Partnering to build surgical capacity in low-resource settings: a qualitative study of Canadian global surgeons

Abstract

ObjectivesThis qualitative study aimed to explore the perspectives of Canadian global surgeons with experience developing surgical education partnerships with low- and middle-income countries (LMICs) for the purpose of identifying factors for success.DesignA purposive sample of leaders from global surgery programmes at Canadian Faculties of Medicine participated in virtual semi-structured interviews. A six-phase thematic analysis was performed using a constructivist lens on verbatim transcripts by three independent researchers. Key factors for success were thematically collated with constant comparison and inter-investigator triangulation in NVivo software until theoretical saturation was reached.ParticipantsFifteen surgeons, representing 11 subspecialties at 6 Canadian academic institutions and a combined experience across 6 continents, were interviewed between January and June 2022.ResultsFour facilitators for success of global surgery training programmes were identified, with a strong undertone of relationship-building permeating all subthemes: (1) facilitative skill sets and infrastructure, (2) longitudinal engagement, (3) local ownership and (4) interpersonal humility. Participants defined facilitative skill sets to include demonstrated surgical competence and facilitative infrastructure to include pre-existing local networks, language congruency, sustainable funding and support from external organisations. They perceived longitudinal engagement as spanning multiple trips, enabled by strong personal motivation and arrangements at their home institutions. Ownership of projects by local champions, including in research output, was noted as key to preventing brain drain and catalysing a ripple effect of surgical trainees. Finally, interviewees emphasised interpersonal humility as being crucial to decolonising the institution of global surgery with cultural competence, reflexivity and sustainability.ConclusionsThe interviewed surgeons perceived strong cross-cultural relationships as fundamental to all other dimensions of success when working in low-resource capacity-building. While this study presents a comprehensive Canadian perspective informed by high-profile leadership in global surgery, a parallel study highlighting LMIC-partners’ perspectives will be critical to a more complete understanding of programme success.

Empowering rural communities is the catalyst for global surgery equity

“…These challenges exacerbate health disparities, leading not only to higher morbidity and mortality rates for surgical conditions, but also an absence of partnerships to promote surgical education, development of accreditation bodies and equity of technology acquisition. [4][5][6] By developing targeted actionable strategies to overcome these obstacles, we also form the blueprint to start global initiatives that bring about sustainable improvement worldwide.…”

“…Despite Australia's bronze‐medal rank for overall health care system performance, rural communities often face unique barriers to surgical care, such as limited healthcare infrastructure, inadequate surgical workforce, transportation difficulties, and socioeconomic constraints. These challenges exacerbate health disparities, leading not only to higher morbidity and mortality rates for surgical conditions, but also an absence of partnerships to promote surgical education, development of accreditation bodies and equity of technology acquisition 4–6 . By developing targeted actionable strategies to overcome these obstacles, we also form the blueprint to start global initiatives that bring about sustainable improvement worldwide.…”