Lasting impact: a qualitative study of perspectives on surgery by adult recipients of free mission-based surgical care in Benin

Abstract

ObjectivesThis study aimed to explore how adult patients who received free mission-based elective surgery experienced surgery and its outcomes, in order to provide recommendations for improved service delivery, measurement of impact and future quality initiatives for the humanitarian organisation Mercy Ships and other mission-based surgical platforms.SettingData were collected in June 2017 in Cotonou, Benin, where the participants had previously received free mission-based elective surgery aboard the Africa Mercy, a non-governmental hospital ship.ParticipantsSixteen patients (seven male, nine female, age range 22–71, mean age 43.25) who had previously received surgical care aboard the Africa Mercy hospital ship between September 2016 and May 2017 participated in the study.MethodsUsing a qualitative design, 16 individual semistructured interviews were conducted with the assistance of two interpreters. Participants were recruited using purposive sampling from the Mercy Ships patient database. Interview data were coded and organised into themes and subthemes using thematic content analysis in an interpretivist approach.FindingsAnalysis of interview data revealed three main themes: barriers to surgery, experiences with Mercy Ships and changes in perspectives of surgery after their experiences. Key findings included barriers to local surgical provision such as cost, a noteworthy amount of fear and distrust of local surgical teams, exceptional positive experiences with the care at Mercy Ships, and impactful surgery, resulting in high levels of trust in foreign surgical teams.ConclusionsWhile foreign surgical teams are meeting an immediate need for surgical care, the potential enduring legacy is one of trusting only foreigners for surgery. Patients are a critical component to a well-functioning surgical system, and mission-based surgical providers must formulate strategies to mitigate this legacy while strengthening the local surgical system.

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

“… 29 Similarly, visiting surgical teams were believed to sometimes infringe on local healthcare providers’ authority towards patients, instilling a sense of distrust of local providers. 40 …”

“… 42 This was also expressed by patients who stated that they preferred to deter seeking care until the visiting surgical team would come and they could get the surgery for free. 40 43 …”

“…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.…”

“…Eight studies (27%) expressed the importance of visiting surgical teams in helping alleviate the immediate need for surgical care, especially to marginalised communities who may not be able to afford or access care in other ways 21 28 32 36 38 40 41 43. This was reported both by local healthcare providers and patients.…”

“…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.…”