Acute care surgery, trauma and disaster relief: a clinical exchange between the University of British Columbia and the Mexican Red Cross

Abstract

Background: Our objective was to establish a sustainable educational partnership and clinical exchange between the trauma services at Vancouver General Hospital (VGH) and the Mexican Red Cross hospital in Mexico City (Hospital Central de la Cruz Roja [HCCR] Polanco). Methods: In 2017, a general surgery resident in postgraduate year 4 travelled from VGH to HCCR Polanco for the initial exchange, followed by a trauma fellow. The surgical case volumes in a month at VGH and a month at HCCR Polanco were compared. At the end of the exchange, a 36-item Likert style questionnaire was administered to the Mexican surgeons and residents who interacted with the Canadian resident and fellow during the exchange. Results: The most commonly performed procedures on the VGH acute care surgery service were laparoscopic cholecystectomy (35%) and laparoscopic appendectomy (17%). The most commonly performed procedures on the VGH trauma service were chest tube insertions (24%) and tracheostomies (24%). The most commonly performed procedures at HCCR Polanco were surgery for penetrating abdominal trauma (19%) and extremity trauma (13%). The survey results indicated that the costs of travel and accommodation were obstacles to future exchanges. All survey respondents wanted to continue collaborating with Canadians on clinical and research endeavours, felt that hosting Canadian residents was a valuable experience and felt that visiting VGH would also be valuable. Conclusion: Canadian surgical trainees gained valuable exposure to operative trauma during the exchange. The mix of operations performed at VGH and HCCR Polanco was vastly different; therefore, the exchange broadened the trainees' surgical experience. There was a unanimously positive response to the exchange among the Mexican survey respondents. This exchange is part of a long-term collaboration between our surgical centres. Contexte : Notre objectif était d'établir un partenariat pédagogique et un échange clinique durables entre les services de traumatologie de l'Hôpital général de Vancouver

Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries

“… 41 Margolick et al also identified the cost of flights, meal and accommodation as a financial barrier to reciprocity in potential twinning programmes with the HIC partner institution. 39 …”

“…Twenty-five studies (83%) described advantages with visiting surgical teams,17 19–42 further subgrouped into skills improvement, immediate clinical patient care, system-level strengthening, academic and career benefits and broader collaboration opportunities.…”

“…Ten studies (33%) mentioned interest in broader collaboration with visiting surgical teams, including integration of educational efforts such as didactic lectures and workshops in the visits,17 20 23 25 27 29 31 34 36 39 continuous learning beyond short-term visits including educational online rounds20 39 and wishes for bilateral collaboration including opportunities to attend surgical training in HICs 25 29 39. One example of collaboration beyond short-term visits was a US-Peruvian partnership consisting of multiple on-site visits and regular remote learning sessions, where a prospective study found the two strategies to be complementary with ‘on-site missions’ preferentially building capacity for diagnosis, repair technique and intraoperative decision-making, whereas remotes sessions preferentially helped develop understanding of operative design and anatomy (all p<0.005) 34…”

“…Potential areas of contention associated with visiting surgical teams were highlighted in 22 (73%) studies 17 18 21 22 25–27 29 31 33 35–46. These were further subgrouped as ethical dilemmas and inequity, insufficient knowledge transfers, poor quality of care, administrative and financial issues, competition and language barriers.…”

“…The most common potential controversy involved administrative and financial issues (n=15, 50%),17 18 25 26 29 31 35 36 38–43 45 such as poor coordination with hospital duty schedules,25 26 29 lack of needed resources to do planned surgeries,31 overlapping ‘missions’26 or failure to notify host staff of planned mission36 and visits being too short 17 25 29 46. Another example of administrative shortcoming was HIC surgeons failing to adhere to regulations regarding registration of planned visits to local authorities41 or reporting outcomes 42…”