Chartering Patient Flights for Surgery in a Road Inaccessible Nation: The Samaritan’s Purse Cleft Lip Missions Model in South Sudan

Abstract

Introduction: Few patients in South Sudan have access to cleft lip repair due to limitations in health care facilities, personnel and road infrastructure. Samaritan’s Purse is a non-governmental organization that provides chartered flights from road inaccessible regions to a single central hospital in this nation’s capital. This study’s purpose was to describe the chartered flight model for conducting nationwide cleft lip mission trips. Methods: The authors performed a retrospective chart review of all patients who received cleft lip surgery at Juba Teaching Hospital during mission trips from 2011 to 2023. Patient sex, age, cleft characteristics, and home location were retrieved. Disability-adjusted life years (DALYs) were calculated and compared with the GDP/capita to assess cost-effectiveness using World Health Organization (WHO) standards. Results: Chart review identified 1085 patients who received cleft lip surgery. The average age of patients decreased from a high of 14.0 years in 2013 to a low of 8.2 years in 2023 (P<0.001). Patients were flown to Juba from all 10 states of South Sudan. The number of patients treated correlated with the state population (P<0.001). Each mission utilized an average of 14 flight paths. The cost of intervention per DALY averted was less than the GDP/capita of South Sudan, indicating the procedure was very cost-effective by WHO standards. Conclusions: Flight chartered mission trips in South Sudan have significantly decreased the backlog of patients with cleft lip in that country and are very cost-effective according to WHO standards. Investigating this model’s utility for other surgical missions while continuing to build local surgical capacity is warranted.