Abstract
Background
There is increasing interest by surgeons in high-income countries to support colleagues in low-income countries to improve the provision of surgical care, particularly in rural areas. Such interest may be demonstrated by single individuals, short-term surgical missions, or establishment of partnerships. Such altruistic efforts may cause problems unless properly planned and carried out.
Methods
We reviewed the available literature and consulted widely to establish consensus guidelines for any surgeon considering participating in an initiative to improve surgical care in low-income countries.
Results
A series of recommendations is presented. These include ensuring that projects are appropriate, that there is an emphasis on training local healthcare providers in all aspects of perioperative care, that outcomes are monitored, and that initiatives work with local and regional training programs.
Conclusions
With adherence to these recommendations, we hope that future partnerships and missions can maximize their effectiveness and minimize the risks of potential harm done.
Similar content being viewed by others
References
Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144. doi:10.1016/S0140-6736(08)60878-8
Funk LM, Weiser TG, Berry WR, Lipsitz SR, Merry AF, Enright AC et al (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376(9746):1055–1061. doi:10.1016/S0140-6736(10)60392-3
Grimes CE, Law RS, Borgstein ES, Mkandawire NC, Lavy CB (2012) Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 36(1):8–23. doi:10.1007/s00268-011-1330-1
Richard F, Hercot D, Ouedraogo C, Delvaux T, Samake S, van Olmen J et al (2011) Sub-Saharan Africa and the health MDGs: the need to move beyond the “quick impact” model. Reprod Health Matters 19(38):42–55. doi:10.1016/S0968-8080(11)38579-5
Farmer DL (2010) The need for sustainability in contemporary global health efforts: missions vs mission. Arch Surg 145(8):752–753
Bae JY, Groen RS, Kushner AL (2011) Surgery as a public health intervention: common misconceptions versus the truth. Bull WHO 89(6):394. doi:10.2471/BLT.11.088229
Haglund MM, Kiryabwire J, Parker S, Zomorodi A, MacLeod D, Schroeder R et al (2011) Surgical capacity building in Uganda through twinning, technology, and training camps. World J Surg 35(6):1175–1182. doi:10.1007/s00268-011-1080-0
Khambaty FM, Ayas HM, Mezghebe HM (2010) Surgery in the Horn of Africa: a 1-year experience of an American-sponsored surgical residency in Eritrea. Arch Surg 145(8):749–752. doi:10.1001/archsurg.2010.125
Welling DR, Ryan JM, Burris DG, Rich NM (2010) Seven sins of humanitarian medicine. World J Surg 34(3):466–470. doi:10.1007/s00268-009-0373-z
Wolfberg AJ (2006) Volunteering overseas–lessons from surgical brigades. N Engl J Med 354(5):443–445. doi:10.1056/NEJMp058220
Riviello R, Ozgediz D, Hsia RY, Azzie G, Newton M, Tarpley J (2010) Role of collaborative academic partnerships in surgical training, education, and provision. World J Surg 34(3):459–465. doi:10.1007/s00268-009-0360-4
Mitchell KB, Tarpley MJ, Tarpley JL, Casey KM (2011) Elective global surgery rotations for residents: a call for cooperation and consortium. World J Surg 35(12):2617–2624. doi:10.1007/s00268-011-1311-4
Operation Giving Back American College of Surgeons (2012) http://www.operationgivingback.facs.org. Accessed 4 Aug 2012
Tropical Health and Education Trust (2012) www.thet.org. Accessed 22 Mar 2012
Meier D (2010) Opportunities and improvisations: a pediatric surgeon’s suggestions for successful short-term surgical volunteer work in resource-poor areas. World J Surg 34(5):941–946. doi:10.1007/s00268-010-0454-z
Nthumba PM (2010) “Blitz surgery”: redefining surgical needs, training, and practice in sub-Saharan Africa. World J Surg 34(3):433–437. doi:10.1007/s00268-009-0256-3
Eberlin KR, Zaleski KL, Snyder HD, Hamdan US (2008) Quality assurance guidelines for surgical outreach programs: a 20-year experience. Cleft Palate-Craniofac J 45(3):246–255. doi:10.1597/07-094.1
Ali J, Adam R, Butler AK, Chang H, Howard M, Gonsalves D et al (1993) Trauma outcome improves following the advanced trauma life support program in a developing country. J Trauma 34(6):890–898; discussion 898–899
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499. doi:10.1056/NEJMsa0810119
Ozgediz D, Chu K, Ford N, Dubowitz G, Bedada AG, Azzie G et al (2011) Surgery in global health delivery. Mt Sinai J Med 78(3):327–341. doi:10.1002/msj.20253
Gosselin RA, Gyamfi YA, Contini S (2011) Challenges of meeting surgical needs in the developing world. World J Surg 35(2):258–261. doi:10.1007/s00268-010-0863-z
Heimann P, Yunkap Kwankam S (eds) (2000) Guidelines for health care equipment donations. World Health Organisation, Geneva
Hardcastle T (2012) Global surgery rotations for residents. World J Surg 36(6):1441–1442. doi:10.1007/s00268-012-1541-0
Hardcastle TC (2008) Ethics of surgical training in developing countries. World J Surg 32(7):1562. doi:10.1007/s00268-007-9449-9
WHO QOL-BREF: World Health Organization (1993) http://www.who.int/substance_abuse/research_tools/whoqolbref/en/. Accessed 22 Mar 2012
Acknowledgments
We thank the following for their review of these recommendations: Professor Bomi Ogedengbe, President, West African College of Surgeons, Professor Clement Nwawolo, Secretary-General, West African College of Surgeons; Professor Mohamed Labib, Committee Member, College of Surgeons of East Central and Southern Africa; Professor Krikor Erzingatsian, Registrar and Committee Member, College of Surgeons of East, Central and Southern Africa.
Conflict of interest
RHSL is the Honorary Surgical Advisor to the Tropical Health and Education Trust. There are no other competing interests.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was conducted on behalf of and endorsed by the International Development Committee, Association of Surgeons of Great Britain and Ireland; West African College of Surgeons; College of Surgeons of East, Central and Southern Africa; Operation Hernia Foundation and International Federation of Surgical Colleges
Rights and permissions
About this article
Cite this article
Grimes, C.E., Maraka, J., Kingsnorth, A.N. et al. Guidelines for Surgeons on Establishing Projects in Low-Income Countries. World J Surg 37, 1203–1207 (2013). https://doi.org/10.1007/s00268-013-1999-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-1999-4