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Richard K, Sanchez R, Amado B, Lubner R, Niconchuk J, Chen H, Phillips J, Kynes M, Belcher RH. Pediatric Otolaryngology Short-Term Mission Outcomes at a Surgical Mission Hospital in Guatemala. Otolaryngol Head Neck Surg 2024; 170:252-259. [PMID: 37466003 DOI: 10.1002/ohn.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes. STUDY DESIGN Retrospective cohort study. SETTING Guatemalan surgery center is called the Moore Center. METHODS Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. RESULTS A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. CONCLUSION This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.
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Affiliation(s)
- Kelsey Richard
- Medical Doctorate Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Barbara Amado
- Centro Quirugico Pediatrico Moore, Guatemala City, Guatemala
| | - Rory Lubner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Niconchuk
- Department of Anesthesia, Pediatric Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Phillips
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
| | - Matthew Kynes
- Department of Anesthesia, Pediatric Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan H Belcher
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
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Huerta S, Huchim-Peña CJ, Ta T, Quiñones ME, Mendoza JA, Corzo VF, Ortiz C. Patients', Local Staff, and Medical Students' Perceptions on a Medical Mission Trip to Guatemala. Curr Probl Surg 2023; 60:101378. [PMID: 37993236 DOI: 10.1016/j.cpsurg.2023.101378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, Dallas, TX; Hospital Nacional de San Benito, El Peten, Guatemala.
| | - Cristian J Huchim-Peña
- Federico Gomez Children's Hospital of Mexico, Mexico City, Mexico; Faculty of Medicine, Autonomous University of Yucatan, Merida, Yucatan, Mexico
| | - Timothy Ta
- Texas A&M University, College Station, TX
| | | | | | | | - Cesar Ortiz
- Hospital Nacional de San Benito, El Peten, Guatemala
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Worlton TJ, Gunasingha RMKD, Atwood R, Johnson M, Uber IC. A Decade of Surgery Aboard the U.S. Naval Ship COMFORT (T-AH 20). Mil Med 2023; 188:e1802-e1807. [PMID: 36242546 DOI: 10.1093/milmed/usac278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The U.S. Naval Ship COMFORT has performed six humanitarian assistance and disaster relief mission since 2007. This paper describes the surgical volume per surgical specialty for five missions spanning 19 countries. MATERIALS AND METHODS Raw surgical case logs were analyzed for total case volume, total operating days, unanticipated return to operating room, and percentage of pediatric cases (<18 years old) for each country visited. RESULTS Total surgical volume for the five missions was 5,142. The countries most frequently visited were Columbia and Haiti with seven and five visits, respectively. General surgery, ophthalmology, and plastic surgery have had consistent volume over time. Orthopedic surgery volume has steadily decreased with the exception of the 2018 mission. CONCLUSION As volume in military treatment facilities declines, alternative sources of surgical volume for military surgeons are being examined. This paper highlights the historical volume which can inform future personnel planning requirements of U.S. Naval Ship COMFORT missions. With the exception of orthopedic surgery, surgical volume has remained consistent over the last decade. For future best practice, historical case data should be used to determine staffing needs on hospital ships and case logs and operating procedures and follow-up protocols should be standardized.
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Affiliation(s)
- Tamara J Worlton
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | | | - Rex Atwood
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Mark Johnson
- Department of General Surgery, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA
| | - Ian C Uber
- Department of Ophthalmology, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA
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Velin L, Lantz A, Ameh EA, Roy N, Jumbam DT, Williams O, Elobu A, Seyi-Olajide J, Hagander L. Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries. BMJ Glob Health 2022; 7:e008791. [PMID: 35483711 PMCID: PMC9052057 DOI: 10.1136/bmjgh-2022-008791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The shortage of surgeons, anaesthesiologists and obstetricians in low-income and middle-income countries (LMICs) is occasionally bridged by foreign surgical teams from high-income countries on short-term visits. To advise on ethical guidelines for such activities, the aim of this study was to present LMIC stakeholders' perceptions of visiting surgical teams from high-income countries. METHOD We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in November 2021, using standardised search terms in PubMed/Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO) and Global Index Medicus, and complementary hand searches in African Journals Online and Google Scholar. Included studies were analysed thematically using a meta-ethnographic approach. RESULTS Out of 3867 identified studies, 30 articles from 15 countries were included for analysis. Advantages of visiting surgical teams included alleviating clinical care needs, skills improvement, system-level strengthening, academic and career benefits and broader collaboration opportunities. Disadvantages of visiting surgical teams involved poor quality of care and lack of follow-up, insufficient knowledge transfers, dilemmas of ethics and equity, competition, administrative and financial issues and language barriers. CONCLUSION Surgical short-term visits from high-income countries are insufficiently described from the perspective of stakeholders in LMICs, yet such perspectives are essential for quality of care, ethics and equity, skills and knowledge transfer and sustainable health system strengthening. More in-depth studies, particularly of LMIC perceptions, are required to inform further development of ethical guidelines for global surgery and support ethical and sustainable strengthening of LMIC surgical systems.
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Affiliation(s)
- Lotta Velin
- Department of Biomedical and Clinical Sciences, Linköping University, Centre for Teaching and Research in Disaster Medicine and Traumatology, Linkoping, Sweden
| | - Adam Lantz
- Department of Clinical Sciences in Lund, Orthopedic Surgery, Helsingborg Hospital, Faculty of Medicine, Lund University, Lund, Sweden
| | - Emmanuel A Ameh
- Department of Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Mumbai, India
- The George Institute for Global Health, New Delhi, India
| | - Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Omolara Williams
- Department of Surgery, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Alex Elobu
- Gastrointestinal Surgery, Mulago Hospital, Kampala, Uganda
- Institute of Digestive Diseases, Kampala, Uganda
| | - Justina Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Lars Hagander
- Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden
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Shapiro LM, Park MO, Mariano DJ, Kamal RN. Development of a Needs Assessment Tool to Promote Capacity Building in Hand Surgery Outreach Trips: A Methodological Triangulation Approach. J Hand Surg Am 2020; 45:729-737.e1. [PMID: 32561162 DOI: 10.1016/j.jhsa.2020.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/03/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The surgical burden in low- and middle-income countries (LMIC) is immense. Despite the increase in resources invested in surgical outreach trips to LMIC, there is no consistent process for understanding the needs of the site and for preparing the necessary resources to deliver care. Given the importance and lack of a comprehensive and standardized needs assessment tool, we aimed to create a tool that assesses the needs and capacity of a site to inform site selection and expectations and improve quality of care. METHODS We used methodological triangulation, a technique that incorporates multiple and different types of data collection methods to study a phenomenon. We used 2 standardized World Health Organization (WHO) tools to develop a hand surgery-specific needs assessment tool. We then identified missing items and made refinements as a result of field testing at 2 facilities and qualitative analysis of semistructured interviews of hand surgeons with international outreach experience. Interviews were coded and analyzed using conductive content analysis. Key concepts explored included domains and subdomains pertaining to essential considerations prior to a hand surgery outreach trip. RESULTS Current generic needs assessment tools do not capture all necessary domains and subdomains for a hand surgery outreach trip. The WHO tools provide a framework for reference and foundation; field testing and qualitative interviews identified hand surgery-specific items. We developed a tool that includes 7 domains: (1) human resources; (2) physical resources; (3) procedures; (4) cultural and language barriers; (5) safety, quality, and access; (6) regulation and cost; and (7) knowledge transfer and teaching and associated subdomains relevant to hand surgery. CONCLUSIONS A hand surgery-specific standardized needs assessment tool may ensure appropriate resources and personnel are deployed for outreach trips to improve site selection, expectation setting, and quality of care. CLINICAL RELEVANCE A needs assessment tool is a standardized, comprehensive tool to assess the needs and capacity of a new site prior to hand surgery outreach trips to improve site selection, expectation setting, and delivery of high-quality, safe, and effective care in LMIC.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA; Sustainable Global Surgery, Palo Alto, CA
| | - Meewon O Park
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - David J Mariano
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- Sustainable Global Surgery, Palo Alto, CA; VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
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Al-Hadidi A, Alslaim H, Ghawanmeh M, Alfarajat F, Habra H, Brahmamdam P, Novotny N. Short-term surgical trips: local collaboration and its effects on complications and patient satisfaction. Pediatr Surg Int 2020; 36:977-981. [PMID: 32415355 DOI: 10.1007/s00383-020-04667-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Short-term surgical missions can provide communities in need with desired expertise; however, it is uncertain who will manage the complications after visiting experts leave. Poor outcomes, decreased patient satisfaction, and tension on the healthcare system develop when local providers, often excluded from the initial patient care, are unable to cope with subsequent morbidity. METHODS Two-year retrospective review of pediatric general, plastic, and reconstructive surgery, and urology cases performed by a relief organization in the developing world. Case complexity and postoperative complications were analyzed. Phone interviews conducted with patients/families to quantify postoperative outcomes and satisfaction. RESULTS 474 surgeries were performed on pediatric patients with 60% response rate. Respondents stratified into three levels of complexity: 159 simple, 72 intermediate, and 54 advanced surgeries. Six (2.1%) high-level complications occurred. No association between the complexity of the surgery and the occurrence of a complications. 83.5% were satisfied with outcomes and > 92% were happy with the provided support. CONCLUSION Facilitating visiting and local surgeons performing cases together increases the expertise of local providers, strengthens infrastructure, and establishes clear follow-up. Despite complications, patients and families continued to recommend care to family and friends by the relief organization and were happy with support from local providers. Engaging local providers is the gold-standard for short-term trips.
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Affiliation(s)
- Ameer Al-Hadidi
- Department of General Surgery, Beaumont Health, 3535 W. 13 Mile Rd Ste 307, Royal Oak, MI, 48073, USA.
| | - Hossam Alslaim
- Department of General Surgery, Medical College of Georgia, Augusta, Georgia.,Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Hani Habra
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Pavan Brahmamdam
- Department of Pediatric Surgery, Beaumont Children's, Beaumont Health, Royal Oak, MI, USA
| | - Nathan Novotny
- Department of Pediatric Surgery, Beaumont Children's, Beaumont Health, Royal Oak, MI, USA
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Bath M, Bashford T, Fitzgerald JE. What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health 2019; 4:e001808. [PMID: 31749997 PMCID: PMC6830053 DOI: 10.1136/bmjgh-2019-001808] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/20/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
'Global surgery' is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings.
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Affiliation(s)
- Michael Bath
- Centre for Neuroscience, Surgery, and Trauma, Queen Mary University of London, London, UK
| | - Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, Division of Anaesthesia, University of Cambridge, Cambridge, UK
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