Expansion of Reconstructive Surgical Capacity in Vietnam: Experience from the ReSurge Global Training Program.

BACKGROUND: Building local surgical capacity in low-income and middle-income countries is critical to addressing the unmet global surgical need. Visiting educator programs can be utilized to train local surgeons, but the quantitative impact on surgical capacity has not yet been fully described. The authors' objective was to evaluate the effectiveness of training utilizing a visiting educator program on local reconstructive surgical capacity in Vietnam. METHODS: A reconstructive surgery visiting educator program was implemented in Vietnam. Topics of training were based on needs defined by local surgeons, including those specializing in hand surgery, microsurgery, and craniofacial surgery. A retrospective analysis of annual case numbers corresponding to covered topics between the years 2014 and 2019 at each hospital was conducted to determine reconstructive surgical volume and procedures per surgeon over time. Direct costs, indirect costs, and value of volunteer services for each trip were calculated. RESULTS: Over the course of 5 years, 12 visiting educator trips were conducted across three hospitals in Vietnam. Local surgeons subsequently independently performed a total of 2018 operations corresponding to topics covered during visiting educator trips, or a mean of 136 operations annually per surgeon. Within several years, the hospitals experienced an 81.5 percent increase in surgical volume for these reconstructive clinical conditions, and annual case volume continues to increase over time. Total costs were $191,290, for a mean cost per trip of $15,941. CONCLUSIONS: Surgical capacity can be successfully expanded by utilizing targeted visiting educator trips to train local reconstructive surgeons. Local providers ultimately independently perform an increased volume of complex procedures and provide further training to others.

An Assessment Tool for Hand Surgical Education Needs and Capacity in Resource-Limited Settings.

BACKGROUND: Hand surgeons have the potential to substantially decrease the surgical disability burden in the developing world through educator trips. The Lancet Commission supports contextually driven educator trips grounded in the needs of local hosts, yet few organizations perform a comprehensive assessment of learning interests or the hosting institutions' surgical capacity before the trips. METHODS: The authors adapted the Personnel, Infrastructure, Procedures, Equipment, and Supplies questionnaire, which was modified from the World Health Organization's validated Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. The authors revised each aspect of the questionnaire to reflect items pertinent to upper extremity surgery and hand trauma care. They added sections to gauge self-identified learning needs, local disease burden, operative resources, and current practices. The tool was distributed by means of Qualtrics; descriptive statistics were used to summarize data. The authors analyzed the data for all participants and performed two subgroup analyses to examine variation by regions and countries. RESULTS: The authors received 338 responses from 27 countries. There was wide variability in local surgical disease burden, learning interests, and skill level of upper extremity procedures. Although learners were most interested in learning tendon transfers and microsurgical techniques, the majority did not have adequate infrastructure at their institution to sustain capacity for microvascular procedures. CONCLUSIONS: Needs assessments can gauge how best to provide education during short-term visiting educator trips and optimize its impact in resource-limited settings. Understanding the needs, learning interests, and availability of resources of local learners is imperative to creating a sustainable global surgical workforce.

Missions, Humanitarianism, and the Evolution of Modern Global Surgery.

Modern global surgery, which aims to provide improved and equitable surgical care worldwide, is a product of centuries of international care initiatives, some borne out of religious traditions, dating back to the first millennium. The first hospitals (xenodochia) were established in the 4th and 5th centuries CE by the early Christian church. Early "missions," a term introduced by Jesuit Christians in the 16th century to refer to the institutionalized expansion of faith, included medical care. Formalized Muslim humanitarian medical care was marked by organizations like the Aga Khan Foundation and the Islamic Association of North America in the 20th century. Secular medical humanitarian programs developed in the 19th century, notably with the creation of the International Committee of the Red Cross (1863) and the League of Nations Health Organization (1920) (which later became the World Health Organization [1946]). World War II catalyzed another proliferation of nongovernmental organizations, epitomized by the quintessential humanitarian health provider, Médecins Sans Frontières (1971). "Global health" as an academic endeavor encompassing education, service, and research began as an outgrowth of departments of tropical medicine and international health. The American College of Surgeons brought a surgical focus to global health beginning in the 1980s. Providing medical care in distant countries has a long tradition that parallels broad themes in history: faith, imperialism, humanitarianism, education, and service. Surgery as a focus of academic global health is a recent development that continues to gain traction.

Local and Visiting Physician Perspectives on Short Term Surgical Missions in Guatemala: A Qualitative Study.

OBJECTIVE: To explore the impact of short-term surgical missions (STMs) on medical practice in Guatemala as perceived by Guatemalan and foreign physicians. SUMMARY BACKGROUND DATA: STMs send physicians from high-income countries to low and middle-income countries to address unmet surgical needs. Although participation among foreign surgeons has grown, little is known of the impact on the practice of foreign or local physicians. METHODS: Using snowball sampling, we interviewed 22 local Guatemalan and 13 visiting foreign physicians regarding their perceptions of the impact of Guatemalan STMs. Interviews were transcribed verbatim, iteratively coded, and analyzed to identify emergent themes. Findings were validated through triangulation and searching for disconfirming evidence. RESULTS: We identified 2 overarching domains. First, the delivery of surgical care by both Guatemalan and foreign physicians was affected by practice in the STM setting. Differences from usual practice manifested as occasionally inappropriate utilization of skills, management of postoperative complications, the practice of perioperative care versus "pure surgery," and the effect on patient-physician communication and trust. Second, both groups noted professional and financial implications of participation in the STM. CONCLUSIONS: While Guatemalan physicians reported a net benefit of STMs on their careers, they perceived STMs as an imperfect solution to unmet surgical needs. They described missed opportunities for developing local capacity, for example through education and optimal resource planning. Foreign physicians described costs that were manageable and high personal satisfaction with STM work. STMs could enhance their impact by strengthening working relationships with local physicians and prioritizing sustainable educational efforts.

The governance of overseas surgical collaborations - BFIRST/BSSH.

Clinical governance is the structured approach to maintaining and improving the quality of patient care and is a vital part of global surgery. BFIRST and BSSH closely collaborate with local doctors on a number of overseas projects, seeking to strengthen and develop local knowledge and skills, aiming for an independent local practice in reconstructive and upper limb surgery. Thoughts on essential requirements, improvements and pitfalls in the ethical approach to global collaboratives are presented.

The All Babies Count Initiative: Impact of a Health System Improvement Approach on Neonatal Care and Outcomes in Rwanda.

INTRODUCTION: Poor-quality care contributes to a significant portion of neonatal deaths globally. The All Babies Count (ABC) initiative was an 18-month district-wide approach designed to improve clinical and system performance across 2 rural Rwandan districts. METHODS: This pre-post intervention study measured change in maternal and newborn health (MNH) quality of care and neonatal mortality. Data from the facility and community health management information system and newly introduced indicators were extracted from facility registers. Medians and interquartile ranges were calculated for the health facility to assess changes over time, and a mixed-effects logistic regression model was created for neonatal mortality. A difference-in-differences analysis was conducted to compare the change in district neonatal mortality with the rest of rural Rwanda. RESULTS: Improvements were seen in multiple measures of facility readiness and MNH quality of care, including antenatal care coverage, preterm labor management, and postnatal care quality. District hospital case fatality decreased, with a statistically significant reduction in district neonatal mortality (odds ratio [OR]=0.54; 95% confidence interval [CI]=0.36, 0.83) and among preterm/low birth weight neonates (OR=0.47; 95% CI=0.25, 0.90). Neonatal mortality was reduced from 30.1 to 19.6 deaths/1,000 live births in the intervention districts and remained relatively stable in the rest of rural Rwanda (difference in differences -12.9). CONCLUSION: The ABC initiative contributed to improved MNH quality of care and outcomes in rural Rwanda. A combined clinical and health system improvement approach could be an effective strategy to improve quality and reduce neonatal mortality.

Occupational Therapy in Haiti: A Pilot Study to Identify Intervention Methods Used during Short-Term Medical Missions.

Due to the shortage of occupational therapists (OTs) in Haiti and over 800,000 individuals with disabilities, most occupational therapy assessments and interventions are provided by OTs on short-term medical missions (STMMs). Learning which methods OT use to provide assessments and interventions during these STMMs is the first step to understanding how to facilitate follow-up and carry-over for clients and ensure longevity for STMMs in Haiti. This study used a cross-sectional, descriptive design to gather data on methods used by OTs. Thirty-three OTs, who travelled to Haiti on STMMs, completed a 16-question, online survey. The most common method provided by OTs was education to patients, caregivers, and local providers. Training of Haitian rehabilitation technicians was also prevalent. There was an association between the years of the OTs' clinical experience and the effort of OTs to train local providers, but this result was not statistically significant. Further research should be implemented on specific methods that can be used in the absence or shortage of Haitian OTs to ensure follow-up for Haitian clients. The sharing of data regarding OT methods on STMMs will promote evidence-based, client-centered, and cost-effective therapy to enhance effective client outcomes.

Assessment of Local Health Worker Attitudes toward International Medical Volunteers in Low- and Middle-income Countries: A Global Survey.

BACKGROUND: International Medical Volunteers (IMVs) positively and negatively impact host countries, and the goals of their trips may not always align with the interests of the hosts in Low- and Middle-Income Countries (LMICs). We sought to better understand local physicians' interest of hosting IMVs and what type of support they desired. METHODS: This study was a convenience sample survey-based needs assessment. The surveys were distributed to local physicians by 28 professional society groups in LMICs. FINDINGS: A total of 102 physicians from 51 countries completed the survey. Despite 61.8% participants having no experience with IMVs, 75% were interested in hosting them. Host physicians most desired clinical education (39%), research collaboration (18%), and Systems Development (11%). The most requested specialties were obstetrics and gynecology (25%) and emergency medicine (11%). Respondents considered public hospitals (62%) to be the most helpful clinical setting in which IMVs could work, and 3 months (47%) as the ideal length of stay.Respondents expressed interest in advertising the specific needs of the host country to potential IMVs (80%). Qualitative analyses suggested hosts wanted more training opportunities, inclusion of all stakeholders, culturally competent volunteers, and aid focused on subspecialty education, health policy, public health, and research. CONCLUSION: Hosts desire more bidirectional clinical education and research capacity building than just direct clinical care. Importantly, cultural competence is key to a successful host partnership, potentially improved through IMV preparation. Finally, respondents want IMVs to ensure that they stay within their scope of practice and training.

Misión de cooperación internacional de Cirugía Plástica en Liberia. Experiencia personal de un médico residente y reflexiones / Plastic Surgery international cooperation campaign in Liberia. Personal experience of a resident and reflexions

En el presente artículo exponemos nuestra experiencia personal durante la cuarta misión médico-humanitaria de la Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) en Liberia, llevada a cabo en noviembre de 2019. Describimos las características principales de la campaña quirúrgica y hacemos énfasis en la capacidad de los cirujanos plásticos para mejorar la calidad de vida de las personas, incluso en condiciones adversas y con medios limitados. También en la participación por primera vez de un médico residente de Cirugía Plástica en la actividad de labor humanitaria de la SECPRE. Para tener éxito en una misión de este tipo resulta imprescindible una planificación rigurosa de los objetivos, así como conocer los medios de los que se dispone para llegar a ellos. Pretendemos proporcionar una visión general del proyecto y servir de apoyo para futuras campañas quirúrgicas, así como hacer referencia al importante papel que juega la Cirugía Plástica en la Salud Global

In this paper we resume our personal experience during the fourth international cooperation mission of the Spanish Society of Plastic Surgery (SECPRE) in Liberia, which took place in November 2019. The main features of the mission are thoroughly depicted and the great capacity of plastic surgeons to improve quality of life of people, even in adverse conditions and with limited resources, is highlighted. We also focus on the first participation of a Plastic Surgery resident in this humanitarian activity of SECPRE. To achieve success in a mission of this kind it is imperative to follow a strict planning as well as having a detailed knowledge of resources available. With the publication of this article we aim to provide a general vision of the mission and to serve as support for future surgical campaigns. We also would like to make reference to the important role of Plastic Surgery in Global Health

COVID-19​ live Q&A about travels with Dr Carmen Dolea &Dr Negret Emiroglu. Ask WHO​ of 7 August 2020

#AskWHO​ series: This was the live discussion 7 August 2020 about the COVID-19 pandemic and international travels, with Dr Carmen Dolea, Head of the International Health Regulation Secretariat (IHR), and Dr Negret Emiroglu, Director of WHO's Country Readiness Strengthening Department. Questions from the audience were taken.

Apoyos sanitarios externos requeridos durante la mision Enhanced Forward Presence III (Letonia) / External health supports required during Enhanced Forward Presence III mission (Latvia)

ANTECEDENTES Y OBJETIVOS: En julio de 2016 se dio luz verde a la operacion eFP (Enhanced Forward Presence), con el objetivo de proveer de defensa a los paises balticos miembros de la OTAN, frente a Rusia. Espana desplego un contingente en Letonia, cuya sanidad la compuso una celula de estabilizacion y un enfermero de enlace. En caso de necesitar apoyos sanitarios se acordo hacer uso del ROLE 1 canadiense o los servicios sanitarios civiles letones. El objetivo de este estudio fue analizar los apoyos sanitarios externos requeridos durante la mision Enhanced Forward Presence III. MATERIAL Y MÉTODOS: Se llevo a cabo un estudio transversal. Se utilizaron los 78 casos de la mision eFP-III en los que hubo que gestionar apoyo externo. El analisis estadistico se llevó a cabo a traves del GNU PSPP Statistical Analysis Software version 1.2.0-g0fb4db. RESULTADOS: Los resultados se expresaron en frecuencias. Se hallo relacion significativa entre el tipo de apoyo requerido y el tipo de medios (militares o civiles) utilizados para su resolucion. El apoyo más numeroso fue el odontologico, seguido del radiodiagnostico y de la fisioterapia. El mayor número de apoyos correspondió a hombres, escala Militares Profesionales de Tropa y Marineria, resueltos por medios militares y en una unica consulta. Los medios militares resolvieron la mayoria de los casos para los que contaron con la especialidad concreta necesaria

ANTECEDENT AND OBJECTIVES: In July 2016, the eFP (Enhanced Forward Presence) operation was given a green light, with the aim of providing defense to the Baltic countries members of NATO, against Russia. Spain deployed a contingent in Latvia, whose health consisted of a stabilization cell and a liaison nurse. In case of needing health support, it was agreed to use the Canadian ROLE 1 or the latvian civil health services. The objective of this study was to analyze the external health support required during the Enhanced Forward Presence III mission. MATERIAL AND METHODS: A cross-sectional study was carried out. The 78 cases of the eFP-III mission were used in which external support had to be managed. Statistical analysis was carried out through the GNU PSPP Statistical Analysis Software version 1.2.0-g0fb4db. RESULTS: The results were expressed in frequencies. A significant relationship was found between the type of support required and the type of means (military or civil) used to resolve it. The most numerous support was the dentist, followed by radiodiagnosis and physiotherapy. The largest number of support corresponded to men, Professional Military Troop and Maritime scale, resolved by military means and in a single consultation. The military media resolved most of the cases for which they had the necessary concrete specialty

The 10 Cow Project: Building Mission Sustainability.

Using lessons from a modern parable about the 10-cow bride, a short-term medical missions team created a sustainable program for Ugandans, helping establish businesses for needy families by providing start-up farm animals. Christian nurses can partner with those in veterinary medicine to provide essential training related to health promotion and prevention of disease transmission in order to promote positive long-term outcomes of such projects.

The Development of a Surgical Mission in the Peruvian Amazon: A 15-Year Expedition.

Musculoskeletal disorders and injuries represent a substantial proportion of the global burden of disease. This burden is particularly prevalent in low and middle-income countries that already have insufficient health-care resources. The purpose of this paper is to highlight the vision, the history, the implementation, and the challenges in establishing an orthopaedic surgical mission in a developing nation to help address the epidemic of musculoskeletal trauma.Scalpel At The Cross (SATC) is a nonprofit Christian orthopaedic surgical mission organization that sends teams of 10 to 20 members to Pucallpa, Peru, a rural town in the Amazon, to evaluate patients with musculoskeletal conditions, many that require surgery. The organization employs 4 full-time staff members and has included over 400 medical volunteers in 32 surgical campaigns since 2005. SATC has provided approximately 8.1 million U.S. dollars in total medical care, while investing approximately 2.2 million U.S. dollars in implementation and overhead.Given the projected increase in trauma in low and middle-income countries, the SATC model may be increasingly relevant as a possible blueprint for other medical professionals to take on similar endeavors. This paper also highlights the importance of continued research into the effectiveness of various organizational models to advance surgical services in these countries.

Reflections and interdisciplinary perceptions of pharmacy learners on an international medical brigade.

BACKGROUND AND PURPOSE: The Mountain Area Health Education Center, Inc. and Shoulder to Shoulder have partnered on medical brigades in rural Honduras since 2005, with pharmacy learner participation beginning in 2007. This study assesses the value of this experience to pharmacy learners and their contribution to a brigade's success. EDUCATIONAL ACTIVITY AND SETTING: Pharmacy learners and faculty, family medicine residents and faculty physicians, student volunteers, and other health care professionals participate in two-week medical brigades each February and August. Since 2011, brigades have been based out of Camasca, a small town in rural, southwest Honduras. February brigade teams conduct home visits, while August brigades consist primarily of mobile clinics. In both situations, the pharmacy team prepares, dispenses, and counsels on medications. Participants from three trips were surveyed. FINDINGS: All pharmacy learners agreed the brigade contributed to improvements in their skills and competence as pharmacists. Brigade members agreed that pharmacy learners made valuable contributions, particularly in counseling patients, maintaining an organized workflow, and assisting in activities outside of pharmacy services. All respondents agreed that pharmacy learners were necessary to a trip's success. SUMMARY: These international medical brigades were impactful educational experiences for pharmacy learners. Brigade participants viewed pharmacy learners as essential team members.