Building surgical capacity in low-resource countries: a qualitative analysis of task shifting from surgeon volunteers’ perspectives

Building surgical capacity in low-resource countries: a qualitative analysis of task shifting from surgeon volunteers’ perspectives

Journal:

Annals of Plastic Surgery

Author(s):

Scott Corlew

Date Published: January 2014
Training and capacity building
OPEN PUBLICATION

Introduction: Surgical volunteer organizations (SVOs) focus considerable resources on addressing the backlog of cases in low-resource countries. This model of service may perpetuate dependency. Efforts should focus on models that establish independence in providing surgical care. Independence could be achieved through surgical capacity building. However, there has been scant discussion in literature on SVO involvement in surgical capacity building.

Methods: Using qualitative methods, we evaluated the perspectives of surgeons with extensive volunteer experience in low-resource countries. We collected data through in-depth interviews that centered on SVOs using task shifting as a tool for surgical capacity building.

Results: Some of the key themes from our analysis include the ethical ramifications of task shifting, the challenges of addressing technical and clinical education in capacity building for low-resource settings, and the allocation of limited volunteer resources toward surgical capacity building.

Conclusion: These themes will be the foundation of subsequent studies that will focus on other stakeholders in surgical capacity building including host communities and SVO administrators.

Epidemiology of Injuries, Outcomes at a Rural Hospital in Cameroon: Results and Lessons Learned

Epidemiology of Injuries, Outcomes at a Rural Hospital in Cameroon: Results and Lessons Learned

Journal:

Journal of the West African College of Surgeons

Author(s):

Chao Long

Date Published: April 2016
Training and capacity building
Education
Measurement
Quality Improvement
Follow Up and Outcomes
OPEN PUBLICATION

Objective

The aim of this study was to evaluate the Antibiotic susceptibility profile of Enterococcus spp. isolated from patients with urinary tract infection and health care environment in two Reference Hospitals in Cameroon.

Methodology

Clinical and environmental specimens were collected and cultured in the appropriate culture media: CPS chromogenic medium for urine, bile esculin agar supplemented with vancomycin for stools and bile esculin agar for environmental specimens. The antibiotic susceptibility testing was done using the disk diffusion method as recommended by Antibiotic Committee of French Microbiology Society (CASFM 2013) and the resistance to vancomycin was determined by the agar screen method.

Result

Out of 250 clinical and environmental specimens collected, 50 strains of enterococci were isolated with the most prevalent in the following order: 26 E. faecium, 17 E. faecalis, 4 E. durans, 3 E. avium. Resistance observed in E. faecalis and E. faecium to erythromycin (84)% , ampicillin (60%), cotrimoxazol (42.4)%, tetracycline (41.6)%, vancomycin 28% and teicoplanin (19.2%). Out of the 50 isolates, 7 were resistant to vancomycin (with CMI greater or equal to 4µg/ml) from which 04 were isolated from urine, 02 from environment and one from faeces. Genes Van A, Van B and the phenotypes S and SKG were frequently observed with E. faecium.

Conclusion

Vancomycin enterococci resistance and high level of aminoglycoside resistance (HLAR) lead us to recommend that health policy planners need to reinforce the bacterial resistance committee activities in order to monitor enterococci infections.

Metrics Without Borders: Advancing the Global Surgery Agenda Through Data

Metrics Without Borders: Advancing the Global Surgery Agenda Through Data

Journal:

Journal of Public Health and Emergency

Author(s):

Chao Long

Date Published: December 2020
Education
Quality Improvement
Technology
OPEN PUBLICATION

The field of global surgery has matured significantly and asserted itself as a critical constituent in the landscape of global health. Various initiatives and resolutions hallmark recent momentum, summarize agenda items, and chart a path towards maximizing the impact of surgical services in healthcare systems worldwide. We appraise the global surgery literature and emphasize the role of data in propelling the field into its current space. We use three case studies to demonstrate that current global surgery data enterprises are best understood as a series of processes and practices and not merely as a summary of statistical methodologies and outcomes. First, the rapid dissemination and timely success of the COVIDSurg Project displays the utility of web-based platforms in sustaining far-reaching collaborations. Second, the iterative adoption of standardized global surgery metrics at the World Health Organization and World Bank tells the story of political integration into the broader universe of global health. Third, the early monitoring and evaluation of the World Health Organization’s Surgical Safety Checklist demonstrates the central role of implementation science in taking interventions to scale. Taken together, these case studies exemplify how research prioritization, data collection, data analysis, and outcomes reporting represent windows of opportunity to advance the global surgery’s reach. This perspective allows us to consider critical advances in technology and health policy in the machinery of knowledge production and how data platforms will promote an agenda of collaboration, integration, and implementation in the 21st century.

Factors associated with delays to surgical presentation in North-West Cameroon

Factors associated with delays to surgical presentation in North-West Cameroon

Journal:

Surgery

Author(s):

Chao Long

Date Published: September 2015
Training and capacity building
Measurement
Quality Improvement
OPEN PUBLICATION

Background

Few studies have examined critically the delays in definitive management for surgical diseases in Sub-Saharan Africa. This study investigates factors contributing to delays at Mbingo Baptist Hospital, a tertiary referral hospital in Cameroon.

Methods

During a 6-week period, we randomly interviewed 220 patients (39.2%) admitted to the surgical or orthopedic service and/or their caregivers. All patients >age 15 years admitted with a diagnosis of cancer or urgent operative condition (defined as requiring a definitive operation within 48 hours of admission) including trauma were interviewed. Delay was defined as receiving treatment >7 days after symptoms appeared in the urgent cohort and >1 month for the cancer cohort.

Results

In the urgent cohort, 60.3% patients had delays >7 days to hospital presentation. Compared with nondelayed patients, delayed patients were more likely to have sought care >1 day after symptoms appeared (45.4% vs 6.3%, P < .0001) and to have received previous medical care (92.8% vs 73.4%, P = .0007). Of all patients who received previous care, those with delays, compared those with no delays, visited ≥2 other providers (50.5% vs 18.8%, P < .0001), received a surgical procedure at previous episode(s) of care (21.1% vs 6.4%, P = .026), and felt no improvement after this care (80.4% vs 61.0%, P = .003). In the cancer cohort, 100% experienced >1 month delay. 100% had received medical care prior to arriving at Mbingo Baptist Hospital, 81.4% sought care from at least 3 different facilities, and none believed this care addressed their health concerns.

Conclusion

Significant delays most often were caused by time spent on previous failed attempts at care. This information can be used to inform policy discussions about optimal health care organization within the country.