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de Cates C, Guéroult AM, Narantsolmon GE. Sustainable equipment donation in otolaryngology in low-resource settings. Curr Opin Otolaryngol Head Neck Surg 2024; 32:193-199. [PMID: 38547365 DOI: 10.1097/moo.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine current practices in surgical equipment donation to lower- and middle-income countries (LMICs) with a particular focus on otolaryngology-head and neck surgery (OHNS). This is designed as a pragmatic review to guide potential donor communities to implement sustainable OHNS equipment donation in LMICs. RECENT FINDINGS LMICs are increasingly reliant on international equipment donation. In terms of OHNS services, global OHNS have compiled a list of essential equipment for baseline care in LMICs. Especially in terms of audiology, OHNS equipment donation has the potential to have a significant impact on populational health. However, there is a scarcity of research on donated equipment in OHNS. A suggested blueprint for sustainable equipment donation follows these steps: establish partnerships, assess needs, source equipment, and follow-up and evaluate the intervention. Key further considerations for sustainability include remanufacturing and repurposing methods, maintenance, and contextual understanding. SUMMARY Sustainable equipment donation in otolaryngology is an important part of global health equity and healthcare delivery in low-resource settings. Despite the good intentions behind medical equipment donations, there are many challenges; donors and recipients should engage in collaborative, needs-based planning processes that result in long-term sustainability, local capacity building, and community participation.
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Affiliation(s)
- Catherine de Cates
- Department of Otolaryngology, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage
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Shahbaz S, Howard N. Anaesthesia delivery systems in low and lower-middle-income Asian countries: A scoping review of capacity and effectiveness. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001953. [PMID: 38498415 PMCID: PMC10947636 DOI: 10.1371/journal.pgph.0001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 02/18/2024] [Indexed: 03/20/2024]
Abstract
Literature on anaesthesia systems in low and lower middle-income countries is limited, focused on the Africa region, and provides minimal data on anaesthesia or associated disciplines within intensive care, pain management and emergency medicine. We thus conducted a scoping review of primary and secondary research literature on capacity and effectiveness of anaesthesia delivery in low and lower middle-income countries in the Asia region from 2000-2021, to clarify existing knowledge, important gaps, and possible subsequent steps. We applied Arksey and O'Malley's scoping literature review method to search five databases (i.e. EMBASE, CINAHL, Medline, Scopus, Web of Science), screen, extract, and synthesise data under three themes: (i) availability and type of anaesthesia workforce; (ii) anaesthesia system infrastructure, equipment, and supplies; and (iii) effectiveness of anaesthesia provision. We included 25 eligible sources of 603 identified. Only ten (40%) were published in the last 5 years and Asian lower-income countries were primarily represented in 15 multi-country sources. Fifteen (60%) sources used quantitative methods and provided limited information on data collection, e.g. sampling criteria or geographic areas included. No sources included countrywide data, despite anaesthesia delivery and resources differing significantly sub-nationally (e.g. central versus rural/remote, or insecure areas). Data on anaesthesiology delivery were limited, with findings including insufficiencies in workforce, supplies, training, and skills-building of anaesthesia personnel, along with the lack of consistent strategies for overcoming maldistribution of resources and improving anaesthesia delivery systems in the region. This review, a first attempt to synthesise existing data on anaesthesia delivery systems in low and lower-middle-income Asian countries, shows the anaesthesia literature is still limited. Findings highlight the urgent need for additional research and collaboration nationally and regionally to strengthen anaesthesia delivery and surgical facilities in resource-constrained settings.
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Affiliation(s)
- Sumbal Shahbaz
- Department of Health Professional Technologies, The University of Lahore, Lahore, Pakistan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Kis A, Razek T, Grushka J, Boulanger N, Watt L, Deckelbaum D, Khwaja K, Fata P, Wong EG. Surgical, trauma and telehealth capacity in Indigenous communities in Northern Quebec: a cross-sectional survey. Can J Surg 2023; 66:E572-E579. [PMID: 38016727 DOI: 10.1503/cjs.013822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Delivering trauma and surgical care to Northern Quebec presents unique challenges owing to the region's remoteness, extreme weather and limited transport; the expansion of telehealth could help address these difficulties. We aimed to evaluate current surgical, trauma and telemedicine capacity in Nunavik, Quebec. METHODS We used validated assessment tools, including the Personnel, Infrastructure, Procedures, Equipment and Supplies survey, the International Assessment of Capacity for Trauma index and the Maryland Health Care Commission Telemedicine Readiness tool to evaluate surgical, trauma and telemedicine capacity, respectively. We adapted these tools to the Northern Quebec context through discussions with local leadership. Data were collected in 2 regional hospitals - the Ungava Tulattavik Health Centre (UTHC) and the Inuulitsivik Health Centre (IHC) - and 12 Centres locaux de services communautaires (CLSCs; local community services centres) in 6 villages along the Hudson Bay coast and 6 villages along the Ungava Bay coast through iterative discussions with 4 chief nurses from each regional hospital and set of CLSCs; resources were confirmed through on-site evaluation by the respondents. We performed a descriptive analysis of the data. RESULTS Surgical capacity was highest in the IHC (6.76) and lowest in the Ungava Bay CLSCs (5.52). Personnel (0%-0%) and procedures (13%-33%) were the least available resources. Trauma capacity was highest in the IHC (7.25) and lowest in the Hudson Bay CLSCs (5.58). Although equipment (90%-100%) and supplies (100%-100%) were readily available, personnel (0%-0%) and procedures (25%-56%) were lacking. The UTHC was most prepared for telehealth (67.80%), and the Ungava Bay CLSCs achieved a lower score (51.13%). Underdeveloped telehealth criteria included funding, administrative support, quality improvement and physical spaces (all 33%-67%). CONCLUSION Acute care capacity in Nunavik appears heterogeneous, with readily available equipment and supplies, but a lack of personnel capable of performing lifesaving procedures. To address the need for telemedicine, future initiatives should focus on improving funding, administrative support, physical spaces and quality-improvement initiatives.
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Affiliation(s)
- Allyson Kis
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
| | - Tarek Razek
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
| | - Jeremy Grushka
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
| | - Nathalie Boulanger
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
| | - Larry Watt
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
| | - Dan Deckelbaum
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
| | - Kosar Khwaja
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
| | - Paola Fata
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
| | - Evan G Wong
- From the Faculty of Medicine, McGill University, Montréal, Que. (Kis); the Régie régionale de la santé et des services sociaux du Nunavik, Kuujjuaq, Que. (Boulanger); the Division of General Surgery, Department of Surgery, McGill University, Montréal, Que. (Razek, Grushka, Deckelbaum, Khwaja, Fata, Wong); and the Ungava Tulattavik Health Centre, Kuujjuaq, Que. (Watt)
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Srinivasan T, Cherches A, Seguya A, Salano V, Patterson RH, Xu MJ, Alkire BC, Okerosi SN, Tamir SO. Essential equipment and services for otolaryngology care: a proposal by the Global Otolaryngology-Head and Neck Surgery Initiative. Curr Opin Otolaryngol Head Neck Surg 2023; 31:194-201. [PMID: 36942853 PMCID: PMC10155687 DOI: 10.1097/moo.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW To highlight the need for comprehensive resource lists to provide baseline care of otolaryngologic conditions; to present a proposed list of essential equipment and services that may be applied toward surgical systems research, policymaking, and charitable efforts in global otolaryngology-head and neck surgery. RECENT FINDINGS To provide effective and high-quality surgical care across care settings, there must be a global standard for equipment and ancillary services necessary to provide baseline care. Though there have been efforts to devise resource standards via equipment lists and appraisal tools, these have been limited in scope to general surgery, emergency care, and a few other subspecialty surgical contexts. Recent efforts have brought attention to the significant burden imposed by otolaryngologic conditions such as hearing loss, otitis media, head and neck cancer, head and neck trauma, and upper airway foreign bodies. Yet, there has not been a comprehensive list of resources necessary to provide baseline care for common otolaryngologic conditions. SUMMARY Through an internal survey of its members, the Global Otolaryngology-Head and Neck Surgery Initiative has compiled a list of essential equipment and services to provide baseline care of otolaryngologic conditions. Our efforts aimed to address common otolaryngologic conditions that have been previously identified as high-priority with respect to prevalence and burden of disease. This expert-driven list of essential resources functions as an initial framework to be adapted for internal quality assessment, implementation research, health policy development, and economic priority-setting.
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Affiliation(s)
- Tarika Srinivasan
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Harvard Medical School, Boston, Massachusetts
| | - Alexander Cherches
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Amina Seguya
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Mulago National Referral Hospital, Kampala, Uganda
| | - Valerie Salano
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Nyahururu County Hospital, Laikipia County, Kenya
| | - Rolvix H Patterson
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Mary Jue Xu
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Blake C Alkire
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical Schoo
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Samuel N Okerosi
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Kenyatta National Hospital, Nairobi, Kenya
| | - Sharon Ovnat Tamir
- The Global Otolaryngology-Head and Neck Surgery Initiative
- Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
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