Dominique Martin
- Department of Plastic & Reconstructive Surgery, University of Bordeaux, Bordeaux, France
| | - Mark McGurk
- Department of Oral & Maxillofacial Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Crockett CJ, Zeigler LN, Kynes JM, Lawson KC, Figueroa LI, Hayes CB, Samen CDK, McQueen KA. A prospective observational study of postoperative follow-ups and outcomes at a nonprofit, internationally supported pediatric surgery center in Guatemala. Paediatr Anaesth 2020; 30:469-479. [PMID: 31976589 DOI: 10.1111/pan.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Global surgical access is unequally distributed, with the greatest surgical burden in low- and middle-income countries, where surgical care is often supplemented by nongovernmental organizations. Quality data from organizations providing this care are rarely collected or reported. The Moore Pediatric Surgery Center in Guatemala City, Guatemala, is unique in that it offers a permanently staffed, freestanding pediatric surgical center. Visiting surgical teams supplement the local permanent staff by providing a broad range of pediatric subspecialty surgical and anesthesia care. AIM The aim of this study was to collect and report the incidence of completed postoperative follow-up visits and outcome measures at this nonprofit, internationally supported surgery center. METHODS De-identified demographic and postoperative outcome data were collected from each routinely scheduled, one-week pediatric surgical mission trip and incorporated into an electronic data collection system. Emphasis was placed on identification of completed postoperative visits and associated perioperative complications. After 27 months of data collection, results were analyzed to identify and quantify trends in patient follow-ups and postoperative outcomes. RESULTS Over 27 months, 1639 pediatric surgical procedures were performed and included in data analysis. The percentage of completed postoperative day-1 follow-up visits was 99.1%, and seven complications were identified out of these 1624 cases (postoperative complication rate of 0.4%). The percentage of completed first postoperative visits after discharge was 93.3%, and 67 complications were identified out of these 1530 cases (postoperative complication rate of 4.4%). CONCLUSION Our data show a high rate of postoperative follow-up visits completed and low perioperative complication rates similar to those of high-income countries. Our data suggest that The Moore Surgery Center model of care offers an alternative to the short-term visiting surgical model by incorporating the local system and allows for improved follow-up, outcomes analysis, and high quality of care.
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Affiliation(s)
- Christy J Crockett
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura N Zeigler
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James M Kynes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katheryne C Lawson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Caleb B Hayes
- Pathology Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Christelle D K Samen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A McQueen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Fabia R, Gallagher J, Wheeler KK, Johnson M, Cadelski K, Armstrong M, Pilato T, Heffernan J, Thakkar RK, Sales S, Giles S, Jeng JC. Efforts to catalogue non-governmental organizations with a role in global burn relief. Burns 2020; 46:804-816. [PMID: 32165028 DOI: 10.1016/j.burns.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Non-governmental organizations (NGOs) have been instrumental in the treatment of traumatic injuries, including burns, particularly in low- and middle-income counties. The purpose of this project was to catalogue burn injury related NGO activities, describe coordinated efforts, and provide insight to burn health care professionals seeking volunteer opportunities. METHODS Eligible burn NGOs were identified through internet searches, literature reviews, and social media. The organizations' websites were reviewed for eligibility and contact was attempted to confirm details. Global health organizations, including the World Health Organization, were consulted for their viewpoints. RESULTS We identified 27 unique NGOs working in the area of burn care in African countries, all with differing missions, capacities, recruitment methods, and ability to respond to disaster. We also describe 14 global NGOs, some of which accept volunteers. Some NGOs were local, while others were headquartered in western countries. CONCLUSIONS To our knowledge, this is the first effort towards the establishment of a Burn-NGO catalogue. Challenges included: frequent shifts in geographical regions supported, lack of collaboration among organizations, availability of public information, and austere environments. We invite collaborators to assist in the creation of a comprehensive, interactive and complete catalogue.
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Affiliation(s)
- Renata Fabia
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - James Gallagher
- Weill Cornell's Medical Center, 1300 York Avenue, New York, NY 10065, USA.
| | - Krista K Wheeler
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Morgan Johnson
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Karol Cadelski
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Megan Armstrong
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Tara Pilato
- Weill Cornell's Medical Center, 1300 York Avenue, New York, NY 10065, USA.
| | - Jamie Heffernan
- Weill Cornell's Medical Center, 1300 York Avenue, New York, NY 10065, USA.
| | - Rajan K Thakkar
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Stephen Sales
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Sheila Giles
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - James C Jeng
- Nathan Speare Regional Burn Center, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA 19013, USA.
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Vervoort D, Meuris B, Meyns B, Verbrugghe P. Global cardiac surgery: Access to cardiac surgical care around the world. J Thorac Cardiovasc Surg 2019; 159:987-996.e6. [PMID: 31128897 DOI: 10.1016/j.jtcvs.2019.04.039] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Cardiovascular disease is the leading cause of death worldwide, responsible for 17.5 million deaths every year, of which 80% occur in low- and middle-income countries. Some 75% of the world does not have access to cardiac surgery when needed because of lack of infrastructure, human resources, and financial coverage. This study aims to map access to cardiac surgery around the world. METHODS A scoping review was done on access to cardiac surgery for an undifferentiated population. Workforce data were collected from the Cardiothoracic Surgery Network database and used to calculate numbers and ratios of adult and pediatric cardiac surgeons to population. RESULTS A total of 12,180 adult cardiac surgeons and 3858 pediatric cardiac surgeons were listed in the Cardiothoracic Surgery Network in August 2017, equaling 1.64 (0-181.82) adult cardiac surgeons and 0.52 (0-25.97) pediatric cardiac surgeons per million population globally. Large disparities existed between regions, ranging from 0.12 adult cardiac surgeons and 0.08 pediatric cardiac surgeons per million population (sub-Saharan Africa) to 11.12 adult cardiac surgeons and 2.08 pediatric cardiac surgeons (North America). Low-income countries possessed 0.04 adult cardiac surgeons and 0.03 pediatric cardiac surgeons per million population, compared with 7.15 adult cardiac surgeons and 1.67 pediatric cardiac surgeons in high-income countries. CONCLUSIONS This study maps the current global state of access to cardiac surgery. Disparities exist between and within world regions, with a positive correlation between a nation's economic status and access to cardiac surgery. Low early mortality rates in low-resource settings suggest the possibility of high-quality cardiac surgery in low- and middle-income countries. There is the need to increase human and physical resources, while focusing on safety, quality, and efficiency to improve access to cardiac surgery for the 4.5 billion people without.
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Affiliation(s)
- Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass.
| | - Bart Meuris
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
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Hendriks TCC, Botman M, Rahmee CNS, Ket JCF, Mullender MG, Gerretsen B, Nuwass EQ, Marck KW, Winters HAH. Impact of short-term reconstructive surgical missions: a systematic review. BMJ Glob Health 2019; 4:e001176. [PMID: 31139438 PMCID: PMC6509599 DOI: 10.1136/bmjgh-2018-001176] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/19/2019] [Accepted: 01/25/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Short-term missions providing patients in low-income countries with reconstructive surgery are often criticised because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low-income and middle-income countries. Methods A systematic review was conducted according to PRISMA guidelines. We searched five medical databases from inception up to 2 July 2018. Original studies of short-term reconstructive surgical missions were included, which reported data on patient safety measurements, health gains of individual patients and sustainability. Data were combined to generate overall outcomes, including overall complication rates. Results Of 1662 identified studies, 41 met full inclusion criteria, which included 48 546 patients. The overall study quality according to Oxford CEBM and GRADE was low. Ten studies reported a minimum of 6 months’ follow-up, showing a follow-up rate of 56.0% and a complication rate of 22.3%. Twelve studies that did not report on duration or follow-up rate reported a complication rate of 1.2%. Fifteen out of 20 studies (75%) that reported on follow-up also reported on sustainable characteristics. Conclusions Evidence on the patient outcomes of reconstructive surgical missions is scarce and of limited quality. Higher complication rates were reported in studies which explicitly mentioned the duration and rate of follow-up. Studies with a low follow-up quality might be under-reporting complication rates and overestimating the positive impact of missions. This review indicates that missions should develop towards sustainable partnerships. These partnerships should provide quality aftercare, perform outcome research and build the surgical capacity of local healthcare systems. PROSPERO registration number CRD42018099285.
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Affiliation(s)
- Thom C C Hendriks
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Botman
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Charissa N S Rahmee
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | | | - Margriet G Mullender
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands
| | | | - Emanuel Q Nuwass
- Department of Surgery, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Klaas W Marck
- Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Henri A H Winters
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
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Abstract
BACKGROUND A substantial global inequality exists between surgical need and the availability of safe, affordable surgical care. Low- and middle-income countries have the greatest burden of untreated surgical disease and addressing this inequity is the goal of the Global Surgery movement. Reconstructive surgery is a fundamental component of Global Surgery as it is central to the appropriate treatment of trauma, burns, wounds, and congenital malformations. The objective of this study was to analyze the most frequently cited articles in the field of global reconstructive surgery to understand the main publication trends. METHODS The 25 most cited articles relating to global reconstructive surgery were identified from all available journals through the Web of Science online database. The following data were extracted from each included article: title, source journal, publication year, total citations, average citations per year, authors, main subject, reconstructive surgery subspecialty, country, and institution of origin. RESULTS The average number of citations per article was 21.7 (median, 19; range, 10-40). Most articles originated from the United States, and only 1 originated from a low-income country. The majority of the articles focused on cleft lip and palate (CLP) (72%), with few articles discussing burns or trauma. The main discussion themes were the quality of care provided in low- and middle-income countries both by local and visiting teams, the burden of diseases in relation to global reconstructive surgery, and the impact of surgical interventions economically and on patients. CONCLUSIONS The number of research articles and citations related to global reconstructive surgery are limited. Despite having a lower incidence than burns or trauma, there is a preponderance of reports focusing on missions treating CLP. These findings suggest that more research funding could be invested in global reconstructive surgery for conditions other than CLP.
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Johnston PF, Kunac A, Gyakobo M, Jalloh S, Livingston DH, Sifri ZC. Short-term surgical missions in resource-limited environments: Five years of early surgical outcomes. Am J Surg 2019; 217:7-11. [DOI: 10.1016/j.amjsurg.2018.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/15/2018] [Indexed: 11/26/2022]
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Innovate Global Plastic and Reconstructive Surgery: Cleft Lip and Palate Charity Database. J Craniofac Surg 2018; 29:937-942. [PMID: 29485559 DOI: 10.1097/scs.0000000000004374] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is an emerging interest in global surgery. The Lancet Commission on Global Surgery recognizes the important role that nongovernmental organizations (NGOs) play in the delivery of cleft lip and/or palate (CLP) surgical care. To better address the unmet burden of surgical disease, the commissioners propose the use of a centralized registry to maximize coordination of global surgical volunteerism efforts. This study aims to create a comprehensive database of CLP organizations. METHODS A systematic search of the following resources was conducted: The Plastic Surgery Foundation, Smile Train, Wikipedia, Google, and lists of surgical NGOs. A secondary review of each organization's website was performed to verify inclusion criteria and to extract data. Organizations were classified as providing surgical or nonsurgical care. RESULTS Thirty-one organizations providing CLP care were reviewed, with 30 that met inclusion criteria. Of the 20 surgical NGOs, 50% use a diagonal approach of international outreach, 40% a vertical one-way approach, and 10% a horizontal approach. All 10 of the nonsurgical NGOs provide care through a horizontal approach. Their offices are distributed across North America (43%), Asia (27%), Europe (23%), and Australia (7%). Forty-three percent of the organizations provide CLP surgeries or services in more than 1 country; 93% do so with a multidisciplinary team. A majority of the organizations established collaborations with host institutions (80%). CONCLUSION To the authors' best knowledge, this database includes the largest collection of CLP organizations. This list will be made publicly available to inform surgical care planning, facilitate collaboration, and promote further research.
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White MC, Randall K, Avara E, Mullis J, Parker G, Shrime MG. Clinical Outcome, Social Impact and Patient Expectation: a Purposive Sampling Pilot Evaluation of Patients in Benin Seven Years After Surgery. World J Surg 2018; 42:1254-1261. [PMID: 29026968 DOI: 10.1007/s00268-017-4296-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Access to affordable and timely surgery is not equitable around the world. Five billion people lack access, and while non-governmental organizations (NGOs) help to meet this need, long-term surgical outcomes, social impact or patient experience is rarely reported. METHOD In 2016, Mercy Ships, a surgical NGO, undertook an evaluation of patients who had received surgery seven years earlier with Mercy Ships in 2009 in Benin. Using purposive sampling, patients who had received maxillofacial, plastics or orthopedic surgery were invited to attend a surgical evaluation day. In this pilot study, we used semi-structured interviews and questionnaire responses to assess patient expectation, surgical and social outcome. RESULTS Our results show that seven years after surgery 35% of patients report surgery-related pain and 18% had sought further care for a clinical complication of their condition. However, 73% of patients report gaining social benefit from surgery, and overall patient satisfaction was 89%, despite 35% of patients saying that they were unclear what to expect after surgery indicating a mismatch of doctor/patient expectations and failure of the consent process. CONCLUSION In conclusion, our pilot study shows that NGO surgery in Benin provided positive social impact associated with complication rates comparable to high-income countries when assessed seven years later. Key areas for further study in LMICs are: evaluation and treatment of chronic pain, consent and access to further care.
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Affiliation(s)
- Michelle C White
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin.
- Great Ormond Street Children's Hospital, London, UK.
| | | | - Esther Avara
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin
| | - Jenny Mullis
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin
| | - Gary Parker
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin
| | - Mark G Shrime
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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White MC, Barki BJ, Lerma SA, Couch SK, Alcorn D, Gillerman RG. A Prospective Observational Study of Anesthesia-Related Adverse Events and Postoperative Complications Occurring During a Surgical Mission in Madagascar. Anesth Analg 2018; 127:506-512. [DOI: 10.1213/ane.0000000000003512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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White MC, Randall K, Alcorn D, Greenland R, Glasgo C, Shrime MG. Measurement of patient reported disability using WHODAS 2.0 before and after surgical intervention in Madagascar. BMC Health Serv Res 2018; 18:305. [PMID: 29703195 PMCID: PMC5923000 DOI: 10.1186/s12913-018-3112-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcomes (PRO) measure the quality of care from the patient's perspective. PROs are an important measure of surgical outcome and can be used to calculate health gains after surgical treatment. The World Health Organisation Disability Assessment Schedule (WHODAS) 2.0 is a PRO used to evaluate pre and post-operative disability across a range of surgical specialities. In this study, Mercy Ships, a non-governmental organisation (NGO), used WHODAS 2.0 to evaluate patient reported disability in 401 consecutive patients in Madagascar. We hypothesised that surgical interventions would decrease pre-operative patient reported disability across a range of specialties (maxillofacial, plastic, orthopaedic, general and obstetric fistula surgery). METHOD WHODAS 2.0 was administered preoperatively by face-to-face interview, and at 3 months post-operatively by telephone. Demographic data, American Society of Anesthesiologists (ASA) physical classification score, duration of surgery, length of hospital stay, and in-hospital post-operative complications were collected from a separately maintained patient database. The primary outcome measure was difference in pre- and post-operative WHODAS 2.0 scores. RESULTS No differences were seen between the two groups in preoperative disability (p = 0.25), ASA score (p = 0.46), or duration of surgery (p = 0.85). At 3 months 44% (176/401) of patients were available for telephone for postoperative evaluation. All had a significant reduction in their disability score from 8.4% to 1.0% (p < 0.001), 17 experienced a post-operative complication, but none had residual disability and there were no deaths. The group lost to follow-up were more likely to be female (65% versus 50%, p < 0.05), were younger (mean age 31 versus 35, p < 0.05), had longer hospital stays (10 versus 4 days, p < 0.001), and were more likely to have experienced post-operative complications (p < 0.05). CONCLUSION This study demonstrates that surgical intervention in a LMIC decreases patient reported disability as measured by WHODAS 2.0.
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Affiliation(s)
- Michelle C White
- Mercy Ships, Department of Medical Capacity Building, Port of Toamasina, Toamasina, Madagascar. .,Mercy Ships, Department of Medical Capacity Building, Port of Cotonou, Cotonou, Benin. .,Great Ormond Street Hospital, London, UK.
| | - Kirsten Randall
- Mercy Ships, Department of Medical Capacity Building, Port of Toamasina, Toamasina, Madagascar.,Mercy Ships, Department of Medical Capacity Building, Port of Cotonou, Cotonou, Benin
| | - Dennis Alcorn
- Mercy Ships, Department of Medical Capacity Building, Port of Toamasina, Toamasina, Madagascar.,Mercy Ships, Department of Medical Capacity Building, Port of Cotonou, Cotonou, Benin
| | - Rachel Greenland
- Mercy Ships, Department of Medical Capacity Building, Port of Toamasina, Toamasina, Madagascar.,Mercy Ships, Department of Medical Capacity Building, Port of Cotonou, Cotonou, Benin
| | - Christine Glasgo
- Mercy Ships, Department of Medical Capacity Building, Port of Toamasina, Toamasina, Madagascar.,Mercy Ships, Department of Medical Capacity Building, Port of Cotonou, Cotonou, Benin
| | - Mark G Shrime
- Mercy Ships, Department of Medical Capacity Building, Port of Toamasina, Toamasina, Madagascar.,Mercy Ships, Department of Medical Capacity Building, Port of Cotonou, Cotonou, Benin.,Program in Global Surgery and Social Change, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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40
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Shrime MG, Hamer M, Mukhopadhyay S, Kunz LM, Claus NH, Randall K, Jean-Baptiste JH, Maevatombo PH, Toh MPS, Biddell JR, Bos R, White M. Effect of removing the barrier of transportation costs on surgical utilisation in Guinea, Madagascar and the Republic of Congo. BMJ Glob Health 2017; 2:e000434. [PMID: 29225959 PMCID: PMC5717941 DOI: 10.1136/bmjgh-2017-000434] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND 81 million people face impoverishment from surgical costs every year. The majority of this impoverishment is attributable to the non-medical costs of care-for transportation, for food and for lodging. Of these, transportation is the largest, but because it is not viewed as an actual medical cost, it is frequently unaddressed. This paper examines the effect on surgical utilisation of paying for transportation. METHODS A hierarchical logistic regression was performed on 2692 patients presenting for surgical care to a non-governmental organisation operating in the Republic of the Congo, Guinea and Madagascar. Controlling for distance from the hospital, age, gender, the need for air travel and time between appointments, the effect of payment for transportation on the surgical no-show rate was evaluated. RESULTS After adjustment for observed confounders, paying for transportation drops the surgical no-show rate by 45% (OR 0.55; 95% CI 0.40 to 0.77; p<0.001). Age, delay between appointments and the number of hours travelled for surgery also predict surgical no-show. For 28% of no-show patients, the cost of transportation from their homes to a nearby predetermined pick-up point remained a barrier, even when transportation from the pick-up point to the hospital was free. CONCLUSION Transportation costs are a significant barrier to surgical care in low-resource settings, and paying for it halves the no-show rate. This finding highlights that decreasing demand-side barriers to surgical care cannot be limited only to the removal of user fees.
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Affiliation(s)
- Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA
| | - Mirjam Hamer
- Paediatric Intensive Care Unit, University Medical Center, Utrecht, The Netherlands
- Mercy Ships, Lindale, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | - Michelle White
- Mercy Ships, Lindale, USA
- Anaesthesia, Great Ormond Street Hospital, London, UK
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Cost-Effectiveness of a Locally Organized Surgical Outreach Mission: Making a Case for Strengthening Local Non-Governmental Organizations. World J Surg 2017; 41:3074-3082. [PMID: 28741201 DOI: 10.1007/s00268-017-4131-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Bolkan HA, van Duinen A, Waalewijn B, Elhassein M, Kamara TB, Deen GF, Bundu I, Ystgaard B, von Schreeb J, Wibe A. Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone. Br J Surg 2017; 104:1315-1326. [PMID: 28783227 PMCID: PMC5574034 DOI: 10.1002/bjs.10552] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/19/2017] [Accepted: 03/06/2017] [Indexed: 12/26/2022]
Abstract
Background Surgical task‐sharing may be central to expanding the provision of surgical care in low‐resource settings. The aims of this paper were to describe the set‐up of a new surgical task‐sharing training programme for associate clinicians and junior doctors in Sierra Leone, assess its productivity and safety, and estimate its future role in contributing to surgical volume. Methods This prospective observational study from a consortium of 16 hospitals evaluated crude in‐hospital mortality over 5 years and productivity of operations performed during and after completion of a 3‐year surgical training programme. Results Some 48 trainees and nine graduated surgical assistant community health officers (SACHOs) participated in 27 216 supervised operations between January 2011 and July 2016. During training, trainees attended a median of 822 operations. SACHOs performed a median of 173 operations annually. Caesarean section, hernia repair and laparotomy were the most common procedures during and after training. Crude in‐hospital mortality rates after caesarean sections and laparotomies were 0·7 per cent (13 of 1915) and 4·3 per cent (7 of 164) respectively for operations performed by trainees, and 0·4 per cent (5 of 1169) and 8·0 per cent (11 of 137) for those carried out by SACHOs. Adjusted for patient sex, surgical procedure, urgency and hospital, mortality was lower for operations performed by trainees (OR 0·47, 95 per cent c.i. 0·32 to 0·71; P < 0·001) and SACHOs (OR 0·16, 0·07 to 0·41; P < 0·001) compared with those conducted by trainers and supervisors. Conclusion SACHOs rapidly and safely achieved substantial increases in surgical volume in Sierra Leone. Benchmark analysis
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Affiliation(s)
- H A Bolkan
- Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,CapaCare, Trondheim, Norway and Freetown, Sierra Leone
| | - A van Duinen
- Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,CapaCare, Trondheim, Norway and Freetown, Sierra Leone.,Royal Tropical Institute, Amsterdam, The Netherlands
| | - B Waalewijn
- CapaCare, Trondheim, Norway and Freetown, Sierra Leone.,Royal Tropical Institute, Amsterdam, The Netherlands
| | - M Elhassein
- United Nations Population Fund, Freetown, Sierra Leone
| | - T B Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone.,College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - G F Deen
- Department of Medicine, Connaught Hospital, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone.,College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - I Bundu
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone.,College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - B Ystgaard
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,CapaCare, Trondheim, Norway and Freetown, Sierra Leone
| | - J von Schreeb
- Health System and Policy Research Group, Karolinska Institute, Stockholm, Sweden
| | - A Wibe
- Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Roche SD, Ketheeswaran P, Wirtz VJ. International short-term medical missions: a systematic review of recommended practices. Int J Public Health 2016; 62:31-42. [PMID: 27592359 DOI: 10.1007/s00038-016-0889-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify practices for conducting international short-term medical missions (STMMs) recommended in the literature and examine how these link STMMs to recipient countries' existing health systems. METHODS Systematic review of PubMed-indexed articles on STMMs and their bibliographies using preferred reporting items for systematic reviews and meta-analyses guidelines. Recommendations were organized using the World Health Organization Health Systems Framework. RESULTS In 92 publications, 67 % offered at least one recommendation that would link STMMs to the recipient country's health system. Among these recommendations, most focused on service delivery and few on health financing and governance. There is a lack of consensus around a proper standard of care, patient selection, and trip duration. CONCLUSIONS Comprehensive global standards are needed for STMM work to ensure that services are beneficial both to patients and to the broader healthcare systems of recipient countries. By providing an overview of the current recommendations and important gaps where practice recommendations are needed, this study can provide relevant input into the development of global standards for STMMs.
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Affiliation(s)
- Stephanie D Roche
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, 20 Overland Street, 5th Floor, Boston, MA, 02215, USA.
| | - Pavinarmatha Ketheeswaran
- Herbert Wertheim College of Medicine, Florida International University, 11200 Southwest 8th Street, Miami, FL, 33199, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, CT 363, Boston, MA, 02118, USA
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