Mobile Surgical Scouts Increase Surgical Access for Patients with Cleft Lip and Palate in Nepal

Abstract

Background: In Nepal's remote regions, challenging topography prevents patients with cleft lip and palate (CLP) from seeking care. Objective: To measure the effect of a mobile surgical scout program on CLP surgical care in remote regions of Nepal. Methods: Forty-four lay people were trained as mobile surgical scouts and over 5 months traversed remote districts of Nepal on foot to detect and refer CLP patients for surgical care. Surgical patients from remote districts were compared with matched time periods in the year before intervention. Diagnostic accuracy of the surgical scouts was assessed. Findings: Mobile surgical scouts accurately diagnosed (90%) and referred (82%) patients for cleft surgery. Before the intervention, CLP surgeries from remote districts represented 3.5% of cleft surgeries performed. With mobile surgical scouting, patients from remote districts comprised 8.2% of all cleft surgeries ( p = 0.007). When transportation and accompaniment was provided in addition to mobile surgical scouts, patients from remote districts represented 13.5% ( p ≤ 0.001) of all cleft surgeries. Conclusion: Task-shifting the surgical screening process to trained scouts resulted in accurate diagnoses, referrals, and increased access to cleft surgery in remote districts of Nepal.

Factors Influencing Delay in Diagnosis of Head and Neck Cancer in Rwanda

“…Non-physicians such as traditional healers may be able to assist in the identification and referral of head and neck cancer patients through collaborative educational programs, as is done for cleft lip and palate. 22 It is also important to work within communities to increase knowledge of holistic treatment so that patients may feel comfortable seeking medical doctors in addition to their traditional healer. Furthermore, educational initiatives at the health center level (and inclusive of traditional healers) may address more than a single disease and can cost-effectively teach additional skills.…”

“…Instead of excluding traditional healers, an approach that views them as the initial patient contact in the African health care system may be wise. Non‐physicians such as traditional healers may be able to assist in the identification and referral of head and neck cancer patients through collaborative educational programs, as is done for cleft lip and palate 22 . It is also important to work within communities to increase knowledge of holistic treatment so that patients may feel comfortable seeking medical doctors in addition to their traditional healer.…”

Perspectives on the state of cleft lip and cleft palate patient care in Africa

“…Consequently, this renders them inaccessible by much of the population who reside in more rural and remote areas. Creative alternatives to bringing surgical care to remote areas including outreach programs, the use of active case finding, task sharing, remote surgical mentorship, and telecommunication solutions [31,32].…”

“…The challenge to maximizing awareness is reaching those who live in more rural and remote areas. One innovative strategy using mobile scouts has been piloted in Nepal, where trained laypeople were sent to remote districts of Nepal on foot to screen and refer patients for surgical care [32]. Additionally, the rise of mobile phones and the expansion of internet access bring promise for more efficient information delivery, democratization of health education, and ultimately lower the barrier to surgical care.…”

“…Another example of decentralization is through active case-finding targeted toward remote regions. In Nepal, mobile scouts, consisting of laypeople who underwent 1 week of training, travelled to remote districts on foot over a period of 5 months to screen and refer patients for CLP surgical care [32]. This initiative led to an increase in the number of patients from remote districts presenting to a large CLP center, from 3.5 to 8.2%, and up to 13.5% when transportation was provided.…”