Scholarship
Lifecycle of surgical devices: Global, environmental, and regulatory considerations
Technological advancements, improved surgical access, and heightened demand for surgery have fueled unprecedented device and supply turnover impelling wealthy hospitals to upgrade continually and sell, donate, recycle, or dispose of used, expired, antiquated, or surplus goods. This paper reviews the issues related to device and supply lifecycles and discusses the opportunities and challenges they present for sustainable surgical growth in low- and middle-income countries (LMICs).
An Outcomes-Focused Analysis of Laparoscopic and Open Surgery in a Nigerian Hospital
The benefits of laparoscopic surgery such as swifter recovery and fewer wound complications, elude much of the developing world. Nigeria, a lower middle-income country, is the most populous sub-Saharan nation; an excellent model for studying the impact of laparoscopy in resource-constrained environments. The Department of Surgery at the Obafemi Awolowo University Teaching Hospital and the University of Utah’s Center for Global Surgery...
Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana
Breast Cancer in Ghana is the leading type of cancer and second most common cause of cancer related death. Five-year survival in Ghana has been cited at 40-48% with most cases being stage 3 or 4 at diagnosis. Robust access to early detection and diagnostic services can lead to earlier stages of diagnosis and improved survival. The purpose of this study was to evaluate the early detection and...
Availability and Geographic Access to Hospital Based Breast Cancer Early Detection and Diagnostic Services in Ghana
Breast cancer is now the most common type of cancer diagnosed worldwide irrespective of sex. In Ghana breast cancer is the leading type of cancer diagnosed and second most common cause of cancer related death. Five-year survival in Ghana has been cited at 40-48% (compared to 90% in many HICs). Most cases are stage 3 or 4 at diagnosis. Access to early detection and diagnostic services soon...
Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda
Timely prehospital emergency care significantly improves health outcomes. One substantial challenge delaying prehospital emergency care is in locating the patient requiring emergency services. The goal of this study was to describe challenges emergency medical services (EMS) teams in Rwanda face locating emergencies, and explore potential opportunities for improvement.
Academic global surgical competencies: A modified Delphi consensus study
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball...
Creating a Colorectal Surgery Fellowship in Ghana to Address the Growing Need for Colorectal Surgeons in West Africa
Globally, the incidence of colorectal cancers (CRCs) more than doubled between 1990 and 2019, with approximately 2.7 million new cases diagnosed each year. In Africa, 66,000 cases of CRC were diagnosed in 2020. As low-middle-income countries (LMICs) increasingly adopt Western lifestyles, the incidence of CRC and benign anorectal disease and IBD is projected to increase. In high-income countries, colorectal...
Geospatial availability of breast cancer treatment modalities and hypothetical access improvement in Ghana: A nationwide survey
Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and systematically identify high yield areas for targeted expansion.
International Liver Transplantation Society Global Census: First Look at Pediatric Liver Transplantation Activity Around the World
Over 16,000 children under the age of 15 died worldwide in 2017 because of liver disease. Pediatric liver transplantation (PLT) is currently the standard of care for these patients. The aim of this study is to describe global PLT activity and identify variations between regions.
Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda
Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges.
Capacity assessment and spatial analysis of cervical cancer services in The Gambia
Cervical cancer is the most common cancer and the leading cause of cancer-related death in Gambian women. The Gambian Ministry of Health is striving to improve access to screening, diagnostic, and treatment services for cervical cancer, but comprehensive data on currently available services is limited...
Cost-Effectiveness of Lay First Responders Addressing Road Traffic Injury in Sub-Saharan Africa
To investigate the cost-effectiveness of training lay first responders (LFRs) to address road traffic injury (RTI) in sub-Saharan Africa (SSA) as the first step toward formal emergency medical services (EMS) development.
Response Regarding: Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach
We thank Dr Pasha and colleagues for their thoughtful commentary and appreciate the important points that they raise. There is no doubt that excellent programs in global surgery exist and that these programs have thought deeply about competencies in the field. However, we did not attempt to conduct such a search for several reasons. First, there is unfortunately no systematic or standardized method for...
Developing Sustainable Prehospital Pediatric Care in Rwanda
Unintentional injury is the leading cause of death in children older than 1 year and disproportionately affects pediatric patients in low- and middle-income countries. Improved prehospital care capacity has demonstrated the ability to improve care and save lives. Our collaboration developed and implemented a sustainable prehospital emergency pediatrics care course (EPCC) for Service d'Aide Medicale Urgente, the public emergency medical service in Rwanda.
A global view of pediatric urology
Over the course of approximately 60 years, the field of pediatric urology has evolved as a convergence of pediatric surgery, urology, and plastic surgery to address congenital anomalies of the urinary tract and genitalia in children. Guidelines for training and certification are narrowing in high-income countries (HICs) at the same time as the fertility rate is declining and the prevalence of complex genitourinary (GU) conditions is...
Decolonizing Global Surgery: Bethune Round Table, 2022 Conference on Global Surgery (virtual), June 16-18, 2022
Trauma remains a leading cause of child mortality and disability worldwide, taking the lives of 1 million children annually. Of all deaths from pediatric trauma, 95% occur in low- and middle-income countries (LMICs). To improve quality of care, the Royal College of Physicians and Surgeons of Canada has developed and validated the Trauma Resuscitation in Kids (TRIK) course. While initially designed for North American settings, TRIK has...
Surgical Capacity Building in Low- and Middle-Income Countries: Lessons for Thoracic Surgery
There is great need for intentional investment in capacity building for thoracic surgical conditions. This article provides a brief overview of thoracic surgical capacity building for low- and middle-income countries using the Lancet framework of infrastructure, workforce, financing, and information management. The authors highlight the needs, opportunities, and challenges that are relevant for the thoracic surgery community, as it aims to increase care for patients with these conditions globally.
Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019
Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades.
Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality
Few studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda.
Building Trauma and EMS Systems Capacity in Rwanda: Lessons and Recommendations
Surgical capacity building has gained substantial momentum. However, care at the hospital level depends on improved access to emergency services. There is no established model for facilitating trauma and EMS system capacity in LMIC settings. This manuscript describes our model for multi-disciplinary collaboration to advance trauma and EMS capacity in Rwanda, along with our lessons and recommendations.
Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach
We aimed to search the literature for global surgical curricula, assess if published resources align with existing competency frameworks in global health and surgical education, and determine if there is consensus around a fundamental set of competencies for the developing field of academic global surgery.
Development and Implementation of a Longitudinal Global Acute Care and Systems Strengthening Program
Increasing access to safe, timely, and affordable acute care in low- and middle-income countries is a worldwide priority. Longitudinal curricula on systems of acute care have not been previously described.
Towards defining the surgical workforce for children: a geospatial analysis in Brazil
The optimal size of the health workforce for children's surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health.
Prehospital emergency obstetric and neonatal care train-the-trainers program in Rwanda
To improve maternal mortality rates, our collaboration developed and implemented a context-specific, prehospital Emergency Obstetrics and Neonatal Course (EONC) and train-the-trainers program in Rwanda.
Developing sustainable prehospital trauma education in Rwanda
Every year, >5 million people worldwide die from trauma. In Kigali, Rwanda, 50% of prehospital care provided by SAMU, the public prehospital system, is for trauma. Our collaboration developed and implemented a context-specific, prehospital Emergency Trauma Care Course (ETCC) and train-the-trainers program for SAMU, based on established international best practices.
Global Initiative for Children's Surgery: A Model of Global Collaboration to Advance the Surgical Care of Children
Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low- and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded in 2016 to identify solutions to problems in children's surgery by utilizing the expertise of practitioners from around the world. This report details this unique process and underlying principles.
Perspectives on International Urological Volunteerism: A Survey of IVUmed Resident Scholar Alumni
The primary intentions of international surgical programs are to directly benefit those receiving medical care, educate local physicians and staff, and improve care delivery models. IVUmed, a nonprofit organization dedicated to providing urological care to resource poor areas of the world, provides scholarship opportunities for urology trainees. We assessed the motivations and barriers of IVUmed traveling resident...
Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance)
After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidence-based argument for the fundamental role of surgery and anaesthesia within...
Global Surgical Ecosystems: A Need for Systems Strengthening
As surgery is gaining recognition as a critical component of universal health care worldwide, surgical communities have come together with unprecedented unity to advocate for systems to support surgical care. This community has long believed that much care could be performed in a cost-effective manner even in low resource settings, despite skepticism voiced by many in public health. To do so will require...
Building operative care capacity in a resource limited setting: The Mongolian model of the expansion of sustainable laparoscopic cholecystectomy
The benefits of laparoscopic cholecystectomy, including rapid recovery and fewer infections, have been largely unavailable to the majority of people in developing countries. Compared to other countries, Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were performed laparoscopically. This is a retrospective review of the transition from open to laparoscopic...
Geospatial Mapping of Surgical Capacity in Zambia
Recent strides in advocacy, financial modeling, and reevaluation of the global burden of diseases that can be treated by surgery have led to the point that the World Health Assembly, World Bank, and ministries of health are now adopting resolutions and indicators for scaling up surgical care to meet the needs of the 5 billion people who currently lack access to it. There has been a burst of interdisciplinary creativity as the surgical community...
IVUmed: a nonprofit model for surgical training in low-resource countries
Low- and middle-income countries (LMICs) face both training and infrastructural challenges for surgical care, particularly for specialty care, such as for urology. Practitioners charged with caring for these patients have few options for basic or advanced training.
Hernia and Hydrocele
Groin hernia and hydrocele are two of the most common surgical conditions globally. This chapter summarizes the literature on the pathogenesis, clinical presentation, and treatment for groin hernia and hydrocele, focusing on unique clinical characteristics and management strategies for these conditions in low- and middle-income countries (LMICs). We present our estimate of the global and regional...
Expansion of laparoscopic cholecystectomy in a resource limited setting, Mongolia: a 9-year cross-sectional retrospective review
The benefits of laparoscopic cholecystectomy have been largely unavailable to most people in developing countries. Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were being done laparoscopically. Open cholecystectomies were associated with high rates of wound infections, complications, and increased recovery time. Because of the...
The Conundrum of Training in Global Surgery: Are We There Yet?
Recent updates regarding the unmet surgical need indicate that 5 billion of the world's 7 billion people lack access to safe and timely surgical care. One of the critically missing pieces is trained surgical staff, including surgeons, anesthesiologists, nurses, and biomedical engineers. The ecosystem of people and processes, as well as supplies and infrastructure, is necessary to being to remove the gaps in care.
Questions?
Anna Darelli-Anderson, MEd, BA, C-TAGME
University of Utah
Department of Surgery
30 N. Mario Capecchi Dr. 4N153
Salt Lake City, UT 84112
801-581-6345
anna.darelli-anderson@utah.edu