scholarly journals Global health, global surgery and mass casualties. I. Rationale for integrated mass casualty centres

2019 ◽  
Vol 4 (6) ◽  
pp. e001943 ◽  
Author(s):  
Tariq Khan ◽  
Leonidas Quintana ◽  
Sergio Aguilera ◽  
Roxanna Garcia ◽  
Haitham Shoman ◽  
...  
Keyword(s):  
Low Income ◽  
Disaster Response ◽  
Emergency Services ◽  
Surgical Care ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Middle Income ◽  
Middle Income Countries ◽  
Development Goals ◽  
Efficient Care

It has been well-documented recently that 5 billion people globally lack surgical care. Also well-documented is the need to improve mass casualty disaster response. Many of the United Nations (UN) Sustainable Development Goals (SDGs) for 2030—healthcare and economic milestones—require significant improvement in global surgical care, particularly in low-income and middle-income countries. Trauma/stroke centres evolved in high-income countries with evidence that 24/7/365 surgical and critical care markedly improved morbidity and mortality for trauma and stroke and for cardiovascular events, difficult childbirth, acute abdomen. Duplication of emergency services, especially civilian and military, often results in suboptimal, expensive care. By combining all healthcare resources within the ongoing healthcare system, more efficient care for both individual emergencies and mass casualty situations can be achieved. We describe progress in establishing mass casualty centres in Chile and Pakistan. In both locations, planning among the stakeholders (primarily civilian and military) indicates the feasibility of such integrated surgical and emergency care. We also review other programmes and initiatives to provide integrated mass casualty disaster response. Integrated mass casualty centres are a feasible means to improve both day-to-day surgical care and mass casualty disaster response. The humanitarian aspect of mass casualty disasters facilitates integration among stakeholders—from local healthcare systems to military resources to international healthcare organisations. The benefits of mass casualty centres—both healthcare and economic—can facilitate achieving the 2030 UN SDGs.

scholarly journals Artificial Intelligence and its role in surgical care in low-income and middle-income countries

2019 ◽  
Vol 1 (8) ◽  
pp. e384-e386 ◽  
Author(s):  
Ché L Reddy ◽  
Shivani Mitra ◽  
John G Meara ◽  
Rifat Atun ◽  
Salim Afshar
Keyword(s):  
Artificial Intelligence ◽  
Low Income ◽  
Surgical Care ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals Theatres without borders: a systematic review of the use of intraoperative telemedicine in low- and middle-income countries (LMICs)

2021 ◽  
pp. bmjinnov-2021-000837
Author(s):  
Hariharan Subbiah Ponniah ◽  
Viraj Shah ◽  
Arian Arjomandi Rad ◽  
Robert Vardanyan ◽  
George Miller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Case Reports ◽  
Surgical Care ◽  
Cochrane Collaboration ◽  
Optimal Care ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

ObjectiveThis systematic review aims to provide a summary of the use of real-time telementoring, telesurgical consultation and telesurgery in surgical procedures in patients in low/middle-income countries (LMICs).DesignA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration published guidelines.Data sourcesEMBASE, MEDLINE, Cochrane, PubMed and Google Scholar were searched for original articles and case reports that discussed telementoring, telesurgery or telesurgical consultation in countries defined as low-income or middle-income (as per the World Banks’s 2021–2022 classifications) from inception to August 2021.Eligibility criteria for selecting studiesAll original articles and case reports were included if they reported the use of telemedicine, telesurgery or telesurgical consultation in procedures conducted on patients in LMICs.ResultsThere were 12 studies which discussed the use of telementoring in 55 patients in LMICs and included a variety of surgical specialities. There was one study that discussed the use of telesurgical consultation in 15 patients in LMICs and one study that discussed the use of telesurgery in one patient.ConclusionThe presence of intraoperative telemedicine in LMICs represents a principal move towards improving access to specialist surgical care for patients in resource-poor settings. Not only do several studies demonstrate that it facilitates training and educational opportunities, but it remains a relatively frugal and efficient method of doing so, through empowering local surgeons in LMICs towards offering optimal care while remaining in their respective communities.

scholarly journals Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries

2020 ◽  
Vol 5 (6) ◽  
pp. e002375 ◽  
Author(s):  
Ché L Reddy ◽  
Alexander W Peters ◽  
Desmond Tanko Jumbam ◽  
Luke Caddell ◽  
Blake C Alkire ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Critical Role ◽  
Scale Up ◽  
Surgical Care ◽  
Healthcare Intervention ◽  
Strengthen Health System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Fiscal Space

Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.

scholarly journals Global health, global surgery and mass casualties: II. Mass casualty centre resources, equipment and implementation

2020 ◽  
Vol 5 (1) ◽  
pp. e001945 ◽  
Author(s):  
Sergio Aguilera ◽  
Leonidas Quintana ◽  
Tariq Khan ◽  
Roxanna Garcia ◽  
Haitham Shoman ◽  
...  
Keyword(s):  
Low Income ◽  
Prehospital Care ◽  
Limited Resource ◽  
Cost Effective ◽  
Mass Casualty ◽  
Advanced Technology ◽  
Mass Casualties ◽  
Middle Income ◽  
Electronic Data Collection ◽  
Surgical Critical Care

Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care—from prevention to acute care to rehabilitation. Integration of the various healthcare systems—governmental, non-governmental and military—is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds—trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration—creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

scholarly journals Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis

2018 ◽  
Vol 3 (3) ◽  
pp. e000810 ◽  
Author(s):  
Joshua S Ng-Kamstra ◽  
Sumedha Arya ◽  
Sarah L M Greenberg ◽  
Meera Kotagal ◽  
Catherine Arsenault ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Procedures ◽  
Low Income ◽  
Meta Analysis ◽  
Surgical Care ◽  
Low Income Countries ◽  
Perioperative Mortality ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wide Range

IntroductionThe Lancet Commission on Global Surgery proposed the perioperative mortality rate (POMR) as one of the six key indicators of the strength of a country’s surgical system. Despite its widespread use in high-income settings, few studies have described procedure-specific POMR across low-income and middle-income countries (LMICs). We aimed to estimate POMR across a wide range of surgical procedures in LMICs. We also describe how POMR is defined and reported in the LMIC literature to provide recommendations for future monitoring in resource-constrained settings.MethodsWe did a systematic review of studies from LMICs published from 2009 to 2014 reporting POMR for any surgical procedure. We extracted select variables in duplicate from each included study and pooled estimates of POMR by type of procedure using random-effects meta-analysis of proportions and the Freeman-Tukey double arcsine transformation to stabilise variances.ResultsWe included 985 studies conducted across 83 LMICs, covering 191 types of surgical procedures performed on 1 020 869 patients. Pooled POMR ranged from less than 0.1% for appendectomy, cholecystectomy and caesarean delivery to 20%–27% for typhoid intestinal perforation, intracranial haemorrhage and operative head injury. We found no consistent associations between procedure-specific POMR and Human Development Index (HDI) or income-group apart from emergency peripartum hysterectomy POMR, which appeared higher in low-income countries. Inpatient mortality was the most commonly used definition, though only 46.2% of studies explicitly defined the time frame during which deaths accrued.ConclusionsEfforts to improve access to surgical care in LMICs should be accompanied by investment in improving the quality and safety of care. To improve the usefulness of POMR as a safety benchmark, standard reporting items should be included with any POMR estimate. Choosing a basket of procedures for which POMR is tracked may offer institutions and countries the standardisation required to meaningfully compare surgical outcomes across contexts and improve population health outcomes.

scholarly journals Double standards in healthcare innovations: the case of mosquito net mesh for hernia repair

2020 ◽  
pp. bmjinnov-2020-000535
Author(s):  
Mark Skopec ◽  
Alessandra Grillo ◽  
Alvena Kureshi ◽  
Yasser Bhatti ◽  
Matthew Harris
Keyword(s):  
Hernia Repair ◽  
Low Income ◽  
Low Cost ◽  
Surgical Care ◽  
Biomechanical Properties ◽  
Double Standard ◽  
Healthcare Sector ◽  
Mosquito Net ◽  
Middle Income ◽  
Middle Income Countries

With over two decades of evidence available including from randomised clinical trials, we explore whether the use of low-cost mosquito net mesh for inguinal hernia repair, common practice only in low-income and middle-income countries, represents a double standard in surgical care. We explore the clinical evidence, biomechanical properties and sterilisation requirements for mosquito net mesh for hernia repair and discuss the rationale for its use routinely in all settings, including in high-income settings. Considering that mosquito net mesh is as effective and safe as commercial mesh, and also with features that more closely resemble normal abdominal wall tissue, there is a strong case for its use in all settings, not just low-income and middle-income countries. In the healthcare sector specifically, either innovations should be acceptable for all contexts, or none at all. If such a double standard exists and worse, persists, it raises serious questions about the ethics of promoting healthcare innovations in some but not all contexts in terms of risks to health outcomes, equitable access, and barriers to learning.

scholarly journals Geospatial mapping to estimate timely access to surgical care in nine low-income and middle-income countries

The Lancet ◽  
2015 ◽  
Vol 385 ◽  
pp. S16 ◽  
Author(s):  
Nakul P Raykar ◽  
Alexis N Bowder ◽  
Charles Liu ◽  
Martha Vega ◽  
Jong H Kim ◽  
...  
Keyword(s):  
Low Income ◽  
Surgical Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Timely Access ◽  
Geospatial Mapping

scholarly journals Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Paul Truché ◽  
Haitham Shoman ◽  
Ché L. Reddy ◽  
Desmond T. Jumbam ◽  
Joanna Ashby ◽  
...  
Keyword(s):  
Financial Burden ◽  
Surgical Care ◽  
Obstetric Care ◽  
Global Surgery ◽  
Health System Strengthening ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Private And Public ◽  
Development Goals

AbstractEfforts from the developed world to improve surgical, anesthesia and obstetric care in low- and middle-income countries have evolved from a primarily volunteer mission trip model to a sustainable health system strengthening approach as private and public stakeholders recognize the enormous health toll and financial burden of surgical disease. The National Surgical, Obstetric and Anesthesia Plan (NSOAP) has been developed as a policy strategy for countries to address, in part, the health burden of diseases amenable to surgical care, but these plans have not developed in isolation. The NSOAP has become a phenomenon of globalization as a broad range of partners – individuals and institutions – help in both NSOAP formulation, implementation and financing. As the nexus between policy and action in the field of global surgery, the NSOAP reflects a special commitment by state actors to make progress on global goals such as Universal Health Coverage and the United Nations Sustainable Development Goals. This requires a continued global commitment involving genuine partnerships that embrace the collective strengths of both national and global actors to deliver sustained, safe and affordable high-quality surgical care for all poor, rural and marginalized people.

Systematic Review of Barriers to Surgical Care in Low-Income and Middle-Income Countries

2011 ◽  
Vol 35 (5) ◽  
pp. 941-950 ◽  
Author(s):  
Caris E. Grimes ◽  
Kendra G. Bowman ◽  
Christopher M. Dodgion ◽  
Christopher B. D. Lavy
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Surgical Care ◽  
Middle Income ◽  
Middle Income Countries
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