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Nthumba PM. Global Surgery: The Challenges and Strategies to Win a War That Must Be Won. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5953. [PMID: 38962157 PMCID: PMC11221857 DOI: 10.1097/gox.0000000000005953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/17/2024] [Indexed: 07/05/2024]
Abstract
Background Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in 2015, has not made much progress. The burden of surgical disease in low- and middle-income countries remains seemingly unconquerable, and its growth unstoppable. The myriad challenges in meeting the surgical needs of 5 billion people has intrigued the author. Methods The author collected the views of plastic surgeons on sources and impediments to the scale-up of plastic surgery in low- and middle-income countries, as well as potential strategies for overcoming these obstacles. The author then performed a literature search reviewing the topics that arose from those discussions. The author proposes a strategy using plastic surgery as a model surgical discipline. Results A root-cause analysis suggests that the Alma Ata Declaration, with its focus on primary healthcare, is the probable genesis of global surgery (GS) woes. The absence of a clear GS community leader and the fragmented nature of GS advocates who operate in multiple silos, without a clear unified goal, are the primary reasons GS advocates have achieved so little on the ground. Conclusions Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully.
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Affiliation(s)
- Peter M. Nthumba
- From Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
- Department of Plastic Surgery, Baylor College of Medicine, Temple, Tex
- EACH Research, Kijabe, Kenya
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Nthumba PM, Odhiambo M, Pusic A, Kamau S, Rohde C, Onyango O, Gosman A, Vyas R, Nthumba MN. The State of Surgical Research in Sub-Saharan Africa: An Urgent Call for Surgical Research Trainers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5903. [PMID: 38881962 PMCID: PMC11177832 DOI: 10.1097/gox.0000000000005903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/01/2024] [Indexed: 06/18/2024]
Abstract
Background Surgery in low- and middle-income countries (LMICs) is poorly developed because of years of neglect. Sustained research on global surgery led to its recognition as an indivisible and indispensable part of primary healthcare in 2015. However, this has had little visible effect on surgical ecosystems within LMICs, especially in sub-Saharan Africa (SSA). SSA surgical research systems strengthening, which includes skills transfer, with local priority setting driving the research agenda, is needed to propel global surgery into the future. Methods The authors performed a literature review of the state of surgical research within SSA and also report the initial efforts of two research training nonprofits to empower young African surgeons with research skills. Results Surgical research in SSA is disadvantaged even before it is birthed, facing monumental challenges at every stage of development, from research agenda determination to funding, study execution, and publication. Compared with a global output of 17.49 publications per 100,000 population, SSA produces 0.9 (P < 0.0001). The Surgeons in Humanitarian Alliance for Reconstructive, Research, and Education and Enabling Africa Clinical Health Research programs are involved in the longitudinal research mentorship of surgical residents within SSA; the improved quality of research and successful publications by participants suggest nascent steps in growing young surgical scientists. Conclusions In the absence of an existing surgical research infrastructure within LMICs, global surgery research trainers should link up and collaborate to help develop a surgical research community that will provide the local data required to help transform the SSA surgical ecosystem.
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Affiliation(s)
- Peter M Nthumba
- From the Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
- Department of Plastic Surgery, Baylor College of Medicine, Temple, Tex
- EACH Research, University of Nairobi, Nairobi, Kenya
| | - Moses Odhiambo
- From the Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- EACH Research, University of Nairobi, Nairobi, Kenya
| | - Andrea Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Stephen Kamau
- EACH Research, University of Nairobi, Nairobi, Kenya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Christine Rohde
- Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York, N.Y
| | - Onesmus Onyango
- EACH Research, University of Nairobi, Nairobi, Kenya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Amanda Gosman
- Department of Plastic Surgery, UC San Diego School of Medicine, Calif
| | - Raj Vyas
- Department of Plastic Surgery, UC Irvine, School of Medicine, Irvine, Calif
| | - Michelle N Nthumba
- EACH Research, University of Nairobi, Nairobi, Kenya
- African Women's Studies Centre, University of Nairobi, Nairobi, Kenya
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Dje Bi Dje-Assi V, Amouzou KS, Kouevi-Koko TE, Jalloh A. African primary research publications in plastic surgery: A PRISMA-S-compliant systematic review. J Plast Reconstr Aesthet Surg 2024; 91:421-429. [PMID: 38479124 DOI: 10.1016/j.bjps.2024.01.058] [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: 04/05/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Plastic surgery (PS) in Africa is a relatively young surgery specialty, and the number of available plastic surgeons on average is one or two surgeons per country in many African low-income countries. This systematic review aims to geographically map the research activities through scientific publications of African PS centres, between February 2012-February 2023. METHODS We searched four literature databases (Medline, Embase, Google Scholar and African Journal Online) and did a manual search. We included case reports, randomised controlled trials, and clinical, comparative, observational and multicentre studies conducted in Africa and published in English and French. In the Google Scholar database, we analysed the first 200 references (scientific articles) selected per relevance according to the Boolean terms. In the African Journals Online database, we analysed the references from the first five pages. The selected keywords were: burns, trauma reconstruction, pressure injuries, wound, cleft lip and palate, breast reconstruction, microsurgery, aesthetic surgery, face surgery, head and neck surgery, hand surgery, open fracture surgery, oculoplastic surgery, skin surgery, and soft tissue surgery. RESULTS We retrieved a total of 228 articles. Out of the 73 African centres we identified, 27 were in the North, 22 in the West, 8 in the East, 3 in the Centre, and 14 in the South. Most of the retrieved 228 articles involved burns (60, 26.31%), congenital abnormalities (52, 22.80%) and reconstruction (28,12.80%); however, other conditions, such as breast or skin cancer, hand surgery, microsurgery or aesthetics are emerging. The studies were case reports/case series (93, 40.78%), retrospective (78, 34.21%), prospective (36, 15.78%), randomised controlled studies (10, 4.38%), cross-sectional (5, 2,19%) and cohort (2, 0.87%). CONCLUSIONS Beyond burns, congenital abnormalities, or reconstructions, other PS indications are emerging, such as skin cancer, breast reconstruction, hand surgery, microsurgery, and aesthetics.
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Affiliation(s)
- Valerie Dje Bi Dje-Assi
- Service de Chirurgie Plastique, Reconstructice et Esthétique, Chirurgie de la main et de Brulologie du CHU de Treichville, Abidjan, Ivory Coast
| | - Komla Séna Amouzou
- Department of Surgery, University of Lomé, Sylvanus Olympio Teaching Hospital, Lomé, Togo.
| | - Tete Edem Kouevi-Koko
- Department of Surgery, University of Lomé, Sylvanus Olympio Teaching Hospital, Lomé, Togo
| | - Abdulai Jalloh
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Davidson A, Anderson B. Consent issues for vulnerable children in sub-Saharan Africa and beyond. Paediatr Anaesth 2023; 33:995-996. [PMID: 37746930 DOI: 10.1111/pan.14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Andrew Davidson
- Department of Anaesthesia, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Brian Anderson
- Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand
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Malapati SH, Ramly EP, Riesel J, Pusic AL, Lee GK, Magee WP, Nthumba PM. Safety and Sustainability: Optimizing Outcomes and Changing Paradigms in Global Health Endeavors. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5256. [PMID: 37691703 PMCID: PMC10489197 DOI: 10.1097/gox.0000000000005256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/21/2023] [Indexed: 09/12/2023]
Abstract
Background The need to address inequities in global surgical care has garnered increased attention since 2015, after the Lancet Commission on Global Surgery underscored the importance of ensuring safe, accessible, affordable, and timely surgical and anesthetic care. The vast unmet global plastic surgery needs make plastic surgery care essential in reducing the global burden of disease. In the past, many nonprofit organizations undertook humanitarian activities within low- and middle-income countries that were primarily service-provision oriented. The Lancet Commission on Global Surgery report prompted a shift in focus from direct patient care models to sustainable global surgical models. The realization that 33% of deaths worldwide were due to unmet surgical needs led to a global shift of strategy toward the development of local systems, surgical capacity, and a focus on patient safety and quality of care within international global surgery partnerships. Methods In this report, the authors explore some of the primary components of sustainable international global surgical partnerships discussed in a recent panel at the American Society of Plastic Surgeons Plastic Surgery The Meeting 2022, titled "Safety and Sustainability Overseas: Optimizing Outcomes and Changing Paradigms in Global Health Endeavors." A literature review elaborating the topics discussed was performed. Results This report focuses on cultural competence and humility, international collaboration, and the use of technology and innovation, all of which are needed to promote sustainability and patient safety, within global surgery efforts. Conclusions The adoption of these components into international surgical collaborations will lead to greatly enhancing the development and sustainability of mutually beneficial relationships.
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Affiliation(s)
| | - Elie P. Ramly
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Johanna Riesel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea L. Pusic
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Gordon K. Lee
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif
| | - William P. Magee
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, Calif
| | - Peter M. Nthumba
- Plastic, Reconstructive, and Hand Surgery Unit, AIC Kijabe Hospital, Kijabe, Kenya.Kijabe, Kenya
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Gray R, Desalu R, Gathuya Z, Ndikontar Kwinji R, Nabukenya MT, Newton M, Osazuwa M, Sarpong P, Evans FM. The narrative must change: Ethical research tenets do not change when you cross borders. Paediatr Anaesth 2023; 33:773-774. [PMID: 37313641 DOI: 10.1111/pan.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Rebecca Gray
- Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Ronke Desalu
- Department of Anaesthesia, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria
- Department of Anaesthesia, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Raymond Ndikontar Kwinji
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
- Department of Anesthesia and Intensive Care, Yaounde Gyneco Obstetric and Pediatric Hospital, Yaounde, Cameroon
| | - Mary T Nabukenya
- Department of Anaesthesia, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mark Newton
- Department of Anesthesiology and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maryrose Osazuwa
- Department of Anaesthesia, National Hospital Abuja, Abuja, Nigeria
| | - Pokua Sarpong
- Department of Anaesthesia, Korle Bu Teaching Hospital, Accra, Ghana
| | - Faye M Evans
- The Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Dare T, Anderson S. Editorial: Ethics and short-term surgical visits to low-income countries. Paediatr Anaesth 2023; 33:272-273. [PMID: 36876472 DOI: 10.1111/pan.14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 03/07/2023]
Affiliation(s)
- Tim Dare
- Philosophy, Te Kura Tangata, University of Auckland, Auckland, New Zealand
| | - Sarah Anderson
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Sachse K. Building Anesthesia Capacity in the Developing World. Adv Anesth 2022; 40:63-69. [PMID: 36333052 DOI: 10.1016/j.aan.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Over two-thirds of the world's population do not have access to safe surgical and anesthetic care. Barriers to care include a lack of specialty trained personnel and unavailability of essential operating room resources. Aid efforts with the greatest impact focus on forming partnerships between high- and low-income communities, with the goal of creating self-sustaining programs run by local communities. Together these partnerships can work to build local capacity and expand the trained workforce by educating local providers.
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Affiliation(s)
- Kaylyn Sachse
- Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 The Vanderbilt Clinic, Nashville, TN 37232-5614, USA.
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Global pediatric surgery and anesthesia inequities: how do we have a global effort? Curr Opin Anaesthesiol 2022; 35:351-356. [PMID: 35671023 DOI: 10.1097/aco.0000000000001122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The SARS-CoV-2 (COVID-19) pandemic has highlighted the inequities in access to healthcare while also revealing our global connectivity. These inequities are emblematic of decades of underinvestment in healthcare systems, education, and research in low-middle income countries (LMICs), especially in surgery and anesthesiology. Five billion people remain without access to safe surgery, and we must take appropriate action now. RECENT FINDINGS The pediatric perioperative mortality in low-resourced settings may be as high as 100 times greater than in high-resourced settings, and a pediatric surgery workforce density benchmark of 4/1 million population could increase survivability to over 80%. Delay in treatment for congenital surgically correctable issues dramatically increases disability-adjusted life years. Appropriate academic partnerships which promote education are desired but the lack of authorship position priority for LMIC-based researchers must be addressed. Five perioperative benchmark indicators have been published including: geospatial access to care within 2 h of location; workforce/100,000 population; volume of surgery/100,000 population; perioperative mortality within 30 days of surgery or until discharged; and risks for catastrophic expenditure from surgical care. SUMMARY Research that determines ethical and acceptable partnership development between high- and low-resourced settings focusing on education and capacity building needs to be standardized and followed.
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Hamilton ARL, Dylewski Begis M, Vo V, Fuzaylov G. The role of global health opportunities for professional development during anaesthesiology training: A primary survey study. Anaesth Intensive Care 2022; 50:325-328. [PMID: 35086363 DOI: 10.1177/0310057x211051752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Rebecca L Hamilton
- Division of Pediatric Anesthesia, Department of Anesthesia, Critical Care and Pain Medicine, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Department of Cell and Molecular Biology, 27106Karolinska Institute, Karolinska Institute, Stockholm, Sweden
| | - Maggie Dylewski Begis
- Department of Agriculture, Nutrition and Food Systems, 3067University of New Hampshire, University of New Hampshire, Durham, USA
| | - Victoria Vo
- Department of Anesthesiology and Perioperative Medicine, 1867Tufts Medical Center, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Gennadiy Fuzaylov
- Division of Pediatric Anesthesia, Department of Anesthesia, Critical Care and Pain Medicine, 2348Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Sarpong K, Fadalla T, Garba DL, Suliman M, Rolle M, Ammar A, Hussen H, Park KB. Access to training in neurosurgery (Part 1): Global perspectives and contributing factors of barriers to access. BRAIN AND SPINE 2022; 2:100900. [PMID: 36248138 PMCID: PMC9560711 DOI: 10.1016/j.bas.2022.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/21/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
Abstract
Introduction Neurological disorders are one of the leading causes of death and disability adjusted life years (DALYs). Efforts have been made to increase the neurosurgical workforce in an attempt to address the global disease burden. Despite these efforts, there continues to be a shortage of neurosurgeons in both high-income countries (HICs) and low-and middle-income countries (LMICs). Research question The aim of the study was to identify the barriers to neurosurgical training in LMICs and HICs. Materials and methods We administered an electronic survey targeting medical students, neurosurgery residents, and recent neurosurgery graduates from 69 countries in both HICs and LMICs. Questions were framed to assess barriers to training. Results Of the 198 responses received (31.3% response rate), 72% identified as male, 27% female, and 0.5% as non-binary gender. 33 respondents were from HICs and 165 were from LMICs. 70.1% of respondents reported no availability of dissection labs in their home institutions. There was a significant difference in availability of subspecialty training between LMICs and HMICs (p = 0.001) but no significance was seen for competitiveness of programs (p = 0.473). Discussion and conclusion There are limitations to our study: it is not comprehensive of training programs globally, there is sampling bias, especially among LMICs, and the accuracy of responses is unclear. Nonetheless, our results highlight the need for a deliberate focus on designing and implementing both short and long term goals in tackling barriers to access to neurosurgical training, with a conscientious effort to involve interested stakeholders and governments to invest in the training and education of their neurosurgical workforce. In comparing LMICs to HICs, there was no significant difference found in ranked competitiveness for entering neurosurgical training. A significant difference was found in weekly work hours (p = 0.016) and subspecialty training availability (p = 0.001) between LMICs and HMICs. 54.4% of countries represented in our study did not have neurosurgical subspecialty training available. A significant number of our respondents (70.1%) reported no availability of dissection and surgical skills labs in their home institutions.
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Nthumba PM. Commentary on 'Academic Global Surgery Curricula - Current Status and a Call for a More Equitable Approach'. J Surg Res 2021; 267:730-731. [PMID: 34905822 DOI: 10.1016/j.jss.2021.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Peter Muli Nthumba
- Department of Plastic Surgery, AIC Kijabe Hospital, Kenya; Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
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