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M'pele P, Seyi-Olajide JO, Elongo T, Lemvik J, Dovlo D, Ameh EA. From research to a political commitment to strengthen access to surgical, obstetric, and anesthesia care in Africa by 2030. Front Public Health 2023; 11:1168805. [PMID: 37261243 PMCID: PMC10228736 DOI: 10.3389/fpubh.2023.1168805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023] Open
Abstract
Objective This study aimed to engage African leaders and key stakeholders to commit themselves toward the strengthening of surgical, obstetric, and anesthesia care systems by 2030 in Africa. Methods From research to a political commitment, a baseline assessment was performed to foster the identification of the gaps in surgical care as a first step of an inclusive process. The preliminary findings were discussed during the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by 2030 in Africa. The conclusions served to draft the Dakar Declaration and its Regional Action Plan 2022-2030 to improve access to surgical care by 2030 in Africa, endorsed by Heads of State. Results The International Symposium was composed of two meetings that gathered (i) 85 scientific experts and (ii) 28 ministers of health or representatives from 28 sub-Saharan African countries. The 28 African countries represent (i) 51% of the continent's total population, (ii) 68% of the 47 African countries of the WHO Africa Region, (iii) 58% of all African Union countries, and (vi) 79% (3,371) of the WHO Africa Region's total (4,271) health districts. The International Symposium and the Heads of State Summit successfully produced the Dakar Declaration on access to equitable, affordable, and quality Surgical, Obstetric, and Anesthesia Care by 2030 in Africa and its Regional Actions Plan 2022-2030 which prioritizes 12 urgent actions needed to be implemented, six strategic priorities, 16 key indicators, and an annual dashboard to monitor progress. Conclusion The Dakar Declaration and its Regional Action Plan 2022-2030 are a commitment to establish quality and sustainable surgical, obstetric, and anesthesia care in each African country within the ambitious framework of "The Africa we want" Agenda 2063.
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Affiliation(s)
- Pierre M'pele
- Scientific Secretariat of the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by 2030 in Africa, Mercy Ships Africa Office, Cotonou, Benin
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Rallo MS, Strong MJ, Teton ZE, Murazsko K, Nanda A, Liau L, Rosseau G. Targeted Public Health Training for Neurosurgeons: An Essential Task for the Prioritization of Neurosurgery in the Evolving Global Health Landscape. Neurosurgery 2023; 92:10-17. [PMID: 36519856 DOI: 10.1227/neu.0000000000002169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022] Open
Abstract
The gap between the tremendous burden of neurological disease requiring surgical management and the limited capacity for neurosurgical care has fueled the growth of the global neurosurgical movement. It is estimated that an additional 23 300 neurosurgeons are needed to meet the burden posed by essential cases across the globe. Initiatives to increase neurosurgical capacity through systems strengthening and workforce development are key elements in correcting this deficit. Building on the growing interest in global health among neurosurgical trainees, we propose the integration of targeted public health education into neurosurgical training, in both high-income countries and low- and middle-income countries. This effort will ensure that graduates possess the fundamental skillsets and experience necessary to participate in and lead capacity-building efforts in the developing countries. This additional public health training can also help neurosurgical residents to achieve the core competencies outlined by accreditation boards, such as the Accreditation Committee on Graduate Medical Education in the United States. In this narrative review, we describe the global burden of neurosurgical disease, establish the need and role for the global neurosurgeon, and discuss pathways for implementing targeted global public health education in the field of neurosurgery.
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Affiliation(s)
- Michael S Rallo
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michael J Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Zoe E Teton
- Department of Neurosurgery, University of California - Los Angeles, Los Angeles, California, USA
| | - Karin Murazsko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Anil Nanda
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Linda Liau
- Department of Neurosurgery, University of California - Los Angeles, Los Angeles, California, USA
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Assessment of the Neurosurgical Capacity in Ghana: Challenges and Opportunities. World Neurosurg 2022; 167:e953-e961. [PMID: 36064120 DOI: 10.1016/j.wneu.2022.08.120] [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: 07/13/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low- and middle-income countries experience numerous challenges in the provision of neurosurgical care. However, limited information exists on the neurosurgical workforce and the constraints under which care is delivered in Ghana, West Africa. METHODS A 19-item survey assessing neurosurgical workforce, infrastructure, and education was administered to Ghanaian consultant neurosurgeons and neurosurgeon trainees between November 8, 2021, and January 20, 2022. The data were analyzed using summary descriptions, and qualitative data were categorized into themes. RESULTS There were 25 consultant neurosurgeons and 8 neurosurgical trainees (from 2 training centers) identified at 11 hospitals in Ghana totaling a workforce density of 1 neurosurgeon per 1,240,000. Most neurosurgical centers were located in Accra, the capital city. Almost half of the population did not have access to a hospital with a neurosurgeon in their region. Of hospitals, 82% had in-house computed tomography and/or magnetic resonance imaging scanners. In the operating room, most neurosurgeons had access to a high-speed drill (91%) but lacked microscopes and endoscopic sets (only 64% and 36% had these tools, respectively). There were no neurointensivists or neurological intensive care units in the entire country, and there was a paucity of neurovascular surgeries and functional neurosurgical procedures. CONCLUSIONS The provision of neurosurgical care in Ghana has come a long way since the 1960s. However, the neurosurgical community continues to face significant challenges. Alleviating these barriers to care will call for systems-level changes that allow for the prioritization of neurosurgical care within the Ghanaian health care system.
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Nguyen BU, Holterman A, Holterman M, Dinh LT. Academic Pediatric Surgery Capacity Building in Vietnam Through PASS, a Pediatric Acute Surgical Support Course. Front Surg 2022; 9:868483. [PMID: 35529908 PMCID: PMC9069233 DOI: 10.3389/fsurg.2022.868483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 01/06/2023] Open
Abstract
Neonatal and pediatric surgical emergencies in Low and Low Middle Income countries remain a significant challenge in combatting the burden and inequities of global health. IPSAC-Vietnam is a small Non-Governmental Organization that has been engaged in a 12-year multi-pronged partnership with several children’s hospitals in Vietnam VN to enhance pediatric surgery capacity. We describe the health care, medical training and emergency system in VN as the background for IPSAC activities and development of Pediatric Acute Surgical Support (PASS) course. The course goal is to prepare health care personnel in the immediate management of neonatal/pediatric life-threatening surgical conditions and road injuries at their first point of entry into Vietnam hospitals. PASS is a horizontal outreach initiative that adopts an interprofessional, multidisciplinary, team-training, train-the-trainers, and outcome-based training approach. PASS can be used as a tool for sustainable horizontal capacity-building by champion leaders at the teaching children’s hospitals and medical universities in developing countries, to strengthen training for pediatric surgical emergencies, to integrate pediatric and pediatric surgical care and to advocate for a comprehensive approach to emergency care of the critically ill child.
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Affiliation(s)
- Bich-Uyen Nguyen
- Department of Pediatric Surgery, Ho Chi Minh University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Aixuan Holterman
- Department of Surgery at Peoria and Chicago; Department of Pediatrics at Chicago, University of Illinois College of Medicine at Peoria and Chicago, Chicago, IL, United States
| | - Mark Holterman
- Department of Surgery at Peoria and Chicago; Department of Pediatrics at Chicago, University of Illinois College of Medicine at Peoria and Chicago, Chicago, IL, United States
| | - Le-Thanh Dinh
- Department of Pediatric Surgery, Children’s Hospital 1, Ho Chi Minh City, Vietnam
- Correspondence: L-T Dinh
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Cao A, Feintuch J, Feintuch J, Tran L, Senior B, Yang CJ. Advancing global medical education in otolaryngology through hands-on skills training and simulation-based learning. J Glob Health 2021; 11:03111. [PMID: 34737855 PMCID: PMC8561334 DOI: 10.7189/jogh.11.03111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Angela Cao
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, New York, USA
| | - Jeremy Feintuch
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, New York, USA
| | - Joshua Feintuch
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, New York, USA
| | - Luan Tran
- Department of Otolaryngology-Head and Neck Surgery, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Ear, Nose, and Throat Hospital of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Brent Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christina J Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, New York, USA
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Oral and Maxillofacial Surgery: An Opportunity to Improve Surgical Care and Advance Sustainable Development Globally. Oral Maxillofac Surg Clin North Am 2020; 32:339-354. [PMID: 32482559 DOI: 10.1016/j.coms.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Global health has evolved to focus on reducing health inequity and obtaining the highest attainable standard of health for all people. To do this, a range of actors now pursue interventions and policy with an eye toward global targets that place strong emphasis on improving health systems. Within global health, global surgery has sought to delineate the burden of surgical disease and propose policy to improve access to surgery. Oral and maxillofacial surgery has been underrepresented in global health but has a vital role in reducing the global health inequity attributable to the impact of oral and craniofacial conditions.
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Scheiner A, Rickard JL, Nwomeh B, Jawa RS, Ginzburg E, Fitzgerald TN, Charles A, Bekele A. Global Surgery Pro-Con Debate: A Pathway to Bilateral Academic Success or the Bold New Face of Colonialism? J Surg Res 2020; 252:272-280. [PMID: 32402397 DOI: 10.1016/j.jss.2020.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 02/03/2023]
Abstract
Global surgery, especially academic global surgery, is of tremendous interest to many surgeons. Classically, it entails personnel from high-income countries going to low- and middle-income countries and engaging in educational activities as well as procedures. Academic medical personnel have included students, residents, and attendings. The pervasive notion is that this is a win-win situation for the volunteers and the hosts, that is, a pathway to bilateral academic success. However, a critical examination demonstrates that it can easily become the bold new face of colonialism of a low- and middle-income country by a high-income country.
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Affiliation(s)
- Alyssa Scheiner
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | | | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Randeep S Jawa
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York.
| | - Enrique Ginzburg
- Division of Trauma, Surgical Critical Care and Burns, Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida
| | | | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Abebe Bekele
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
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