From short-term surgical missions towards sustainable partnerships. A survey among members of foreign teams

Abstract

Introduction: An estimated five billion people lack access to safe surgical care across the globe. Traditionally, providing short-term surgical missions has been the main strategy for health professionals from high-income countries to support surgical care in low- and middle-income countries. However, traditional missions have come under criticism because evidence of their sustainable value is lacking, along with any robust documentation and application of recommendations by participants of ongoing surgical missions. Using survey data collection and analysis, this study aims to provide a framework on how to improve the use of visiting surgical teams to strengthen surgical services in resource-poor settings. Method: An online survey was conducted among members of foreign teams to collect data on five specific areas: basic characteristics of the mission, main activities. Follow-up and reporting, the local registration process and collaboration with local actors. The survey included 58 respondents from 13 countries, and representing 20 organizations. Results: During surgical missions, training activities were considered most impactful, and reporting on outcome/s, along with long-term follow-up was strongly recommended. According to almost all participants (94%), the focus should be on establishing collaborative practices with local actors, and encourage strategic, long-term changes under their leadership. Conclusion: Building sustainable partnerships within local healthcare systems is the way forward for foreign surgical parties that aim to improve surgical care in low- and- middle income countries. When foreign help is offered, local stakeholders should be in the lead. Highlights

Capacity Building During Short‐Term Surgical Outreach Trips: A Review of What Guidelines Exist

“…When examining which capacity building domains were represented, culture and community domains were identified in nearly all guidelines. This finding is reinforced by a number of recent surveys of providers during outreach trips, where local and visiting care team providers most commonly highlighted knowledge of local culture as a necessary skill for visiting providers [ 10 , 69 ]. Preparing visiting providers for unfamiliar contexts, including language, dress standards, and the kind of patients to expect was noted as vitally important [ 10 ].…”

“…and direct all trip activities by local community needs 11 [27-29, 38, 41-43, 46, 47, 50] Ensure appropriate outcomes, including measures of quality, are collected during trips and reviewed afterward 9 [ 8,33,35,39,41,43,45,48,50] Maintain an internal registry or database that is easily accessible and understood by all providers to collect patient outcomes 4 [ 39,42,47,55] Use a safe surgery checklist during outreach 4 [32,33,35,45] Ensure continuity of care by having a local clinician involved in all steps of care 3 [ 26,33,54] For long-term sustainability of impact, have successive trips in one location and focus on health systems strengthening to promote independence of health system 5 [ 8,33,48,50,58] Embed trips within community-led efforts and the local public health infrastructure 1 [ 48] Finance Monitor costs and ensure (organization) financial reports are easily accessible 3 [ 29,35,55] When examining which capacity building domains were represented, culture and community domains were identified in nearly all guidelines. This finding is reinforced by a number of recent surveys of providers during outreach trips, where local and visiting care team providers most commonly highlighted knowledge of local culture as a necessary skill for visiting providers [10,69]. Preparing visiting providers for unfamiliar contexts, including language, dress standards, and the kind of patients to expect was noted as vitally important [10].…”

Decolonizing the decolonization movement in global health: A perspective from global surgery

“…These were originally conceived with the intent of reaching out to communities that lack access to surgical care. In these camps surgeons and their teams from HICs visit and offer surgical services to LMICs, however the utility of this model has been under ongoing scrutiny (Botman et al, 2021). The general observation by many hosts is that most visiting members of surgical camps often lack standardized patient selection methods and routinely neglect to plan for patient follow-up after the camp.…”

Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

“…inpatient trauma mortality rate and surgical volume) [10]. Other surgical specialties are developing implementation tools to help collect outcomes after short‐term surgical outreach trips [7, 11]. After reconstructive surgical outreach trips, for example, some organizations have connected patients with community health workers to reduce barriers such as distance and cost of travel [12]; others have adapted protocols to include telemedicine capabilities in order to increase follow‐up and provide speech therapy [13].…”