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Please H, Narang K, Bolton W, Nsubuga M, Luweesi H, Richards NB, Dalton J, Tendo C, Khan M, Jjingo D, Bhutta MF, Petrakaki D, Dhanda J. Virtual reality technology for surgical learning: qualitative outcomes of the first virtual reality training course for emergency and essential surgery delivered by a UK-Uganda partnership. BMJ Open Qual 2024; 13:e002477. [PMID: 38286564 PMCID: PMC10826552 DOI: 10.1136/bmjoq-2023-002477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/07/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION The extensive resources needed to train surgeons and maintain skill levels in low-income and middle-income countries (LMICs) are limited and confined to urban settings. Surgical education of remote/rural doctors is, therefore, paramount. Virtual reality (VR) has the potential to disseminate surgical knowledge and skill development at low costs. This study presents the outcomes of the first VR-enhanced surgical training course, 'Global Virtual Reality in Medicine and Surgery', developed through UK-Ugandan collaborations. METHODS A mixed-method approach (survey and semistructured interviews) evaluated the clinical impact and barriers of VR-enhanced training. Course content focused on essential skills relevant to Uganda (general surgery, obstetrics, trauma); delivered through: (1) hands-on cadaveric training in Brighton (scholarships for LMIC doctors) filmed in 360°; (2) virtual training in Kampala (live-stream via low-cost headsets combined with smartphones) and (3) remote virtual training (live-stream via smartphone/laptop/headset). RESULTS High numbers of scholarship applicants (n=130); registrants (Kampala n=80; remote n=1680); and attendees (Kampala n=79; remote n=556, 25 countries), demonstrates widespread appetite for VR-enhanced surgical education. Qualitative analysis identified three key themes: clinical education and skill development limitations in East Africa; the potential of VR to address some of these via 360° visualisation enabling a 'knowing as seeing' mechanism; unresolved challenges regarding accessibility and acceptability. CONCLUSION Outcomes from our first global VR-enhanced essential surgical training course demonstrating dissemination of surgical skills resources in an LMIC context where such opportunities are scarce. The benefits identified included environmental improvements, cross-cultural knowledge sharing, scalability and connectivity. Our process of programme design demonstrates that collaboration across high-income and LMICs is vital to provide locally relevant training. Our data add to growing evidence of extended reality technologies transforming surgery, although several barriers remain. We have successfully demonstrated that VR can be used to upscale postgraduate surgical education, affirming its potential in healthcare capacity building throughout Africa, Europe and beyond.
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Affiliation(s)
- Helen Please
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - William Bolton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | - Mike Nsubuga
- African Center of Excellence in Bioinformatics & Data Sciences, Kampala, Uganda
| | | | | | - John Dalton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - Mansoor Khan
- Brighton and Sussex Medical School, Brighton, UK
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics & Data Sciences, Kampala, Uganda
- Department of Computer Science, Makerere University, Kampala, Uganda
| | - Mahmood F Bhutta
- Brighton and Sussex Medical School, Brighton, UK
- Department of ENT, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Dimitra Petrakaki
- ESRC-funded Digital Futures at Work Research Centre, University of Sussex Business School, Brighton, UK
| | - Jagtar Dhanda
- Brighton and Sussex Medical School, Brighton, UK
- Queen Victoria Hospital, East Grinstead, UK
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Kakembo N, Grabski DF, Situma M, Ajiko M, Kayima P, Nyeko D, Shikanda A, Okello I, Tumukunde J, Nabukenya M, Ogwang M, Kisa P, Muzira A, Ruzgar N, Fitzgerald TN, Sekabira J, Ozgediz D. Met and Unmet Need for Pediatric Surgical Access in Uganda: A Country-Wide Prospective Analysis. J Surg Res 2023; 286:23-34. [PMID: 36738566 DOI: 10.1016/j.jss.2022.12.036] [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: 05/21/2022] [Revised: 12/05/2022] [Accepted: 12/24/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Children's surgical access in low and low-middle income countries is severely limited. Investigations detailing met and unmet surgical access are necessary to inform appropriate resource allocation. MATERIALS AND METHODS Surgical volume, outcomes, and distribution of pediatric general surgical procedures were analyzed using prospective pediatric surgical databases from four separate regional hospitals in Uganda. The current averted burden of surgical disease through pediatric surgical delivery in Uganda and the unmet surgical need based on estimates from high-income country data was calculated. RESULTS A total of 8514 patients were treated at the four hospitals over a 6-year period corresponding to 1350 pediatric surgical cases per year in Uganda or six surgical cases per 100,000 children per year. The majority of complex congenital anomalies and surgical oncology cases were performed at Mulago and Mbarara Hospitals, which have dedicated pediatric surgical teams (P < 0.0001). The averted burden of pediatric surgical disease was 27,000 disability adjusted life years per year, which resulted in an economic benefit of approximately 23 million USD per year. However, the average case volume performed at the four regional hospitals currently represents 1% of the total projected pediatric surgical need. CONCLUSIONS This investigation is one of the first to demonstrate the distribution of pediatric surgical procedures at a country level through the use of a prospective locally created database. Significant disease burden was averted by local pediatric and adult surgical teams, demonstrating the economic benefit of pediatric surgical care delivery. These findings support several ongoing strategies to increase pediatric surgical access in Uganda.
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Affiliation(s)
- Nasser Kakembo
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
| | - Martin Situma
- Department of Surgery, Mbarara University of Science and Technology, Mbarara Hospital, Mbarara, Uganda
| | - Margaret Ajiko
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Peter Kayima
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - David Nyeko
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - Anne Shikanda
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Innocent Okello
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Janat Tumukunde
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | - Mary Nabukenya
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | - Martin Ogwang
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - Phyllis Kisa
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Arlene Muzira
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Nensi Ruzgar
- Yale University School of Medicine, New Haven, Connecticut
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - John Sekabira
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, California
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Increased Surgical Delays Seen During the COVID-19 Pandemic in a Regional Referral Hospital in Soroti, Uganda: Perspective from a Low-Resource Setting. World J Surg 2023; 47:1379-1386. [PMID: 36907925 PMCID: PMC10008205 DOI: 10.1007/s00268-023-06965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The impact of COVID-19 on low-resource surgical systems is concerning but there are limited studies examining the effect in low- and middle-income countries. This study assesses changes in surgical capacity during the COVID-19 pandemic at Soroti Regional Referral Hospital, a tertiary healthcare facility in Soroti, Uganda. METHODS Patients from a prospective general surgery registry at SRRH were divided into cohorts admitted prior to the pandemic (January 2017 to February 2020) and during the pandemic (March 2020 to May 2021). Demographics, pre-hospital characteristics, in-hospital characteristics, provider-reported delays in care, and adverse events were compared between cohorts. RESULTS Of the 1547 general surgery patients, 1159 were admitted prior to the pandemic and 388 were admitted during the pandemic. There was no difference in the median number of elective (24.5 vs. 20.0, p value = 0.16) or emergent (6.0 vs. 6.0, p value = 0.36) surgeries per month. Patients were more likely to have a delay in surgical care during the pandemic (22.6% vs. 46.6%, p < 0.01), particularly from lack of operating space (16.9% vs. 46.3%, p < 0.01) and lack of a surgeon (1.6% vs. 4.4%, p < 0.01). Increased proportion of delays in care appear correlated with waves of COVID-19 cases at SRRH. There were no changes in rates of adverse events (5.7% vs. 7.7%, p = 0.18). DISCUSSION The COVID-19 pandemic caused significant increases in surgical care delays and emergency surgery at SRRH. Strengthening surgical systems when not in crisis and including provisions for safe, timely surgical delivery during epidemic resource allocation is needed to strengthen the overall healthcare system.
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van Kesteren J, van Duinen AJ, Marah F, van Delft D, Spector AL, Cassidy LD, Groen RS, Jabbi SMBB, Bah S, Medo JA, Kamanda-Bongay A, van Leerdam D, Westendorp J, Mathéron HM, Mönnink GLE, Vas Nunes J, Lindenbergh KC, Hoel SK, Løvdal SM, Østensen MN, Solberg H, Boateng D, Klipstein-Grobusch K, van Herwaarden D, Martens JPJ, Bonjer HJ, Sankoh O, Grobusch MP, Bolkan HA. PREvalence Study on Surgical COnditions (PRESSCO) 2020: A Population-Based Cross-Sectional Countrywide Survey on Surgical Conditions in Post-Ebola Outbreak Sierra Leone. World J Surg 2022; 46:2585-2594. [PMID: 36068404 PMCID: PMC9529684 DOI: 10.1007/s00268-022-06695-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
Background Understanding the burden of diseases requiring surgical care at national levels is essential to advance universal health coverage. The PREvalence Study on Surgical COnditions (PRESSCO) 2020 is a cross-sectional household survey to estimate the prevalence of physical conditions needing surgical consultation, to investigate healthcare-seeking behavior, and to assess changes from before the West African Ebola epidemic. Methods This study (ISRCTN: 12353489) was built upon the Surgeons Overseas Surgical Needs Assessment (SOSAS) tool, including expansions. Seventy-five enumeration areas from 9671 nationwide clusters were sampled proportional to population size. In each cluster, 25 households were randomly assigned and visited. Need for surgical consultations was based on verbal responses and physical examination of selected household members. Results A total of 3,618 individuals from 1,854 households were surveyed. Compared to 2012, the prevalence of individuals reporting one or more relevant physical conditions was reduced from 25 to 6.2% (95% CI 5.4–7.0%) of the population. One-in-five conditions rendered respondents unemployed, disabled, or stigmatized. Adult males were predominantly prone to untreated surgical conditions (9.7 vs. 5.9% women; p < 0.001). Financial constraints were the predominant reason for not seeking care. Among those seeking professional health care, 86.7% underwent surgery. Conclusion PRESSCO 2020 is the first surgical needs household survey which compares against earlier study data. Despite the 2013–2016 Ebola outbreak, which profoundly disrupted the national healthcare system, a substantial reduction in reported surgical conditions was observed. Compared to one-time measurements, repeated household surveys yield finer granular data on the characteristics and situations of populations in need of surgical treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06695-7.
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Affiliation(s)
- Jurre van Kesteren
- Amsterdam UMC Location Vrije Universiteit, Department of Surgery, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Alex J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Foday Marah
- CapaCare, Trondheim, Norway
- Masanga Hospital, Tonkolili District, Masanga, Sierra Leone
| | - Diede van Delft
- CapaCare, Trondheim, Norway
- Masanga Hospital, Tonkolili District, Masanga, Sierra Leone
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
| | - Antoinette L Spector
- Institute for Health & Equity and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura D Cassidy
- Institute for Health & Equity and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Reinou S Groen
- Johns Hopkins School of Medicine, Baltimore, USA
- SOS - Surgeons OverSeas, New York, NY, USA
| | | | - Silleh Bah
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | - James A Medo
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | | | - Daniel van Leerdam
- CapaCare, Trondheim, Norway
- KIT, Royal Tropical Institute, Amsterdam, The Netherlands
| | - Josien Westendorp
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Hanna M Mathéron
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Giulia L E Mönnink
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Jonathan Vas Nunes
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Karel C Lindenbergh
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sara K Hoel
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sofie M Løvdal
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mia N Østensen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Helene Solberg
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Daniel Boateng
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - H Jaap Bonjer
- Amsterdam UMC Location Vrije Universiteit, Department of Surgery, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - Martin P Grobusch
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
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The Third Delay in General Surgical Care in a Regional Referral Hospital in Soroti, Uganda. World J Surg 2022; 46:2075-2084. [PMID: 35618947 PMCID: PMC9334422 DOI: 10.1007/s00268-022-06591-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/02/2022]
Abstract
Background Building capacity for surgical care in low-and-middle-income countries is essential for the improvement of global health and economic growth. This study assesses in-hospital delays of surgical services at Soroti Regional Referral Hospital (SRRH), a tertiary healthcare facility in Soroti, Uganda. Methods A prospective general surgical database at SRRH was analyzed. Data on patient demographics, surgical characteristics, delays of care, and adverse clinical outcomes of patients seen between January 2017 and February 2020 were extracted and analyzed. Patient characteristics and surgical outcomes, for those who experienced delays in care, were compared to those who did not. Results Of the 1160 general surgery patients, 263 (22.3%) experienced at least one delay of care. Deficits in infrastructure, particularly lacking operating theater space, were the greatest contributor to delays (n = 192, 73.0%), followed by shortage of equipment (n = 52, 19.8%) and personnel (n = 37, 14.1%). Male sex was associated with less delays of care (OR 0.63) while undergoing emergency surgeries (OR 1.65) and abdominal surgeries (OR 1.44) were associated with more frequent delays. Delays were associated with more adverse events (10.3% vs. 5.0%), including death (4.2% vs. 1.6%). Emergency surgery, unclean wounds, and comorbidities were independent risk factors of adverse events. Discussion Patients at SRRH face significant delays in surgical care from deficits in infrastructure and lack of capacity for emergency surgery. Delays are associated with increased mortality and other adverse events. Investing in solutions to prevent delays is essential to improving surgical care at SRRH.
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Davies JI, Gelb AW, Gore-Booth J, Martin J, Mellin-Olsen J, Åkerman C, Ameh EA, Biccard BM, Braut GS, Chu KM, Derbew M, Ersdal HL, Guzman JM, Hagander L, Haylock-Loor C, Holmer H, Johnson W, Juran S, Kassebaum NJ, Laerdal T, Leather AJM, Lipnick MS, Ljungman D, Makasa EM, Meara JG, Newton MW, Østergaard D, Reynolds T, Romanzi LJ, Santhirapala V, Shrime MG, Søreide K, Steinholt M, Suzuki E, Varallo JE, Visser GHA, Watters D, Weiser TG. Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report. PLoS Med 2021; 18:e1003749. [PMID: 34415914 PMCID: PMC8415575 DOI: 10.1371/journal.pmed.1003749] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. METHODS AND FINDINGS The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees. CONCLUSIONS To track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.
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Affiliation(s)
- Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Public Health, Wits University, Johannesburg, South Africa
- * E-mail:
| | - Adrian W. Gelb
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia & Perioperative Care, University of California San Francisco, California, United States of America
| | - Julian Gore-Booth
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
| | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
| | - Jannicke Mellin-Olsen
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway
| | - Christina Åkerman
- Dell Medical School, University of Texas at Austin, Austin, Texas, United States of America
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, Massachusetts, United States of America
| | - Emmanuel A. Ameh
- Division of Paediatric Surgery, The National Hospital, Abuja, Nigeria
- National Surgical, Obstetric and Anaesthesia Planning Committee, Federal Ministry of Health, Abuja, Nigeria
| | - Bruce M. Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Western Cape, South Africa
| | - Geir Sverre Braut
- Research Department of Community Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Miliard Derbew
- School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway
| | | | - Lars Hagander
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carolina Haylock-Loor
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia, Intensive Care Medicine, Interventional Pain Unit, Hospital Del Valle, San Pedro Sula, Honduras
| | - Hampus Holmer
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Walter Johnson
- Department of Neurosurgery, Loma Linda University, Loma Linda, California, United States of America
| | - Sabrina Juran
- Population and Development, United Nations Population Fund, New York, New York, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nicolas J. Kassebaum
- Anesthesiology and Pain Medicine, Health Metrics Sciences, Global Health, and Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Andrew J. M. Leather
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Michael S. Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, United States of America
| | - David Ljungman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmanuel M. Makasa
- SADC-Wits Regional Collaboration Centre for Surgical Healthcare (WitSSurg), Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Mark W. Newton
- Department of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Tennessee, United States of America
- AIC Kijabe Hospital, Kenya
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, The University of Copenhagen, Copenhagen, Denmark
| | - Teri Reynolds
- Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Lauri J. Romanzi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vatshalan Santhirapala
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anaesthesia and Perioperative Care, Guy’s and St. Thomas’ Hospital, London, United Kingdom
| | - Mark G. Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Margit Steinholt
- Helgeland Hospital Trust, Sandnessjøen, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Emi Suzuki
- The World Bank, Washington, DC, United States of America
| | - John E. Varallo
- Department of Safe Surgery, Jhpiego, Baltimore, Maryland, United States of America
| | - Gerard H. A. Visser
- Department of Obstetrics, University Medical Center, Utrecht, the Netherlands
| | - David Watters
- University Hospital Geelong, Victoria, Australia
- Faculty of Health, School of Medicine, Deakin University, Victoria, Australia
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Thomas G. Weiser
- Stanford University School of Medicine, Department of Surgery Division of General Surgery, Section of Trauma & Critical Care Stanford University, Stanford, United States of America
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland
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Moustafa MK, Al-Hajj S, El-Hechi M, El Moheb M, Chamseddine Z, Kaafarani HMA. The Burden of Surgical Disease and Access to Care in a Vulnerable Syrian Refugee Population in Lebanon. World J Surg 2021; 45:3019-3026. [PMID: 34312694 PMCID: PMC8313117 DOI: 10.1007/s00268-021-06242-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Background The Syrian conflict has produced one of the largest refugee crises in modern times. Lebanon has taken in more Syrian refugees per capita than any other nation. We aimed to study the burden of surgical disease and access to surgical care among Syrian refugees in Lebanon. Methods This study was designed as a convenient cross-sectional cluster-based population survey of all refugee camps throughout the Bekaa region of Lebanon. We used a modified version of the Surgeons OverSeas Assessment of Surgical Need to identify surgical conditions and barriers to care access. The head of household of each informal tented settlement provided demographic information after which two household members were randomly chosen and administered the survey. Results A total of 1,500 individuals from 750 households representing 21 camps were surveyed. Respondents had a mean age of 36.6 (15.0) years, 54.6% were female, and 59% were illiterate. Nearly 25% of respondents reported at least one surgical condition within the past year, most commonly involving the face, head, and neck region (32%) and extremities (22%). Less than 20% of patients with a surgical condition reported seeing any healthcare provider, > 75% due to financial hardship. Conclusions The prevalence of surgical disease among Syrian refugees is very high with a fourth of refugees suffering from one or more surgical conditions over the past year. The surgical needs of this vulnerable population are largely unmet as financial reasons prevent patients from seeking care. Local and humanitarian efforts need to include increased access to surgical care.
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Affiliation(s)
| | - Samar Al-Hajj
- Faculty of Health Sciences, Health Management and Policy Department, American University in Beirut, Bliss Street, Beirut, Lebanon.
| | - Majed El-Hechi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Mohamad El Moheb
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Zahraa Chamseddine
- Faculty of Health Sciences, Health Management and Policy Department, American University in Beirut, Bliss Street, Beirut, Lebanon
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
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8
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Kim M, Yoo CB, Lee-Park O, Nang S, Vuthy D, Park KB, Vycheth I. Patterns of Neurosurgical Conditions at a Major Government Hospital in Cambodia. Asian J Neurosurg 2020; 15:952-958. [PMID: 33708669 PMCID: PMC7869294 DOI: 10.4103/ajns.ajns_213_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/03/2020] [Accepted: 07/03/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Low- and middle-income countries (LMICs) have a growing and largely unaddressed neurosurgical burden. Cambodia has been an understudied country regarding the neurosurgical pathologies and case volume. Rapid infrastructure development with noncompliance of safety regulations has led to increased numbers of traumatic injuries. This study examines the neurosurgical caseload and pathologies of a single government institution implementing the first residency program in an effort to understand the neurosurgical needs of this population. Methods: This is a longitudinal descriptive study of all neurosurgical admissions at the Department of Neurosurgery at Preah Kossamak Hospital (PKH), a major government hospital, in Phnom Penh, Cambodia, between September 2013 and June 2018. Results: 5490 patients were admitted to PKH requiring neurosurgical evaluation and care. Most of these admissions were cranial injuries related to road traffic accidents primarily involving young men compared to women by approximately 4:1 ratio. Spinal pathologies were more evenly distributed in age and gender, with younger demographics more commonly presenting with traumatic injuries, while the older with degenerative conditions. Conclusions: Despite increased attention and efforts over the past decade, Cambodia's neurosurgical burden mirrors that of other LMICs, with trauma affecting most patients either on the road or at the workplace. Currently, Cambodia has 34 neurosurgeons to address the growing burden of a country of 15 million with an increasing life expectancy of 69 years of age, stressing the importance of better public health policies and urgency for building capacity for safe and affordable neurosurgical care.
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Affiliation(s)
- Miri Kim
- Department of Neurosurgery, Loyola University Medical Center, Maywood, IL, USA.,Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Chung Bin Yoo
- Department of General Medicine, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Owen Lee-Park
- Department of Emergency Medicine, George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Sam Nang
- Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Din Vuthy
- Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Kee B Park
- Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia.,Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Iv Vycheth
- Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia
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9
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Naidu P, Fagan JJ, Lategan C, Devenish LP, Chu KM. The role of the University of Cape Town, South Africa in the training and retention of surgeons in Sub-Saharan Africa. Am J Surg 2020; 220:1208-1212. [PMID: 32771217 DOI: 10.1016/j.amjsurg.2020.06.070] [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] [Received: 02/13/2020] [Revised: 04/22/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has a shortage of surgeon specialists. Many SSA countries lack specialty training programs but South Africa, an upper middle-income country, has several post-graduate surgical training programs. The primary objective of this study was to describe the retention rates of non-South African SSA surgical trainees from the University of Cape Town (UCT) on the African sub-continent. The secondary objective was to describe advantages and disadvantages of foreign surgical trainees on the UCT surgical training programs. METHODS This was a two-part cross-sectional survey administered via email between June 1, 2018 and March 1, 2019 to UCT 1) surgical residents and fellows who graduated between 2007 and 2017 and whose country of origin was in SSA but outside South Africa, and 2) UCT surgical division heads. RESULTS Thirty out of 78 (38%) trainees responded; 83% (n = 25) were male. There was a 96% retention rate of surgical trainees in SSA, 80% (n = 24) returned to their country of origin after training, 83% (n = 25) worked in the public sector, and 90% (n = 27) in teaching hospitals. Seven out of ten surgical division heads responded. Reported advantages of SSA trainees included more junior staff (n = 5, 71%) and the establishment of SSA networks (n = 4, 57%). Disadvantages included increased training responsibilities for educators (n = 2, 29%) and fewer cases for South African trainees (n = 2, 29%). DISCUSSION Retention on the African sub-continent of surgeons who trained at UCT was high. SSA doctors can utilize South African post-graduate surgical training programs until their own countries increase their training capacity. The majority of trainees returned to their countries of origin, utilizing their skills in the public and academic sectors, and contributing to the teaching of more trainees. These training partnerships also contribute to knowledge-sharing and facilitate a regional network of African surgeons. Active recruitment of more female trainees is needed to ensure gender equity.
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Affiliation(s)
- Priyanka Naidu
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Johannes J Fagan
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Carina Lategan
- Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Liam P Devenish
- Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Kathryn M Chu
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa; Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parow, Cape Town, South Africa.
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10
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Kuwayama DP, Chu KM, Hartman Z, Idris B, Wolfgang C, Frist HWH. Surgical Needs of Internally Displaced Persons in Kerenik, West Darfur, Sudan. World J Surg 2020; 44:3224-3236. [PMID: 32462216 DOI: 10.1007/s00268-020-05603-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The burden of surgical disease in refugee and internally displaced person (IDP) populations has not been well defined. Populations fleeing conflict are mobile, limiting the effectiveness of traditional sampling methods. We employed novel sampling and survey techniques to conduct a population-based surgical needs assessment amongst IDPs in Kerenik, West Darfur, Sudan, over 4 weeks in 2008. METHODS Satellite imagery was used to identify man-made structures. Ground teams were guided by GPS to randomly selected households. A newly created surgical needs survey was administered by surgeons to household members. One randomly selected individual answered demographic and medical history questions pertaining to themselves and first-degree blood relatives. All household members were offered a physical examination looking for surgical disease. FINDINGS There were 780 study participants; 82% were IDPs. A history since displacement of surgical and potentially surgical conditions was reported in 38% of respondents and by 73% of respondents in first-degree blood relatives. Surgical histories included trauma (gunshots, stabbings, assaults) (5% respondents; 27% relatives), burns (6% respondents; 14% relatives), and obstetrical problems (5% female respondents; 11% relatives). 1485 individuals agreed to physical examinations. Untreated surgical and potentially surgical disease was identified in 25% of participants. INTERPRETATION We identified and characterized a high burden of surgical and potentially surgical disease in an IDP population in West Darfur. Our study is unique in its direct assessment of a traumatized, mobile, vulnerable population. Health officials and agencies charged with the care of IDP and refugee populations should be aware of the high prevalence of surgical and potentially surgical conditions in these communities. This study adds to the growing body of evidence that investment in surgical resources may address a significant portion of the overall burden of disease in marginalized populations.
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Affiliation(s)
- David P Kuwayama
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Unit 3V, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Kathryn M Chu
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Bashir Idris
- Department of Pharmacy, University of Maryland Upper Chesapeake Medical Center, Bel Air, MD, USA
| | | | - Hon William H Frist
- Department of Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
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11
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Vaca SD, Feng AY, Ku S, Jin MC, Kakusa BW, Ho AL, Zhang M, Fuller A, Haglund MM, Grant G. Boda Bodas and Road Traffic Injuries in Uganda: An Overview of Traffic Safety Trends from 2009 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062110. [PMID: 32235768 PMCID: PMC7143574 DOI: 10.3390/ijerph17062110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Road traffic injuries (RTIs) are an important contributor to the morbidity and mortality of developing countries. In Uganda, motorcycle taxis, known as boda bodas, are responsible for a growing proportion of RTIs. This study seeks to evaluate and comment on traffic safety trends from the past decade. METHODS Traffic reports from the Ugandan police force (2009 to 2017) were analyzed for RTI characteristics. Furthermore, one month of casualty ward data in 2015 and 2018 was collected from the Mulago National Referral Hospital and reviewed for casualty demographics and trauma type. RESULTS RTI motorcycle contribution rose steadily from 2009 to 2017 (24.5% to 33.9%). While the total number of crashes dropped from 22,461 to 13,244 between 2010 and 2017, the proportion of fatal RTIs increased from 14.7% to 22.2%. In the casualty ward, RTIs accounted for a greater proportion of patients and traumas in 2018 compared to 2015 (10%/41% and 36%/64%, respectively). CONCLUSIONS Although RTIs have seen a gross reduction in Uganda, they have become more deadly, with greater motorcycle involvement. Hospital data demonstrate a rising need for trauma and neurosurgical care to manage greater RTI patient burden. Combining RTI prevention and care pathway improvements may mitigate current RTI trends.
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Affiliation(s)
- Silvia D. Vaca
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.V.); (A.Y.F.); (S.K.); (M.C.J.); (B.W.K.); (A.L.H.); (M.Z.)
- Stanford Center for Global Health Innovation, Palo Alto, CA 94305, USA
| | - Austin Y. Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.V.); (A.Y.F.); (S.K.); (M.C.J.); (B.W.K.); (A.L.H.); (M.Z.)
- Stanford Center for Global Health Innovation, Palo Alto, CA 94305, USA
| | - Seul Ku
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.V.); (A.Y.F.); (S.K.); (M.C.J.); (B.W.K.); (A.L.H.); (M.Z.)
- Stanford Center for Global Health Innovation, Palo Alto, CA 94305, USA
| | - Michael C. Jin
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.V.); (A.Y.F.); (S.K.); (M.C.J.); (B.W.K.); (A.L.H.); (M.Z.)
- Stanford Center for Global Health Innovation, Palo Alto, CA 94305, USA
| | - Bina W. Kakusa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.V.); (A.Y.F.); (S.K.); (M.C.J.); (B.W.K.); (A.L.H.); (M.Z.)
- Stanford Center for Global Health Innovation, Palo Alto, CA 94305, USA
| | - Allen L. Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.V.); (A.Y.F.); (S.K.); (M.C.J.); (B.W.K.); (A.L.H.); (M.Z.)
- Stanford Center for Global Health Innovation, Palo Alto, CA 94305, USA
| | - Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.V.); (A.Y.F.); (S.K.); (M.C.J.); (B.W.K.); (A.L.H.); (M.Z.)
- Stanford Center for Global Health Innovation, Palo Alto, CA 94305, USA
| | - Anthony Fuller
- Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.F.); (M.M.H.)
| | - Michael M. Haglund
- Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.F.); (M.M.H.)
| | - Gerald Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.V.); (A.Y.F.); (S.K.); (M.C.J.); (B.W.K.); (A.L.H.); (M.Z.)
- Stanford Center for Global Health Innovation, Palo Alto, CA 94305, USA
- Correspondence: ; Tel.: +1-(650)-497-8775; Fax: +1-(650)-725-5086
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12
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Schmidt FA, Kirnaz S, Wipplinger C, Kuzan-Fischer CM, Härtl R, Hoffman C. Review of the Highlights from the First Annual Global Neurosurgery 2019: A Practical Symposium. World Neurosurg 2020; 137:46-54. [PMID: 31996336 DOI: 10.1016/j.wneu.2020.01.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
This paper provides a detailed report of Global Neurosurgery 2019: A Practical Symposium held January 18-19, 2019, at Weill Cornell Medical College, New York, New York, USA. The meeting convened an international faculty and audience, leaders in the world of global neurosurgery (GNS), and junior faculty and residents beginning their contribution to the field. Remote access for the symposium was provided to include faculty practicing in developing countries. The goal of the symposium was to present the state of the union of GNS initiatives worldwide, to use this forum as a means to centralize resources and converge parallel efforts, and to identify the largest areas of need and successful means of advancing training and care in these areas. The meeting also served as a conduit for the presentation of funding and training opportunities for junior faculty and trainees looking for avenues to gain support and mentorship in pursuing academic and clinical endeavors globally.
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Affiliation(s)
- Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Claudia M Kuzan-Fischer
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Caitlin Hoffman
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA.
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13
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Albutt K, Drevin G, Yorlets RR, Svensson E, Namanya DB, Shrime MG, Kayima P. 'We are all serving the same Ugandans': A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda. PLoS One 2019; 14:e0224215. [PMID: 31648234 PMCID: PMC6812829 DOI: 10.1371/journal.pone.0224215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/08/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. Methods A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. Results Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. Conclusion As in Uganda’s public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.
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Affiliation(s)
- Katherine Albutt
- Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, United States of America
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Gustaf Drevin
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Rachel R. Yorlets
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, United States of America
| | - Emma Svensson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Didacus B. Namanya
- Ministry of Health (MOH), Kampala, Uganda
- Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Mark G. Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, MA, United States of America
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
- St. Mary's Lacor Hospital, Gulu, Uganda
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14
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Abdelgadir J, Elahi C, Corley J, Wall KC, Najjuma JN, Muhindo A, Nickenig Vissoci JR, Haglund MM, Kitya D. Trends in neurosurgical care in Western Uganda: an interrupted time series analysis. Neurosurg Focus 2019; 45:E15. [PMID: 30269580 DOI: 10.3171/2018.7.focus18270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE In addition to the rising burden of surgical disease globally, infrastructure and human resources for health remain a great challenge for low- and middle-income countries, especially in Uganda. In this study, the authors aim to explore the trends of neurosurgical care at a regional referral hospital in Uganda and assess the long-term impact of the institutional collaboration between Mulago National Referral Hospital and Duke University. METHODS An interrupted time series is a quasi-experimental design used to evaluate the effects of an intervention on longitudinal data. The authors applied this design to evaluate the trends in monthly mortality rates for neurosurgery patients at Mbarara Regional Referral Hospital (MRRH) from March 2013 to October 2015. They used segmented regression and autoregressive integrated moving average models for the analysis. RESULTS Over the study timeframe, MRRH experienced significant increases in referrals received (from 117 in 2013 to 211 in 2015), neurosurgery patients treated (from 337 in 2013 to 625 in 2015), and operations performed (from 61 in 2013 to 173 in 2015). Despite increasing patient volumes, the hospital achieved a significant reduction in hospital mortality during 2015 compared to prior years (p value = 0.0039). CONCLUSIONS This interrupted time series analysis study showed improving trends of neurosurgical care in Western Uganda. There is a steady increase in volume accompanied by a sharp decrease in mortality through the years. Multiple factors are implicated in the significant increase in volume and decrease in mortality, including the addition of a part-time neurosurgeon, improvement in infrastructure, and increased experience. Further in-depth prospective studies exploring seasonality and long-term outcomes are warranted.
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Affiliation(s)
- Jihad Abdelgadir
- 1Department of Neurosurgery, Duke University Medical Center.,2Duke Division of Global Neurosurgery and Neurology
| | - Cyrus Elahi
- 2Duke Division of Global Neurosurgery and Neurology.,3Duke University Global Health Institute
| | - Jacquelyn Corley
- 1Department of Neurosurgery, Duke University Medical Center.,2Duke Division of Global Neurosurgery and Neurology
| | - Kevin C Wall
- 4Duke University School of Medicine, Durham, North Carolina
| | - Josephine N Najjuma
- 5Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara; and
| | - Alex Muhindo
- 6Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Michael M Haglund
- 1Department of Neurosurgery, Duke University Medical Center.,3Duke University Global Health Institute
| | - David Kitya
- 5Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara; and
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15
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Haglund MM, Fuller AT. Global neurosurgery: innovators, strategies, and the way forward. J Neurosurg 2019; 131:993-999. [PMID: 31574484 DOI: 10.3171/2019.4.jns181747] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 02/05/2023]
Abstract
Around the world today, low- and middle-income countries (LMICs) have not benefited from advancements in neurosurgery; most have minimal or even no neurosurgical capacity in their entire country. In this paper, the authors examine in broad strokes the different ways in which individuals, organizations, and universities engage in global neurosurgery to address the global challenges faced in many LMICs. Key strategies include surgical camps, educational programs, training programs, health system strengthening projects, health policy changes/development, and advocacy. Global neurosurgery has begun coalescing with large strides taken to develop a coherent voice for this work. This large-scale collaboration via multilateral, multinational engagement is the only true solution to the issues we face in global neurosurgery. Key players have begun to come together toward this ultimate solution, and the future of global neurosurgery is bright.
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Affiliation(s)
- Michael M Haglund
- 1Duke University Division of Global Neurosurgery and Neurology; and
- 2Department of Neurosurgery, Duke University Medical Center; and
- 3Duke University Global Health Institute, Durham, North Carolina
| | - Anthony T Fuller
- 1Duke University Division of Global Neurosurgery and Neurology; and
- 2Department of Neurosurgery, Duke University Medical Center; and
- 3Duke University Global Health Institute, Durham, North Carolina
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16
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Smith ER, Concepcion TL, Mohamed M, Dahir S, Ismail EA, Rice HE, Krishna A. The contribution of pediatric surgery to poverty trajectories in Somaliland. PLoS One 2019; 14:e0219974. [PMID: 31348780 PMCID: PMC6660125 DOI: 10.1371/journal.pone.0219974] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The provision of health care in low-income and middle-income countries (LMICs) is recognized as a significant contributor to economic growth and also impacts individual families at a microeconomic level. The primary goal of our study was to examine the relationship between surgical conditions in children and the poverty trajectories of either falling into or coming out of poverty of families across Somaliland. METHODS This work used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool, a validated household, cross-sectional survey designed to determine the burden of surgical conditions within a community. We collected information on household demographic characteristics, including financial information, and surgical condition history on children younger than 16 years of age. To assess poverty trajectories over time, we measured household assets using the Stages of Progress framework. RESULTS We found there were substantial fluxes in poverty across Somaliland over the study period. We confirmed our study hypothesis and found that the presence of a surgical condition in a child itself, regardless of whether surgical care was provided, either reduced the chances of moving out of poverty or increased the chances of moving towards poverty. CONCLUSION Our study shows that the presence of a surgical condition in a child is a strong singular predictor of poverty descent rather than upward mobility, suggesting that this stressor can limit the capacity of a family to improve its economic status. Our findings further support many existing macroeconomic and microeconomic analyses that surgical care in LMICs offers financial risk protection against impoverishment.
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Affiliation(s)
- Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, United States of America
| | - Tessa L. Concepcion
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Anirudh Krishna
- Sanford School of Public Policy, Duke University, Durham, NC, United States of America
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17
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How Do We Know? Comparisons of Existing Datasets for Overseas Surgical Missions. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00308-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Albutt K, Punchak M, Kayima P, Namanya DB, Shrime MG. Operative volume and surgical case distribution in Uganda's public sector: a stratified randomized evaluation of nationwide surgical capacity. BMC Health Serv Res 2019; 19:104. [PMID: 30728037 PMCID: PMC6366061 DOI: 10.1186/s12913-019-3920-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/22/2019] [Indexed: 02/03/2023] Open
Abstract
Background Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda. Methods A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda’s population. Results A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p < 0·001); but, relative surgical volume/catchment population was greater at the general versus regional level (p = 0·03). Most patients undergoing operations were women (78·3%) with a mean age of 26·9 years. The overall case distribution was 69·0% obstetrics/gynecology, 23·7% general surgery, 4·0% orthopedics, and 3·3% other subspecialties. Cesarean sections were the most common operation (55·8%). Monthly operative volume was strongly predicted by number of surgical, anesthetic, and obstetric physician providers (훽=10·72, p = 0·005, R2 = 0·94) when controlling for confounders. Notably, operative volume was not correlated with availability of electricity, oxygen, light source, suction, blood, instruments, suture, gloves, intravenous fluid, or antibiotics. Conclusion An understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity. These data suggest that surgical workforce is the critical driver of operative volume in the Ugandan public sector. Investment in the surgical workforce is imperative to ensure access to safe, timely, and affordable surgical and anaesthesia care.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Maria Punchak
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Peter Kayima
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Didacus B Namanya
- Ministry of Health, Kampala, Uganda.,Uganda Martyrs University, Nkozi, Uganda
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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19
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Concepcion T, Mohamed M, Dahir S, Adan Ismail E, Poenaru D, Rice HE, Smith ER. Prevalence of Pediatric Surgical Conditions Across Somaliland. JAMA Netw Open 2019; 2:e186857. [PMID: 30646203 PMCID: PMC6484554 DOI: 10.1001/jamanetworkopen.2018.6857] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Although surgical conditions are increasingly recognized as causing a significant health care burden among adults in low- and middle-income countries (LMICs), the burden of surgical conditions among children in LMICs remains poorly defined. OBJECTIVE To estimate the prevalence of pediatric surgical conditions across Somaliland using a nationwide community-based household survey. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted through a national community-based sampling survey from August through December 2017 in Somaliland. Participants were 1503 children surveyed using the Surgeons OverSeas Assessment of Surgical Need (SOSAS). MAIN OUTCOMES AND MEASURES The SOSAS survey contains 2 components, including a section on household demographics, deaths, and financial information and sections querying children's history of surgical conditions. RESULTS In this cross-sectional study that included 1503 children (55.6% male; mean [SE] age, 6.4 [0.1] years), 221 surgical conditions were identified among 196 children, yielding a mean (SE) prevalence of pediatric surgical conditions of 12.2% (1.5%). Only 53 of these 221 surgical conditions (23.7%) had been surgically corrected at the time of the survey. The most common conditions encountered were congenital anomalies (33.8%) and wound-related injuries (24.6%). Nationally, an estimated 256 745 children have surgical conditions, with an estimated 88 345 to 199 639 children having unmet surgical needs. CONCLUSIONS AND RELEVANCE Using national sampling, this study found that children have a high burden of surgical conditions in Somaliland. These data highlight the need for a scale-up of pediatric surgical infrastructure and resources to provide the needed surgical care for children in LMICs.
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Affiliation(s)
- Tessa Concepcion
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
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20
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MacKinnon N, St-Louis E, Yousef Y, Situma M, Poenaru D. Out-of-Pocket and Catastrophic Expenses Incurred by Seeking Pediatric and Adult Surgical Care at a Public, Tertiary Care Centre in Uganda. World J Surg 2018; 42:3520-3527. [PMID: 29858920 DOI: 10.1007/s00268-018-4691-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Surgical care is critical to establish effective healthcare systems in low- and middle-income countries, yet the unmet need for surgical conditions is as high as 65% in Ugandan children. Financial burden and geographical distance are common barriers to help-seeking in adult populations and are unmeasured in the pediatric population. We thus measured out-of-pocket (OOP) expenses and distance traveled for pediatric surgical care in a tertiary hospital in Mbarara, Uganda, as compared to adult surgical and pediatric medical patients. METHODS Patients admitted to pediatric surgical (n = 20), pediatric medical (n = 18) and adult surgical (n = 18) wards were interviewed upon discharge over a period of 3 weeks. Patient and caregiver-reported expenses incurred for the present illness included prior/future care needed, and travel distance/cost. The prevalence of catastrophic expenses (≥10% of annual income) was calculated and spending patterns compared between wards. RESULTS Thirty-five percent of pediatric medical patients, 45% of pediatric surgical patients and 55% of adult surgical patients incurred catastrophic expenses. Pediatric surgical patients paid more for their current treatment (p < 0.01)-specifically medications (p < 0.01) and tests (p < 0.01)-than pediatric medical patients, and comparable costs to adults. Adult patients paid more for treatment prior to the hospital (p = 0.04) and miscellaneous expenses (e.g., food while admitted) (p = 0.02). Patients in all wards traveled comparable distances. CONCLUSIONS Seeking healthcare at a publicly funded hospital is financially catastrophic for almost half of patients. Out-of-stock supplies and broken equipment make surgical care particularly vulnerable to OOP expenses because analgesics, anaesthesia and preoperative imaging are prerequisites to care.
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Affiliation(s)
| | - Etienne St-Louis
- Center for Global Surgery, McGill University Health Centre, Montreal, Canada
| | - Yasmine Yousef
- Center for Global Surgery, McGill University Health Centre, Montreal, Canada
| | | | - Dan Poenaru
- Center for Global Surgery, McGill University Health Centre, Montreal, Canada.
- Montreal Children's Hospital, Rm. B- 04.2022, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada.
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21
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Albutt K, Punchak M, Kayima P, Namanya DB, Anderson GA, Shrime MG. Access to Safe, Timely, and Affordable Surgical Care in Uganda: A Stratified Randomized Evaluation of Nationwide Public Sector Surgical Capacity and Core Surgical Indicators. World J Surg 2018; 42:2303-2313. [PMID: 29368021 DOI: 10.1007/s00268-018-4485-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Access to safe surgery is critical to health, welfare, and economic development. In 2015, the Lancet Commission on Global Surgery recommended that all countries collect surgical indicators to lend insight into improving surgical care. No nationwide high-quality data exist for these metrics in Uganda. METHODS A standardized quantitative hospital assessment and a semi-structured interview were administered to key stakeholders at 17 randomly selected public hospitals. Hospital walk-throughs and retrospective reviews of operative logbooks were completed. RESULTS This study captured information for public hospitals serving 64.0% of Uganda's population. On average, <25% of the population had 2 h access to a surgically capable facility. Hospitals averaged 257 beds/facilities and there were 0.2 operating rooms per 100,000 people. Annual surgical volume was 144.5 cases per 100,000 people per year. Surgical, anesthetic, and obstetrician physician workforce density was 0.3 per 100,000 people. Most hospitals reported having electricity, oxygen, and blood available more than half the time and running water available at least three quarters of the time. In total, 93.8% of facilities never had access to a CT scan. Sterile gloves, nasogastric tubes, and Foley catheters were frequently unavailable. Uniform outcome reporting does not exist, and the WHO safe surgery checklist is not utilized. CONCLUSION The Ugandan public hospital system does not meet LCoGS targets for surgical access, workforce, or surgical volume. Critical policy and programmatic developments are essential to build surgical capacity and facilitate provision of safe, timely, and affordable surgical care. Surgery must become a public health priority in Uganda and other low resource settings.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA.
| | - Maria Punchak
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Didacus B Namanya
- Ministry of Health (MOH), Kampala, Uganda.,Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Geoffrey A Anderson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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22
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Hewitt-Smith A, Bulamba F, Olupot C, Musana F, Ochieng JP, Lipnick MS, Pearse RM. Surgical outcomes in eastern Uganda: a one-year cohort study. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2018. [DOI: 10.1080/22201181.2018.1517476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- A Hewitt-Smith
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - F Bulamba
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - C Olupot
- Mbale Regional Referral Hospital, Mbale, Uganda
| | - F Musana
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - JP Ochieng
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - MS Lipnick
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - RM Pearse
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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23
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Varela C, Young S, Groen R, Banza L, Mkandawire NC, Viste A. Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey. Malawi Med J 2018; 29:231-236. [PMID: 29872512 PMCID: PMC5811994 DOI: 10.4314/mmj.v29i3.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Noncommunicable diseases, such as surgical conditions have received little attention from public health planners in low income countries (LIC) like Malawi. Though increasingly recognised as a growing global health problem, the burden of surgical pathologies and access to surgical care has not been adequately identified in many LIC. Information on the spectrum and burden of surgical disease in Malawi is important to uncover the unmet need for surgery and for planning of the National Health Service. Methods This was a multistage random cluster sampling national survey. Households were selected from clusters using probability proportional to size method. 1448 households and 2909 interviewees were analysed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used to collect data. This electronic tablet based questionnaire tool included general information and a dual personalised head to toe inquiry on surgical conditions. The general information included number of household members, and inquired on any death within the past twelve months, and if any of the deaths in the family had a suspected surgical condition leading to that death. Data was collected by specially trained third year medical students. Results Out of 1480 selected households, 1448 (98%) agreed to participate, with 2909 interviewed individuals included in the study. The median household size was 6 individuals (range 1 – 47). Median age of interviewed persons was 35 years (range 0.25 – 104 years). 1027 out of 2909 (35%) of the interviewed people reported to be living with a condition requiring surgical consultation or intervention, whereas 146 of 616 (24%) of the total deaths reported to have occurred in the preceding 12 months were reported to have died from a surgically related condition. Most individuals did not seek health care due to lack of funds for transportation to the health facility. Only 3.1% of those that reported a surgical condition had surgical intervention. Conclusions There is a large unmet need for surgical care in Malawi. A third of the population is living with a condition needing surgical consultation or intervention, and a quarter of all deaths are potentially avoidable with surgery. Urgent scale up of surgical services and training are needed to reduce this huge gap in public health planning in the country.
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Affiliation(s)
- Carlos Varela
- Kamuzu Central Hospital, Lilongwe, Malawi.,Lilongwe Campus, College of Medicine, University of Malawi, Lilongwe, Malawi.,Institute of Clinical Sciences (K1 and Centre for International Health, University of Bergen, Bergen, Norway
| | - Sven Young
- Kamuzu Central Hospital, Lilongwe, Malawi.,Lilongwe Campus, College of Medicine, University of Malawi, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Reinou Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Obstetrics and Gynaecology, Alaska Native Medical Center, Anchorage, Alaska, USA
| | - Leonard Banza
- Kamuzu Central Hospital, Lilongwe, Malawi.,Lilongwe Campus, College of Medicine, University of Malawi, Lilongwe, Malawi.,Institute of Clinical Sciences (K1 and Centre for International Health, University of Bergen, Bergen, Norway
| | | | - Asgaut Viste
- Institute of Clinical Sciences (K1 and Centre for International Health, University of Bergen, Bergen, Norway.,Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
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Budohoski KP, Ngerageza JG, Austard B, Fuller A, Galler R, Haglund M, Lett R, Lieberman IH, Mangat HS, March K, Olouch-Olunya D, Piquer J, Qureshi M, Santos MM, Schöller K, Shabani HK, Trivedi RA, Young P, Zubkov MR, Härtl R, Stieg PE. Neurosurgery in East Africa: Innovations. World Neurosurg 2018; 113:436-452. [PMID: 29702967 DOI: 10.1016/j.wneu.2018.01.085] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the last 10 years, considerable work has been done to promote and improve neurosurgical care in East Africa with the development of national training programs, expansion of hospitals and creation of new institutions, and the foundation of epidemiologic and cost-effectiveness research. Many of the results have been accomplished through collaboration with partners from abroad. This article is the third in a series of articles that seek to provide readers with an understanding of the development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare in the region (Innovations). In this article, we describe the ongoing programs active in East Africa and their current priorities, and we outline lessons learned and what is required to create self-sustained neurosurgical service.
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Affiliation(s)
- Karol P Budohoski
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Japhet G Ngerageza
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Benedict Austard
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Anthony Fuller
- Duke Global Neurosurgery and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Robert Galler
- Department of Neurosurgery, Stony Brook Neuroscience Institute, New York, New York, USA
| | - Michael Haglund
- Duke Global Neurosurgery and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Ronald Lett
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | | | - Halinder S Mangat
- Division of Stroke and Critical Care, Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Karen March
- University of Washington School of Nursing, Seattle, Washington, USA
| | - David Olouch-Olunya
- Department of Neurosurgery, Kenyatta Hospital, University of Nairobi, Nairobi, Kenya
| | - José Piquer
- Neurosurgical Unit, Hospital Universitario de la Ribera, Valencia, Spain
| | - Mahmood Qureshi
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Maria M Santos
- Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Karsten Schöller
- Department of Neurosurgery, Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Rikin A Trivedi
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Paul Young
- Department of Neurosurgery, University of St. Louis, St. Louis, Missouri, USA
| | - Micaella R Zubkov
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.
| | - Philip E Stieg
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill-Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
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Albutt K, Yorlets RR, Punchak M, Kayima P, Namanya DB, Anderson GA, Shrime MG. You pray to your God: A qualitative analysis of challenges in the provision of safe, timely, and affordable surgical care in Uganda. PLoS One 2018; 13:e0195986. [PMID: 29664956 PMCID: PMC5903624 DOI: 10.1371/journal.pone.0195986] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception. METHODS From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care. The framework approach was used for thematic and explanatory data analysis. RESULTS The Ugandan public health care sector continues to face significant challenges in the provision of safe, timely, and affordable surgical care. These challenges can be broadly grouped into preparedness and policy, service delivery, and the financial burden of surgical care. Hospital staff reported challenges including: (1) significant delays in accessing surgical care, compounded by a malfunctioning referral system; (2) critical workforce shortages; (3) operative capacity that is limited by inadequate infrastructure and overwhelmed by emergency and obstetric volume; (4) supply chain difficulties pertaining to provision of essential medications, equipment, supplies, and blood; (5) significant, variable, and sometimes catastrophic expenditures for surgical patients and their families; and (6) a lack of surgery-specific policies and priorities. Despite these challenges, innovative strategies are being used in the public to provide surgical care to those most in need. CONCLUSION Barriers to the provision of surgical care are cross-cutting and involve constraints in infrastructure, service delivery, workforce, and financing. Understanding current strengths and shortfalls of Uganda's surgical system is a critical first step in developing effective, targeted policy and programming that will build and strengthen its surgical capacity.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America
| | - Rachel R. Yorlets
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maria Punchak
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Didacus B. Namanya
- Ministry of Health (MOH), Kampala, Uganda
- Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Geoffrey A. Anderson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America
| | - Mark G. Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Boston, Massachusetts, United States of America
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Pilot Use of a Novel Tool to Assess Neurosurgical Capacity in Uganda. World Neurosurg 2017; 108:844-849.e4. [DOI: 10.1016/j.wneu.2017.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 11/20/2022]
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Abdelgadir J, Tran T, Muhindo A, Obiga D, Mukasa J, Ssenyonjo H, Muhumza M, Kiryabwire J, Haglund MM, Sloan FA. Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis. World Neurosurg 2017; 101:651-657. [DOI: 10.1016/j.wneu.2017.02.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
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