First Do No Harm: Ethical Considerations of Pediatric Orthopaedic Global Outreach

Abstract

The purpose of this editorial is to introduce the ethical considerations surrounding pediatric orthopaedic global outreach and stimulate discussion about how to best approach this work. Bidirectional exchange with partner surgeons in low- and middle-income countries forms the foundation of successful outreach. Fostering these relationships and approaching outreach with humility and curiosity allows for a genuine needs assessment. The outreach program can then be designed to address the needs of the target community. Success should not only be defined as the number of surgeries performed, but also the number of healthcare workers trained and sustainable programs created at the host site. Remember that nurses, physical therapists, and surgical technologists also desire training. Finally, it is important to understand and identify any implicit or explicit bias before pursuing global outreach as that may hinder successful outcomes and bidirectional exchange with host surgeons.

Special Report: The Moore Pediatric Surgery Center: An Evolving Model for Pediatric Orthopaedic Surgical Care in a Limited Resource Environment

“…A comprehensive review of ethics of this model is beyond the scope of this report, but we believe our efforts to provide comprehensive follow-up care, operating easily within our capabilities, providing expert language interpretation for consents, bidirectional teaching and learning with our hosts, working with the support of local surgeons, and efforts at record keeping are the evidence of ethical behavior, which meet the standards for global volunteer work being set by our colleagues. [11][12][13]…”

Ethics and benefits of family participation in global surgery: a review of the One World Surgery experience

“…In addition to these four fundamental principles, there are other ethical considerations in STEGHs. One of the most important goals should be to partner and build capacity at local institutions, in efforts to ‘leave skills, not scars.’ 15 After an appropriate needs assessment, care should ideally be provided that is not normally available, improving the host’s capacity, resources, and reputation. Furthermore, given the short duration inherent to STEGHs, appropriate follow-up care is needed, according to accepted standards of care.…”