scholarly journals An Opportunity for Diagonal Development in Global Surgery: Cleft Lip and Palate Care in Resource-Limited Settings

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Pratik B. Patel ◽  
Marguerite Hoyler ◽  
Rebecca Maine ◽  
Christopher D. Hughes ◽  
Lars Hagander ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Surgical Care ◽  
Surgical Capacity ◽  
Middle Income ◽  
Humanitarian Emergencies ◽  
Resource Limited ◽  
Care Delivery Model

Global cleft surgery missions have provided much-needed care to millions of poor patients worldwide. Still, surgical capacity in low- and middle-income countries is generally inadequate. Through surgical missions, global cleft care has largely ascribed to a vertical model of healthcare delivery, which is disease specific, and tends to deliver services parallel to, but not necessarily within, the local healthcare system. The vertical model has been used to address infectious diseases as well as humanitarian emergencies. By contrast, a horizontal model for healthcare delivery tends to focus on long-term investments in public health infrastructure and human capital and has less often been implemented by humanitarian groups for a variety of reasons. As surgical care is an integral component of basic healthcare, the plastic surgery community must challenge itself to address the burden of specific disease entities, such as cleft lip and palate, in a way that sustainably expands and enriches global surgical care as a whole. In this paper, we describe a diagonal care delivery model, whereby cleft missions can enrich surgical capacity through integration into sustainable, local care delivery systems. Furthermore, we examine the applications of diagonal development to cleft care specifically and global surgical care more broadly.

Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery

2017 ◽  
Vol 54 (5) ◽  
pp. 535-539 ◽  
Author(s):  
Christopher Hughes ◽  
Jacob Campbell ◽  
Swagoto Mukhopadhyay ◽  
Susan Mccormack ◽  
Richard Silverman ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Plastic Surgery ◽  
Cleft Lip ◽  
Digital Video ◽  
Cleft Lip And Palate ◽  
Surgical Care ◽  
Short Term ◽  
Middle Income ◽  
Alveolar Cleft ◽  
Middle Income Countries

Objective Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. Setting The setting for this study was a district hospital located in Latacunga, Ecuador. Patients Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. Main Outcome Measures We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Results Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P .01). There was an 82.6% agreement between observers for cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P .74). Conclusions Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World

2018 ◽  
Vol 55 (8) ◽  
pp. 1145-1152 ◽  
Author(s):  
Eugene Park ◽  
Gaurav Deshpande ◽  
Bjorn Schonmeyr ◽  
Carolina Restrepo ◽  
Alex Campbell
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Developing World ◽  
Cleft Lip And Palate ◽  
Care Delivery ◽  
Complication Rates ◽  
Surgical Mission ◽  
Cleft Palate Repair ◽  
Cleft Lip Repair ◽  
Palate Repair

Objective: To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region. Patients and Design: We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center. Setting: Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India. Main Outcome Measure: Overall complication rates following cleft lip and cleft palate repair. Results: Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons ( P < .05). Conclusions: Our findings support the notion that transitioning from a mission-based model to a permanent facility-based model of cleft care delivery in the developing world can lead to decreased complication rates.

Patient-Perceived Barriers to Accessing Cleft Care at a Tertiary Referral Center in São Paulo, Brazil

2018 ◽  
Vol 56 (5) ◽  
pp. 639-645 ◽  
Author(s):  
Ananda Ise ◽  
Camila Menezes ◽  
Joao Batista Neto ◽  
Saurab Saluja ◽  
Julia R. Amundson ◽  
...  
Keyword(s):  
Access To Care ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Sao Paulo ◽  
Perceived Barriers ◽  
Treatment Result ◽  
São Paulo ◽  
Orofacial Clefts ◽  
Middle Income ◽  
Referral Center

Background: In low- and middle-income countries, poor access to care can result in delayed surgical repair of orofacial clefts leading to poor functional outcomes. Even in Brazil, an upper middle-income country with free comprehensive cleft care, delayed repair of orofacial clefts commonly occurs. This study aims to assess patient-perceived barriers to cleft care at a referral center in São Paulo. Methods: A 29-item questionnaire assessing the barriers to care was administered to 101 consecutive patients (or their guardians) undergoing orofacial cleft surgery in the Plastic Surgery Department in Hospital das Clínicas, in São Paulo, Brazil, between February 2016 and January 2017. Results: A total of 54.4% of patients had their first surgery beyond the recommended time frame of 6 months for a cleft lip or cleft lip and palate and 18 months for a cleft palate. There was a greater proportion of isolated cleft palates in the delayed group (66.7% vs 33.3%). Almost all patients had a timely diagnosis, but delays occurred from diagnosis to repair. The mean number of barriers reported for each patient was 3.8. The most frequently cited barriers related to lack of access to care include (1) lack of hospitals available to perform the surgery (54%) and (2) lack of availability of doctors (51%). Conclusion: Delays from diagnosis to treatment result in patients receiving delayed primary repairs. The commonest patient-perceived barriers are related to a lack of access to cleft care, which may represent a lack of awareness of available services.

scholarly journals Access to burn care in low-and middle-income countries: An assessment of timeliness, surgical capacity, and affordability in a regional referral hospital in Tanzania

2021 ◽  
Author(s):  
Matthijs Botman ◽  
Thom C C Hendriks ◽  
Louise de Haas ◽  
Grayson Mtui ◽  
Joost Binnerts ◽  
...  
Keyword(s):  
Burn Injury ◽  
Surgical Care ◽  
Referral Hospital ◽  
Surgical Capacity ◽  
Burn Wound ◽  
Middle Income ◽  
Regional Referral Hospital ◽  
Burn Victims ◽  
Burn Care ◽  
Low And Middle Income

Abstract This study investigates patients’ access to surgical care for burns in a low-and-middle-income setting by studying timeliness, surgical capacity, and affordability. A survey was conducted in a regional referral hospital in Manyara, Tanzania. In total, 67 patients were included. To obtain information on burn victims in need of surgical care, irrespective of time lapsed from the burn injury, both patients with burn wounds and patients with contractures were included. Information provided by patients and/or caregivers was supplemented with data from patient files and interviews with hospital administration and physicians. In the burn wound group, 50 percent reached a facility within 24 hours after the injury. Referrals from other health facilities to the regional referral hospital were made within three weeks for 74 percent in this group. Of contracture patients, seventy four percent, had sought healthcare after the acute burn injury. Of the same group, only 4 percent had been treated with skin grafts beforehand, and 70 percent never received surgical care or a referral. Combined, both groups indicated that lack of trust, surgical capacity, and referral timeliness were important factors negatively impacting patient access to surgical care. Accounting for hospital fees indicated patients routinely exceeded the catastrophic expenditure threshold. It was determined that healthcare for burn victims is without financial risk protection. We recommend strengthening burn care and reconstructive surgical programs in similar settings, using a more comprehensive health systems approach to identify and address both medical and socio-economic factors that determine patient mortality and disability.

scholarly journals Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

2020 ◽  
Author(s):  
Anita Gadgil ◽  
Geetu Bhandoria ◽  
Monty Khajanchi ◽  
Bhakti Sarang ◽  
Deepa Kizhakke Veetil ◽  
...  
Keyword(s):  
Health Care Services ◽  
Emergency Services ◽  
Care Delivery ◽  
Surgical Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Care Services ◽  
Research Consortium

Abstract Background The ongoing COVID-19 pandemic and subsequent lockdown have adversely affected global health care services to varying extent. Emergency Services were also affected along with elective surgeries, which were deferred to accommodate the added burden of COVID 19 affected patients, on the healthcare systems. We aimed to assess the change in delivery of essential and emergency surgeries due to the pandemic.Methodology A research consortium led by WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in Low- and Middle-Income countries (LMIC), India, conducted this retrospective cross-sectional study with 12 recruited centers. All surgeries performed during the months of April 2020 were compared with those performed in April 2019. These surgeries were stratified into emergency and elective, and further categorized based on NHS surgery prioritization documents. Results A total of 4396 surgeries were performed at these centers in April 2019 and 1216 surgeries were performed in same month during 2020, yielding a fall of 72.3% (1216 /4396).We found a 54% reduction in emergency surgeries and a 91% reduction in the elective surgeries. Number of cesarean sections reduced by 29.7% and fracture surgeries declined by 85.3% Laparotomies and surgeries for local soft tissue infections with necrotic tissue reduced by 71.7% and 69.5% respectively.Conclusion Our study quantifies the effects of COVID 19 pandemic on surgical care delivery in India and documents that the overall surgical volume reduced by three fourths in the pandemic period. Emergency surgeries reduced to half when compared with pre-pandemic period. Cesarean section surgeries were affected the least by pandemic, whereas the fracture surgeries and laparotomies were affected the most.

Efficacy of Facilitated Capacity Building in Providing Cleft Lip and Palate Care in Low- and Middle-Income Countries

2017 ◽  
Vol 28 (7) ◽  
pp. 1737-1741 ◽  
Author(s):  
Hillary E. Jenny ◽  
Benjamin B. Massenburg ◽  
Saurabh Saluja ◽  
John G. Meara ◽  
Mark G. Shrime ◽  
...  
Keyword(s):  
Capacity Building ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Reviewing the Orthognathic Surgical Care of the Patient With Cleft Lip and Palate

2009 ◽  
Vol 20 (Suppl 2) ◽  
pp. 1895-1904 ◽  
Author(s):  
David K. Chong ◽  
Jason E. Portnof ◽  
Haisong Xu ◽  
Kenneth E. Salyer
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Care

scholarly journals Smile Train: Making the Grade in Global Cleft Care

2018 ◽  
Vol 11 (1) ◽  
pp. 001-005 ◽  
Author(s):  
Matthew Louis ◽  
Ryan M. Dickey ◽  
Larry H. Hollier
Keyword(s):  
Cleft Lip ◽  
Developing World ◽  
Cleft Lip And Palate ◽  
Medical Personnel ◽  
High Quality ◽  
Middle Income ◽  
Psychological Burden ◽  
Quality Assurance Process ◽  
Assurance Process ◽  
Training Opportunities

The global medical and psychological burden of cleft lip and palate is large, especially in low- and middle-income countries. For decades, medical missions have sought to alleviate this burden; however, there are significant barriers to providing sustainable, high-quality cleft care using the mission model. Smile Train, an international children's charity founded in 1999, has developed a scalable model which provides support to local partner hospitals and surgeons around the world. Smile Train partners with hospitals to support cleft care treatment across the developing world. Partner hospitals are held to strict safety and quality standards. Local or regional providers are primarily used to train medical personnel. A quality assurance process developed by the Smile Train's Medical Advisory Board is used to assess cleft surgery cases and suggest additional review and training as needed. Surgical candidates are systematically evaluated and must meet specific medical criteria to ensure safety. Experienced anesthetists adhere to Smile Train's safety and quality protocols including anesthesia guidelines. Smile Train and its partners have provided more than 1.2 million safe, high-quality cleft surgical treatments since 1999. Smile Train has sponsored more than 3,000 hands-on training opportunities, 30,000 opportunities to participate in cleft conferences, and 40,000 virtual cleft training opportunities. Through rigorous self-governance and its sustainable, scalable model, this organization has elevated the standard of cleft care in the developing world.

scholarly journals P43 Did COVID-19 Pandemic change Anaesthesia Practices in India: A Multi-centre Cross-sectional Study

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Priyansh Shah ◽  
Bhakti Sarang ◽  
Anita Gadgil ◽  
Geetu Bhandoria ◽  
Monty Khajanchi ◽  
...  
Keyword(s):  
Care Delivery ◽  
Surgical Care ◽  
Anaesthetic Management ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Aerosol Generation ◽  
Research Consortium

Abstract Introduction The anaesthetic management for surgeries during the COVID-19 pandemic has posed unique challenges. Safety of all healthcare workers is an additional concern along with heightened risk to patients during General Anesthesia (GA). COVID-19 pneumonia and aerosol generation may be exacerbated during airway intervention and GA. We aimed to assess the change in the mode of anaesthesia due to the pandemic. Methods A research consortium led by WHO Collaboration Centre for Research in Surgical Care Delivery in Low and Middle Income countries, India, conducted this retrospective cross-sectional study in 12 hospitals across the country. We compared the anaesthesia preferences during pandemic (April 2020) to a corresponding pre pandemic period (April 2019) Results A total of 636 out of 2,162 (29.4%) and 156 out of 927 (16.8%) surgeries were performed under GA in April 2019 and April 2020 respectively, leading to a fall of 13% in usage of GA. A 5% reduction in GA and a 12% increase in the usage of regional anaesthesia was observed for cesarean sections. There was no significant change in anesthesia for laparotomies and fracture surgeries. However, 14% increase in GA usage was observed in surgeries for local soft tissue infections and necrotic tissues. Conclusion Though overall usage of GA reduced marginally, the change was mainly contributed by anesthesia for caesarean births. The insignificant change in anaesthesia for other surgeries may be attributed to the lack of facilities for spinal anaesthesia and may reflect the risk taking behaviour of healthcare professionals in COVID-19 pandemic.

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