Global Health and Surgery

Surgical access is inadequate for most people. The Lancet Commission on Global Surgery established 6 indicators to measure surgical access: geographic accessibility, density of surgical providers, number of procedures performed, perioperative mortality, impoverishing expenditure, and catastrophic expenditure. Otolaryngology surgical, training, and research efforts use these 6 indicators to maximize impact and coordination of worldwide efforts in surgery. Research must be rigorous and consider the counterfactual...

BACKGROUND: In the face of staggering global unmet need for surgical care, non-governmental organisations (NGOs) play a substantial part in the surgical workforce, providing surgical care for those who are without it. The number of NGOs providing surgical care in low-income and middle-income countries (LMICs) is unknown. This information is needed to determine the scope of such care, its contributions to global surgical case volume, to improve collaboration in an effort to maximise efficiency, and to inform national surgical workforce planning...

Bangladesh is one of the poorest countries in the world, with a population of more than 120 million people living in a territory of only 55,000 square miles. Pediatric surgery is not recognized as an independent branch of surgery: the Dhaka Shishu Hospital is the only pediatric hospital in the country. Sponsored by the World Organization for Pediatric Surgery in Emerging Countries and Azienda Ospedaliera di Parma, the authors performed four surgical missions in Bangladesh in the city of Khulna from 1991 to 1995...

The global disparities in both surgical disease burden and access to delivery of surgical care are gaining prominence in the medical literature and media. Concurrently, there is an unprecedented groundswell in idealism and interest in global health among North American medical students and trainees in anesthesia and surgical disciplines. Many academic medical centers (AMCs) are seeking to respond by creating partnerships with teaching hospitals overseas. In this article we describe six such partnerships, as follows: (1) University of California San Francisco (UCSF) with the Bellagio Essential Surgery Group; (2) USCF with Makerere University, Uganda; (3) Vanderbilt with Baptist Medical Center, Ogbomoso, Nigeria; (4) Vanderbilt with Kijabe Hospital, Kenya; (5) University of Toronto, Hospital for Sick Children with the Ministry of Health in Botswana; and (6) Harvard (Brigham and Women's Hospital and Children's Hospital Boston) with Partners in Health in Haiti and Rwanda...

No abstract text is available yet for this article.

Addressing global health disparities in the developing world gained prominence during the first decade of the twenty-first century. The HIV/AIDS epidemic triggered much interest in and funding for health improvement and mortality reduction in low- and middle-income nations, particularly in sub-Saharan Africa. Alliances between U.S. academic medical centers and African nations were created through the departments of internal medicine and infectious disease. However, the importance of addressing surgical disease as part of global public health is becoming recognized as part of international health development efforts...

OBJECT: "Operation Enduring Freedom" is the US war effort in Afghanistan in its global war on terror. One US military neurosurgeon is deployed in support of Operation Enduring Freedom to provide care for both battlefield injuries and humanitarian work. Here, the authors analyze a 24-month neurosurgical caseload experience in Afghanistan. METHODS: Operative logs were analyzed between October 2007 and September 2009. Operative cases were divided into minor procedures (for example, placement of an intracranial pressure monitor) and major procedures (for example, craniotomy) for both battle injuries and humanitarian work...

Background. Humanitarian medical missions may be an effective way to temporarily overcome limitations and promote long-term solutions in the local health care system. Operation Smile, an international medical not-for-profit organization that provides surgery for patients with cleft lip and palate, not only provides surgery through short-term international missions but also focuses on developing local capacity. Methods. The history of Operation Smile was evaluated globally, and then on a local level in 3 countries: Colombia, Bolivia, and Ethiopia...

OBJECTIVE: Emerging data demonstrate that a large fraction of the global burden of disease is amenable to surgical intervention. There is a paucity of data related to delivery of surgical care in low- and middle-income countries, and no aggregate data describe the efforts of international organizations to provide surgical care in these settings. This study was designed to describe the roles and practices of international organizations delivering surgical care in developing nations with regard to surgical types and volume, outcomes tracking, and degree of integration with local health systems...

PURPOSE: This study assesses interest in international volunteer work by members of the American Pediatric Surgical Association (APSA) and attempts to identify demographics, motivations, obstacles, and institutional issues of the respondents. METHODS: An online survey service was used to send a 25-question survey to all APSA members with email addresses in November 2009. An answer to all questions was not required. Written comments were encouraged. RESULTS: The survey was sent to 807 members of whom 316 responded, for a response rate of 39%...

The battlefield has changed. UK and US Forces in Iraq and Afghanistan are engaged in asymmetric, three bloc warfare. Three bloc warfare indicates that what is effectively war-fighting occurs in parallel with peace-keeping and humanitarian operations. Casualties are numerically lower than in previous conflicts but many survivors are horrifically mutilated as body armour prevents the fatal injury in this severely injured group. Rapid evacuation of severely injured from the point of injury, usually by helicopter, provides extreme challenges for surgical teams...

The pediatric neurosurgical mission trips led by physicians at Virginia Commonwealth University (VCU) Health Systems began in 1996 with the formation of Medical Outreach to Children, founded by 1 of the authors (J.D.W.) after a visit to Guatemala. Since then, 19 surgical trips to 4 different countries in Central and South America have been coordinated from 1996 to 2008. This humanitarian work serves a number of purposes. First and foremost, it provides children with access to surgical care that they would otherwise not receive, thereby significantly improving their quality of life...

No abstract text is available yet for this article.

BACKGROUND: Inguinal hernia repair is one of the most commonly performed operations in Africa. Prosthetic repair with commercially available mesh is generally considered too expensive in low-income countries. Elective groin hernia surgery with mosquito net mesh has recently been described. However, can mesh sterility in resource-poor countries be guaranteed to ensure both effectiveness and safety? METHODS: Copolymer and polyester mosquito net mesh were steam-sterilized at varying temperatures...

BACKGROUND: Operation Smile is a humanitarian volunteer-based organization that provides cleft care around the world. Successful primary surgery is the key to improving the quality of life of patients with oral clefts. A cleft surgery outcomes database and evaluation system has been developed and implemented. METHODS: During Operation Smile's "World Journey of Smiles" in November 2007, a total of 4100 patients were operated on during a 10-day period at 40 simultaneous missions in 25 countries...

Médecins Sans Frontières (MSF) is a humanitarian organization that performs emergency and elective surgical services in both conflict and non-conflict settings in over 70 countries. In 2006 MSF surgeons departed on approximately 125 missions, and over 64,000 surgical interventions were carried out in some 20 countries worldwide. Historically, the majority of MSF surgical projects began in response to conflicts or natural disasters. During an emergency response, MSF has resources to set up major operating facilities within 48 h in remote areas...

BACKGROUND: Surgical trainees have participated in international missions for decades and are now seeking out these experiences in record numbers. Resident participation in humanitarian service has been highly controversial in the academic plastic surgery community, and little evidence exists elucidating the value of these experiences. This report examines the impact of international volunteerism on surgical training. METHODS: Twenty-one resident physicians who participated in the inaugural Operation Smile Regan Fellowship were surveyed 1 year after their experiences...

OBJECTIVE: Humanitarian surgery is often organized and delivered with short notice and limited time for developing unique strategies for providing care. While some surgical pathologies can be anticipated by the nature of the crisis, the role of foreign medical teams in treating the existing and unmet burden of surgical disease during crises is unclear. The purpose of this study was to examine published data from crises during the years 1990 through 2011 to understand the role of foreign medical teams in providing surgical care in these settings...

BACKGROUND: Information regarding surgical capacity in the developing world is limited by the paucity of available data regarding surgical care, infrastructure, and human resources in the literature. The purpose of this study was to assess surgical and anesthesia infrastructure and human resources in Ethiopia as part of a larger study by the Harvard Humanitarian Initiative examining surgical and anesthesia capacity in ten low-income countries in Africa. METHODS: A comprehensive survey tool developed by the Harvard Humanitarian Initiative was used to assess surgical capacity of hospitals in Ethiopia...

No abstract text is available yet for this article.