Abstract
Subspecialty surgery, the provision of surgical care by trained subspecialists which typically requires advanced technology, materials, and infrastructure, is an emerging field on a global scale. Worldwide, there is a large burden of disease correctable by subspecialty surgery despite insufficient personnel and inadequate access to care for the majority of patients. Historically, subspecialty surgery in resource-limited settings has slowly progressed along a continuum of care. Numerous models and methods of delivery, each with notable advantages and disadvantages, have been utilized to provide care along this continuum. Based on these, providers and those they partner with can apply a model to further the provision of care. When done well, this delivery of subspecialty surgical care benefits not only the individual patient, but the community as a whole. Tenwek Hospital, a faith-based mission hospital that utilizes multiple methods of delivery, represents one example of how the continuum of the delivery of care can be used to promote cardiac surgery for individual patients while improving infrastructure and capacity to care for a community. This chapter illustrates some of the potential models available to enhance the subspecialist in global surgery.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Meara JG, Leather AJ, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624.
Galukande M, von Schreeb J, Wladis A, et al. Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries. PLoS Med. 2010;7(3):e1000243. doi:10.1371/journal.pmed.1000243.
Grimes CE, Law RS, Borgstein ES, Mkandawire NC, Lavy CB. Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg. 2012;36(1):8–23.
Lett R. International surgery: definition, principles, and Canadian practice. Can J Surg. 2003;46(5):365–72.
Gulick EV. Peter Parker and the opening of China. Cambridge: Harvard University Press, Harvard Studies in American-East Asian Relations; 1973.
Johnson WD. Surgery as a global health issue. Surg Neurol Int. 2013;4:47. doi:10.4103/2152-7806.110030.
Rohde J, Cousens S, Chopra M, et al. 30 years after Alma-Ata: has primary health care worked in countries? Lancet. 2008;372(9642):950–61.
Lowenson R. Structural adjustments and health policy in Africa. Int J Health Serv. 1995;23:717–30.
Turshen M. Privatizing health services in Africa. New Brunswick: Rutgers University Press; 1999.
Kuehn BM. Global shortage of health workers, brain drain stress developing countries. JAMA. 2007;298:1853–5.
McQueen KA, Casey KM. The impact of global anesthesia and surgery: professional partnerships and humanitarian outreach. Int Anesthesiol Clin. 2010;48(2):79–90.
Mullan F. Health, equity, and political economy: a conversation with Paul Farmer. Health Aff. 2007;26:1062–8. doi:10.1377/hlthaff.26.4.1062.
Jack A. ‘Brain drain’ puts Africa’s hospitals on the critical list. In: Cole F, editor. U.S. national debate topic, 2007–2008: healthcare in sub-Saharan Africa. The Reference shelf, (Volume 79, No. 3). H.W. Wilson, Bronx, NY: 2007. p. 104–8.
Tankwanchi ABS, Ozden C, Vermund SH. Physician emigration from sub-Saharan Africa to the United States: analysis of the 2011 AMA physician masterfile. PLoS Med. 2013;10(9):e1001513.
Boratyñski J, Chajewski L, Hermelin’ski P, Szymborska A, Tokarz B. Visa policies of European Union member states, monitoring report. Stefan Batory Foundation; 2006.
Shinn D. African migration and brain drain. Paper presented at the Institute for African Studies and Slovenia Global Action, Ljubljana, Slovenia, 20 June, 2008.
Kalipeni E. The brain drain of health care professionals from sub-Saharan Africa: a geographic perspective. Prog Dev Stud. 2012;12:153–71.
Crisp N, Chen L. Global supply of health professionals. N Engl J Med. 2014;370:950–7.
Sykes KJ. Short-term medical service trips: a systematic review of the evidence. Am J Public Health. 2014;104(7):e38–48.
Casey KM. The global impact of surgical volunteerism. Surg Clin North Am. 2007;87(4):949–60.
Chao TE, Riesel JN, Anderson GA, et al. Building a global surgery initiative through evaluation, collaboration, and training: the Massachusetts General Hospital experience. J Surg Educ. 2015;72(4):e21–8. doi:10.1016/j.jsurg.2014.12.018.
Lipnick M, Mijumbi C, Dubowitz G, et al. Surgery and anesthesia capacity-building in resource-poor settings: description of an ongoing academic partnership in Uganda. World J Surg. 2013;37(3):488–97.
Rumstadt B, Klein B, Kirr H, et al. Thyroid surgery in Burkina Faso, West Africa: experience from a surgical help program. World J Surg. 2008;32(12):2627–30.
Cheng LH, McColl L, Parker G. Thyroid surgery in the UK and on board the Mercy Ships. Br J Oral Maxillofac Surg. 2012;50(7):592–6.
Sykes KJ, Le PT, Sale KA, Nicklaus PJ. A 7-year review of the safety of tonsillectomy during short-term medical mission trips. Otolaryngol Head Neck Surg. 2012;146(5):752–6.
Snidvongs K, Vatanasapt P, Thanaviratananicha S, Pothaporna M, Sannikorna P, Supiyaphuna P. Outcome of mobile ear surgery units in Thailand. J Laryngol Otol. 2009;124(4):382–6.
Horlbeck D, Boston M, Balough B, et al. Humanitarian otologic missions: long-term surgical results. Otolaryngol Head Neck Surg. 2009;140(4):559–65.
Barrs DM, Muller SP, Worndell DB, Weidmann EW. Results of a humanitarian otologic and audiologic project performed outside of the United States: lessons learned from the “Oye, Amigos!” project. Otolaryngol Head Neck Surg. 2000;123(6):722–7.
Huijing MA, Marck KW, Combes J, et al. Facial reconstruction in the developing world: a complicated matter. Br J Oral Maxillofac Surg. 2011;49(4):292–6.
Maine RG, Hoffman WY, Palacios-Martinez JH, et al. Comparison of fistula rates after palatoplasty for international and local surgeons on surgical missions in Ecuador with rates at a craniofacial center in the United States. Plast Reconstr Surg. 2012;129(2):319e–26e.
Cousins GR, Obolensky L, McAllen C, Acharya V, Beebeejaun A. The Kenya orthopedic project. Surgical outcomes of a traveling multidisciplinary team. J Bone Joint Surg Br. 2012;94-B(12):1591–4.
Adams C, Kiefer P, Ryan K, et al. Humanitarian cardiac care in Arequipa, Peru: experiences of a multidisciplinary Canadian cardiovascular team. Can J Surg. 2012;55(3):171–6.
Falese B, Sanusi M, Majekodunmi A, et al. Open heart surgery in Nigeria; a work in progress. J Cardiothorac Surg. 2013;8:6.
Swain JD, Pugilese DN, Mucumbitsi J, et al. Partnership for sustainability in cardiac surgery to address critical rheumatic heart disease in sub-Saharan Africa: the experience from Rwanda. World J Surg. 2014;38(9):2205–11.
Tefuarani N, Vince J, Hawker R, et al. Operation open heart in PNG, 1993–2006. Heart Lung Circ. 2007;16(5):373–7.
Young S, Lie SA, Hallan G, et al. Risk factors for infection after 46,113 intramedullary nail operations in low – and middle-income countries. World J Surg. 2013;37(2):349–55.
Jenkins KJ, Castaneda AR, Cherian KM, et al. Reducing mortality and infections after congenital heart surgery in the developing world. Pediatrics. 2014;134(5):e1422–30. doi: http://dx.doi.org/10.1542/peds.2014-0356.
Novick WM, Stidham GL, Karl TR, et al. Are we improving after 10 years of humanitarian paediatric cardiac assistance? Cardiol Young. 2005;15(4):379–84.
Gathura E, Poenaru D, Bransford R, Albright AL. Outcomes of ventriculoperitoneal shunt insertion in sub-Saharan Africa. J Neurosurg. 2012;116(5):329–35.
Kulkrani AV, Warf BC, Drake JM, et al. Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome. Childs Nerv Syst. 2010;26:1711–7.
Meier DE, Tarpley JL, Imediegwu OO, et al. The outcome of suprapubic prostatectomy: a contemporary series in the developing world. Urology. 1995;46(1):40–4.
Stephens KR, Shahab F, Galat D, et al. Management of distal tibial metaphyseal fractures with the SIGN intramedullary nail in 3 developing countries. J Orthop Trauma. 2015;29(12):e469–75. doi:10.1097/BOT.0000000000000396.
Leon-Wyss JR, Veshti A, Veras O. Pediatric cardiac surgery: a challenge and outcome analysis of the Guatemala effort. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2009:8–11. doi:10.1053/j.pcsu.2009.01.003.
Gnanappa GK, Ganigara M, Prabhu A, et al. Outcome of complex adult congenital heart surgery in the developing world. Congenit Heart Dis. 2011;6(1):2–8.
Schönmeyr B, Wendby L, Campbell A. Early surgical complications after primary cleft lip repair: a report of 3108 consecutive cases. Cleft Palate-Craniofac J. 2015;52(6):706–10.
Mathers C, Fat DM, Boerma JT. The global burden of disease: 2004 update. World Health Organization; Geneva; 2008.
UNICEF. The state of the world’s children 2009. UNICEF; New York, NY; 2009.
Rao GN, Khanna R, Payal A. The global burden of cataract. Curr Opin Ophthalmol. 2011;22(1):4–9.
Monasta L, Ronfani L, Marchetti F, Montico M, Brumatti LV, Bavcar A, Grasso D, Barbiero C, Tamburlini G. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7(4):e36226.
Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. 2002 Oct;80(10):829–35.
Stanley CM, Rutherford GW, Morshed S, Coughlin RR, Beyeza T. Estimating the healthcare burden of osteomyelitis in Uganda. Trans R Soc Trop Med Hyg. 2010;104(2):139–42.
Metzler IS, Nguyen HT, Hagander L, et al. Surgical outcomes and cultural perceptions in international hypospadias care. J Urol. 2014;192(2):524–9. doi:10.1016/j.juro.2014.01.101.
Campain NJ, MacDonagh RP, Mteta KA, McGrath JS, BAUS Urolink. Global surgery – how much of the burden is urological? BJU Int. 2015;116(3):314–6. doi:10.1111/bju.13170.
Manganiello M, Hughes CD, Hagander L, et al. Urologic disease in a resource-poor country. World J Surg. 2013;37(2):344–8.
Mossey PA, Modell B. Epidemiology of oral clefts 2012: an international perspective. In: Cobourne MT, editor. Cleft lip and palate. Epidemiology, aetiology and treatment. Front oral biol. Basel: Karger; 2012. p. 1–18. doi:10.1159/000337464.
Wu VK, Poenaru D, Poley MJ. Burden of surgical congenital anomalies in Kenya: a population-based study. J Trop Pediatr. 2013;59(3):195–202.
Hoyler M, Finlayson SR, McClain CD, et al. Shortage of doctors, shortage of data: a review of the global surgery, obstetrics, and anesthesia workforce literature. World J Surg. 2014;38(2):269–80.
Walker IA, Obua AD, Mouton F, Ttendo S, Wilson IH. Paediatric surgery and anaesthesia in south-western Uganda: a cross sectional survey. Bull World Health Organ. 2010;88(12):897–906.
Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139–44. doi:10.1016/S0140-6736(08)60878-8.
Semer NB, Sullivan SR, Meara JG. Plastic surgery and global health: how plastic surgery impacts the global burden of surgical disease. J Plast Reconstr Aesthet Surg. 2010;63(8):1244–8.
Fuller A, Tran T, Muhumuza M, Haglund MM. Building neurosurgical capacity in low and middle income countries. Neurol Sci. 2016;3:1–6. doi:10.1016/j.ensci.2015.10.003.
Krishnaswami S, Nwomeh BC, Ameh EA. The pediatric surgery workforce in low and middle income countries: problems, and priorities. Seminars in pediatric surgery. 2016;25(1):32–42.
Alkire BC, Raykar NP, Shrime MG, et al. Global access to surgical care: a modelling study. Lancet Glob Health. 2015;3(6):e316–23.
Dorman SL, Graham SM, Paniker J, Phalira S, Harrison WJ. Establishing a children’s orthopaedic hospital for Malawi: a review after 10 years. Malawi Med J. 2014;26(4):119–23.
Lavy C, Tindall A, Steinlechner C, Mkandawire N, Chimangeni S. Surgery in Malawi – a national survey of activity in rural and urban hospitals. Ann R Coll Surg Engl. 2007;89(7):722–4.
Notrica MR, Evans FM, Knowlton LM, McQueen KA. Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg. 2011;35(8):1770–80.
Kruk ME, Wladis A, Mbembati N, et al. Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS Med. 2010;7(3):e1000242. doi:10.1371/journal.pmed.1000242.
Knowlton LM, Chackungal S, Dahn B, et al. Liberian surgical and anesthesia infrastructure: a survey of county hospitals. World J Surg. 2013;37(4):721–9. doi:10.1007/s00268-013-1903-2.
Tran TM, Saint-Fort M, Jose MD, et al. Estimation of surgery capacity in Haiti: nationwide survey of hospitals. World J Surg. 2015;39(9):2182–90.
Faierman ML, Anderson JE, Assane A, et al. Surgical patients travel longer distances than non-surgical patients to receive care at a rural hospital in Mozambique. Int Health. 2014; doi:10.1093/inthealth/ihu059.
Melese M, Alemayehu W, Friedlander E, Courtright P. Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia. Trop Med Int Health. 2004;9(3):426–31.
Zafar SN, Fatmi Z, Igbal A, Channa R, Haider AH. Disparities in access to surgical care within a low income country: an alarming inequity. World J Surg. 2013;37(7):1470–7.
Cadotte DW, Viswanathan A, Cadotte A, et al. The consequence of delayed neurosurgical care at Tikur Anbessa Hospital, Addis Ababa, Ethiopia. World Neurosurg. 2010;73(4):270–5.
Chao TE, Burdic M, Ganjawalla K, et al. Survey of surgery and anesthesia in Ethiopia. World J Surg. 2012;36(11):2545–53.
White RE, Parker RK, Fitzwater JW, Kasepoi Z, Topazian M. Stents as sole therapy for oesophageal cancer: a prospective analysis of outcomes after placement. Lancet Oncol. 2009;10(3):240–6.
Parker RK, Dawsey SM, Abnet CC, White RE. Frequent occurrence of esophageal cancer in young people in western Kenya. Dis Esophagus. 2010;23(2):128–35.
Poenaru D, Pemberton J, Cameron BH. The burden of waiting: DALYs accrued from delayed access to pediatric surgery in Kenya and Canada. J Pediatr Surg. 2015;50(5):765–70.
Shrime MG, Dare AJ, Alkire BC, O’Neill K, Meara JG. Catastrophic expenditure to pay for surgery: a modelling study. Lancet Glob Health. 2015;3:S38–44.
Hughes CD, Babigian A, McCormack S, et al. The clinical and economic impact of a sustained program in global plastic surgery: valuing cleft care in resource-poor settings. Plast Reconstr Surg. 2012;130(1):87e–94e. doi:10.1097/PRS.0b013e318254b2a2.
Eeson G, Birabwa-Male D, Pennington M, Blair GK. Costs and cost-effectiveness of Pediatric Inguinal Hernia Repair. World J Surg. 2015;39:343–9.
Davis MC, Than KD, Garton HJ. Cost effectiveness of a short-term pediatric neurosurgical brigade to Guatemala. World Neurosurg. 2014;82(6):974–9.
Chen AT, Pedtke A, Kobs JK, et al. Volunteer orthopedic surgical trips in Nicaragua: a cost-effectiveness evaluation. World J Surg. 2012;36(12):2802–8.
Gosselin RA, Gialamas G, Atkin DM. Comparing the cost-effectiveness of short orthopedic mission in elective and humanitarian situations in developing countries. World J Surg. 2011;35:951–5.
Marseille E. Cost effectiveness of cataract surgery in a public health eye care programme in Nepal. Bull World Health Organ. 1996;74:319–24.
Baltussen R, Sylla M, Mariotti SP. Cost-effectiveness analysis of cataract surgery: a global and regional analysis. Bull World Health Organ. 2004;82:338–45.
Lansingh VC, Carter MJ, Martens M. Global cost-effectiveness of cataract surgery. Ophthalmology. 2007;114:1670–8.
Kuper H, Polack S, Mathenge W, et al. Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh. PLoS One. 2010;5(11):e15431. doi:10.1371/journal.pone.0015431.
Singh AJ, Garner P, Floyd K. Cost–effectiveness of public-funded options for cataract surgery in Mysore, India. Lancet. 2000;355:180–4.
Wittenborn JS, Rein DB. Cost-effectiveness of glaucoma interventions in Barbados and Ghana. Optom Vis Sci. 2011;88:155–63.
Evans TG, Ranson MK, Kyaw TA, Ko CK. Cost effectiveness and cost utility of preventing trachomatous visual impairment: lessons from 30 years of trachoma control in Burma. Br J Ophthalmol. 1996;80:880–9.
Baltussen RM, Sylla M, Frick KD, Mariotti SP. Cost-effectiveness of trachoma control in seven world regions. Ophthalmic Epidemiol. 2005;12:91–101.
Corlew DS. Estimation of impact of surgical disease through economic modeling of cleft lip and palate care. World J Surg. 2010;34:391–6.
Magee WP, Vander Burg R, Hatcher KW. Cleft lip and palate as a cost-effective health care treatment in the developing world. World J Surg. 2010;34:420–7.
Moon W, Perry H, Baek RM. Is international volunteer surgery for cleft lip and cleft palate a cost-effective and justifiable intervention? A case study from East Asia. World J Surg. 2012;36(12):2819–30.
Hackenberg B, Ramos MS, Campbell A, et al. Measuring and comparing the cost-effectiveness of surgical care delivery in low-resource settings: cleft lip and palate as a model. J Craniofacial Surg. 2015;26(4):1121–5.
Tadisina KK, Chopra K, Tangredi J, Thomson JG, Singh DP. Helping hands: a cost-effectiveness study of a humanitarian hand surgery mission. Plast Surg Int. 2014;2014:921625. doi:10.1155/2014/921625.
Chatterjee S, Laxminarayan R. Costs of surgical procedures in Indian hospitals. BMJ Open. 2013;3(6):e002844. doi:10.1136/bmjopen-2013-002844.
Chao TE, Sharma K, Mandigo M, et al. Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Health. 2014;2:e334–45.
Warf BC, Alkire BC, Bhai S, et al. Costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. J Neurosurg Pediatrics. 2011;8(5):509–21.
Shrime MG, Sleemi A, Ravilla TD. Chapter 13. Specialized surgical platforms. In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. Disease control priorities. Essential surgery, vol. 1, 3rd ed. Washington, DC: World Bank; 2015.
Martiniuk A, Manouchehrian M, Negin JA, Zwi AB. Brain gains: a literature review of medical missions to low and middle-income countries. BMC Health Serv Res. 2012;12:134. doi:10.1186/1472-6963-12-134.
Sanders DL, Kingsnorth AN. Operation hernia: humanitarian hernia repairs in Ghana. Hernia. 2007;11:389–91.
Ginwalla R, Rickard J. Surgical missions the view from the other side. JAMA Surg. 2015;150(4):289–90.
Chapin E, Doocy S. International short-term medical service trips: guidelines from the literature and perspectives from the field. World Health Popul. 2010;12(2):43–53.
d’Agostino S, Del Rossi C, Del Curto S, et al. Surgery of congenital malformations in developing countries: experience in 13 humanitarian missions during 9 years. Pediatr Med Chir. 2001;23(2):117–21.
Nthumba PM. “Blitz Surgery”: redefining surgical needs, training, and practice in sub-Saharan Africa. World J Surg. 2010;34(3):433–7.
Campbell A, Sullivan M, Sherman R, Magee WP. The medical mission and modern cultural competency training. J Am Coll Surg. 2011;212(1):124–9.
Aziz SR, Ziccardi VB, Chuang SK. Survey of residents who have participated in humanitarian medical missions. J Oral Maxillofac Surg. 2012;70(2):e147–57.
Tannan SC, Gampper TJ. Resident participation in international surgical missions is predictive of future volunteerism in practice. Arch Plast Surg. 2015;42(2):159–63.
Weir N. Ear surgery camps in Nepal and the work of the Britain Nepal Otology Service (BRINOS). J Laryngol Otol. 1991;105(12):1113–5. doi:http://dx.doi.org/10.1017/S0022215100118377.
Figus A, Fioramonti P, Morselli P, Scuderi N. Interplast Italy: a 20-year plastic and reconstructive surgery humanitarian experience in developing countries. Plast Reconstr Surg. 2009;124(4):1340–8. doi:10.1097/PRS.0b013e3181b5a2ef.
Wall LL, Arrowsmith SD, Lassey AT, Danso K. Humanitarian ventures or ‘fistula tourism?’: the ethical perils of pelvic surgery in the developing world. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):559–62.
Roche S, Hall-Clifford R. Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala. Glob Public Health. 2015;10(10):1201–14. doi:10.1080/17441692.2015.1011189.
Funk LM, Weiser TG, Berry WR, et al. Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet. 2010;376:1055–61.
Gil J, Rodriguez JM, Hernandez Q, Gil E, Balsalobre MD, González M, Torregrosa N, Verdú T, Alcaráz M, Parrilla P. Do hernia operations in African international cooperation programmes provide good quality? World Surgery Surg. 2012;36(12):2795–801.
Grimes CE, Maraka J, Kingsnorth AN, et al. Guidelines for surgeons on establishing projects in low-income countries. World J Surg. 2013;37(6):1203–7.
Welling DR, Ryan JM, Burris DG, Rich NM. Seven sins of humanitarian medicine. World J Surg. 2010;34(3):466–70.
Isaacson G, Drum ET, Cohen MS. Surgical missions to developing countries: ethical conflicts. Otolaryngol Head Neck Surg. 2010;143:476–9.
Meier D. Opportunities and improvisations: a pediatric surgeon’s suggestions for successful short-term surgical volunteer work in resource-poor areas. World J Surg. 2010;34(5):941–6.
Schneider WJ, Migliori MR, Gosain AK, et al. Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world: part II. Ethical considerations. Plast Reconstr Surg. 2011;128(3):216e–22e. doi:10.1097/PRS.0b013e31822213b4.
Wright IG, Walker IA, Yacoub MH. Specialist surgery in the developing world: luxury or necessity? Anaesthesia. 2007;62(s1):84–9.
Dupuis CC. Humanitarian missions in the third world: a polite dissent. Plast Reconstr Surg. 2004;113(1):433–5.
Shrime MG, Sleemi A, Ravilla TD. Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training. World J Surg. 2014;39(1):10–20.
Morgan MA. Another view of “humanitarian ventures” and “fistula tourism”. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(6):705–7.
Qureshi JS, Samuel J, Lee C, et al. Surgery and global public health: the UNC-Malawi surgical initiative as a model for sustainable collaboration. World J Surg. 2011;35(1):17–21.
Klaristenfeld DD, Chupp M, Cioffi WG, White RE. An international volunteer program for general surgery residents at Brown Medical School: the Tenwek Hospital Africa experience. JACS. 2008;207(1):125–8.
Riviello R, Ozgediz D, Hsia RY, et al. Role of collaborative academic partnerships in surgical training, education, and provision. World J Surg. 2010;34:459–65.
Cancedda C, Farmer PE, Kerry V, et al. Maximizing the impact of training initiatives for health professionals in low-income countries: frameworks, challenges, and best practices. PLoS Med. 2015;12(6):e1001840.
Kakande I, Mwandawire N, Thompson MIW. A review of surgical capacity and surgical education programme in the COSECSA Region. East Cent African J Surg. 2011;16(3):6–34.
Blair GK, Duffy D, Birabwa-Male D, et al. Pediatric surgical camps as one model of global surgical partnership: a way forward. J Pediatr Surg. 2014;49(5):786–90.
Lisasi E, Kulanga A, Muiruri C, et al. Modernizing and transforming medical education at the Kilimanjaro Christian Medical University College. Acad Med. 2014;89(8):S60–4.
Bickler SW, Funzamo C, Rose J, Assane A, et al. Building surgical research capacity in Mozambique. Acad Med. 2015;89:S107. doi:10.1097/ACM.0000000000000339.
Binagwaho A, Kyamanywa P, Farmer PE, et al. The human resources for health program in Rwanda — a new partnership. N Engl J Med. 2013;369:2054–9.
Deckelbaum DL, Gosselin-Tardif A, Ntakiyiruta G, et al. An innovative paradigm for surgical education programs in resource-limited settings. Can J Surg. 2014;57(5):298–9.
Crane J. Scrambling for Africa? Universities and global health. Lancet. 2011;377:1388–90.
Eadie LH, Seifalian AM, Davidson BR. Telemedicine in surgery. Br J Surg. 2003;90(6):647–58.
Bagayoko CO, Müller H, Geissbuhler A. Assessment of internet-based tele-medicine in Africa (the RAFT project). Comput Med Imaging Graph. 2006;30(6–7):407–16.
Latifi R, Mora F, Bekteshi F, Rivera R. Preoperative telemedicine evaluation of surgical mission patients: should we use it routinely? Bull Am Coll Surg. 2014;99(1):17–23.
Rodas E, Mora F, Tamariz F, Cone SW, Merrell RC. Low-bandwidth telemedicine for pre- and postoperative evaluation in mobile surgical services. J Telemed Telecare. 2005;11(4):191–3.
Modi KM, Chandwani R, Hari Kumar KVS, Ahmed I, Senthil T. Use of telemedicine in remote screening for retinopathy in type 2 diabetes. Apollo Medicine. 2015; (in press) doi:10.1016/j.apme.2015.10.002.
Dadlani R, Mani S, JG AU, et al. The impact of telemedicine in the postoperative care of the neurosurgery patient in an outpatient clinic: a unique perspective of this valuable resource in the developing world – an experience of more than 3000 teleconsultations. World Neurosurg. 2014;82(3–4):270–83.
Augestad KM, Chomutare T, Bellika JG, et al. “Clinical and educational benefits of surgical telementoring”, simulation training in laparoscopic and robotic surgery. London: Springer; 2012. p. 75–82.
Pradeep PV, Mishra A, Mohanty BN, et al. Reinforcement of endocrine surgery: impact of telemedicine technology in a developing country context. World J Surg. 2007;31(8):1665–71.
Hadley PG, Mars M. Postgraduate medical education in paediatric surgery: videoconferencing – a possible solution for Africa? Pediatr Surg Int. 2008;24:223–6.
Okrainec A, Henao O, Azzie G. Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restrained countries. Surg Endosc. 2010;24(2):417–22.
Henao Ó, Escallón J, Green J, et al. Fundamentals of laparoscopic surgery in Colombia using telesimulation: an effective educational tool for distance learning. Biomedica. 2013;33(1):107–14. doi:10.1590/S0120-41572013000100013.
Federspiel F, Mukhopadhyay S, Milsom P, et al. Global surgical and anaesthetic task shifting: a systematic literature review and survey. Lancet. 2015;385(Suppl 2):S46. doi:10.1016/S0140-6736(15)60841-8.
Beard JH, Oresanya LB, Akoko L, et al. Surgical task-shifting in a low-resource setting: outcomes after major surgery performed by nonphysician clinicians in Tanzania. World J Surg. 2014;38(6):1398–404.
Ford N, Chu K, Mills E. Safety of task-shifting for male medical circumcision: a systematic review and meta-analysis. AIDS. 2012;26(5):559–66. doi:10.1097/QAD.0b013e32834f3264.
van Amelsfoort JJ, van Leeuwen PA, Jiskoot P, Ratsma YE. Surgery in Malawi – the training of clinical officers. Trop Dr. 2010;40(2):74–6. doi:10.1258/td.2009.090068.
De Brouwere V, Dieng T, Diadhiou M, Witter S, Denerville E. Task shifting for emergency obstetric surgery in district hospitals in Senegal. Reprod Health Matters. 2009;17(33):32–44. doi:10.1016/S0968-8080(09)33437-0.
Pereira C, Cumbi A, Malalane R, et al. Meeting the need for emergency obstetric care in Mozambique: work performance and histories of medical doctors and assistant medical officers trained for surgery. BJOG. 2007;114(12):1530–3.
McCord C, Mbaruku G, Pereira C, Nzabuhakwa C, Bergstrom S. The quality of emergency obstetrical surgery by assistant medical officers in Tanzanian district hospitals. Health Aff (Millwood). 2009;28(5):w876–85.
Mkandawire N, Ngulube C, Lavy C. Orthopaedic clinical officer program in Malawi: a model for providing orthopaedic care. Clin Orthop Relat Res. 2008;466(10):2385–91. doi:10.1007/s11999-008-0366-5.
Tyson AF, Msiska N, Kiser M, et al. Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi. Int J Surg. 2012;12:509–15.
Wilhelm TJ, Thawe IK, Mwatibu B, Mothes H, Post S. Efficacy of major general surgery performed by non-physician clinicians at a central hospital in Malawi. Trop Dr. 2011;41(2):71–5.
Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007;370(9605):2158–63.
Ellegala DB, Simpson L, Mayegga E, et al. Neurosurgical capacity building in the developing world through focused training. J Neurosurg. 2014;121(6):1526–32.
Aliu O, Pannucci CJ, Chung KC. Qualitative analysis of the perspectives of volunteer reconstructive surgeons on participation in task-shifting programs for surgical-capacity building in low-resource countries. World J Surg. 2013;37(3):481–7.
Chu K, Rosseel P, Gielis P, Ford N. Surgical task-shifting in sub-Saharan Africa. PLoS Med. 2009;6(5):e1000078. doi:10.1371/journal.pmed.1000078.
Pollock JD, Love TP, Steffes BC. Is it possible to train surgeons for rural Africa? A report of a successful international program. World J Surg. 2011;35(3):493–9.
Newton M, Bird P. Impact of parallel anesthesia and surgical provider training in sub-Saharan Africa: a model for a resource-poor setting. World J Surg. 2010;34(3):445–52.
Chirden LB, Ameh EA, Abantanga FA, Sidler D, Elhalaby EA. Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg. 2010;45(3):610–8.
Ameh EA, Adejuyigbe O, Nmadu PT. Pediatric surgery in Nigeria. J Pediatr Surg. 2006;41(3):542–6.
Galukande M, Ozgediz D, Elobu E, Kaggwa S. Pretraining experience and structure of surgical training at a sub-Saharan African University. World J Surg. 2013;37(8):1836–40.
Mutabdzic D, Bedada AG, Bakanisi B, Motsumi J, Azzie G. Designing a contextually appropriate surgical training program in low-resource settings: the Botswana experience. World J Surg. 2013;37(7):1486–91.
Lebrun DG, Dhar D, Sarkar MI, et al. Measuring global surgical disparities: a survey of surgical and anesthesia infrastructure in Bangladesh. World J Surg. 2013;37(1):24–31. doi:10.1007/s00268-012-1806-7.
Linden AF, Sekidde FS, Galukande M, et al. Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg. 2012;6(5):1056–65. doi:10.1007/s00268-012-1482-7.
Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. PLoS Med. 2012;9(6):e1001244. doi:10.1371/journal.pmed.1001244.
Ekenze SO, Onumaegbu OO, Nwankwo OE. The current status of international partnerships for child surgery in sub-Saharan Africa. Int Surg. 2014;99(5):616–22. doi:10.9738/INTSURG-D-13-00244.1.
Edwin F, Tettey M, Aniteye E, et al. The development of cardiac surgery in West Africa-the case of Ghana. Pan Afr Med J. 2011;9:15.
Price R, Sergelen O, Unursaikhan C. Improving surgical care in Mongolia: a model for sustainable development. World J Surg. 2013;37(7):1492–9.
Nair VD, Morankar S, Jira C, Tushune K. Private hospital sector development: an exploratory study on providers perspective in Addis Ababa. Ethiopia Ethiop J Health Sci. 2011;21(Suppl 1):59–64.
Morgan R, Ensor T. The regulation of private hospitals in Asia. Int J Health Plann Manag. 2014; doi:10.1002/hpm.2257.
Ferrinho P, Van Lerberghe W, Fronteira I, Hipólito F, Biscaia A. Dual practice in the health sector: review of the evidence. Hum Resour Health. 2004;2:14. doi:10.1186/1478-4491-2-14.
Russo G, McPake B, Fronteira I, Ferrinho P. Negotiating markets for health: an exploration of physicians’ engagement in dual practice in three African capital cities. Health Policy Plan. 2014;29:774–83.
Nah SH, Osifo-Dawodu E. Establishing private health care facilities in developing countries: a guide for medical entrepreneurs. Washington D.C.: The World Bank; 2007.
Museru LM, Grob U. Public/private mix: an alternative funding for public hospitals in developing countries: a 5-years’ experience at Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania. East Central African J Surg. 2003;8(1):11–4.
McQueen KA, Hyder JA, Taira BR, Semer N, Burkle Jr FM, et al. The provision of surgical care by International Organizations in developing countries: a preliminary report. World J Surg. 2010;34(3):397–402. doi:10.1007/s00268-009-0181-5.
Ng-Kamstra JS, Arya S, Chung TE, et al. Mapping the playing field—a novel web-based strategy to identify non-governmental actors in global surgery. Lancet. 2015;385(Global Surgery special issue):S55.
Poenaru D. Getting the job done: analysis of the impact and effectiveness of the SmileTrain program in alleviating the global burden of cleft disease. World J Surg. 2013;37:1562–70.
Jalloh M, Wood JP, Fredley M. deVries CR. IVUMed: a nonprofit model for surgical training in low-resource countries. Annals Global Health. 2015;81(2):260–4.
Nagengast ES, Caterson EJ, Magee MW, et al. Providing more than health care: the dynamics of humanitarian surgery efforts on the local microeconomy. J Craniofacial Surg. 2014;25(5):1622–5.
Karam A, Clague J, Marshall K, Olivier J. The view from above: faith and health. Lancet. 2015;386(10005):e22–4.
WHO. The world health report 2004: changing history, community participation in public health. Geneva: World Health Organization; 2004.
Benn C. Why religious health assets matter. ARHAP: assets and agency colloquium. Pietermaritzburg, South Africa: African Religious Health Assets Programme. 2003;40:3–11.
Marshall K, Marsh R. Millennium challenges for faith and development leaders, vol. 41. Washington, DC: World Bank; 2003.
PEPFAR. The president’s emergency plan for AIDS relief: community and faith-based organisations. Washington, USA: (PEPFAR) The President’s Emergency Plan for AIDS Relief, 2005. http://www.pepfar.gov/reports/progress/76864.htm. Accessed 26 Nov 2015.
Kagawa RC, Anglemeyer A, Montagu D. The scale of faith based organization participation in health service delivery in developing countries: systematic [corrected] review and meta-analysis. PLoS One. 2012;7(11) doi:10.1371/annotation/1e80554b-4f8a-4381-97f1-46bf72cd07c9.
Olivier J, Tsimpo C, Gemignani R, et al. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction. Lancet. 2015;386:1765–75.
Davis RE, Hansen EN, Newton MW. Faith-based organizations and academic global surgery’s moral imperative. JAMA Surg. Published online November, 112015; doi:10.1001/jamasurg.2015.3631.
Hankins GW. Surgery in a mission hospital. Ann R Coll Surg Engl. 1980;62(6):439–44. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493776/
Potter AR. Surgery in an African Bush hospital. Med J Aust. 1982;2(10):469–71.
Olivier J, Tsimpo C, Wodon Q. “Satisfaction with faith-inspired health care services in Africa: review and evidence from household surveys.” In Olivier J, Wodon Q, editors. The comparative nature of faith-inspired health care provision in sub-Saharan Africa. Washington, DC: HNP Discussion Paper, World Bank; 2012.
Schmid B, Thomas E, Olivier J, Cochrane JR. The contribution of religious entities to health in sub-Saharan Africa. Study commissioned by Bill and Melinda Gates Foundation. Cape Town: African Religious Health Assets Program (ARHAP); 2008. African Religious Health Assets Program website. Available: http://www.arhap.uct.ac.za/downloads/ARHAPGates_ch1.pdf. Accessed 2015.
Funk LM, Conley DM, Berry WR, Gawande AA. Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals. World J Surg. 2013;37:2520–8.
Wodon Q, Olivier J, Tsimpo C, Nguyen MC. Market share of faith-inspired health care providers in Africa. Rev Faith Int’l Aff. 2014;12:8–20.
Reinikka R, Svensson J. Working for God? Evaluating service delivery of religious not-for-profit health care providers in Uganda. Washington, DC: World Bank; 2003.
Duff JF, Buckingham WW. Strengthening of partnerships between the public sector and faith-based groups. Lancet. 2015;386(10005):1786–94. doi:10.1016/S0140-6736(15)60250-1.
Butler MW, Ozgediz D, Poenaru D, et al. The global paediatric surgery network: a model of subspecialty collaboration within global surgery. World J Surg. 2014;39:335–42. doi:10.1007/s00268-014-2843-1.
Purnell CA, McGrath JL, Gosain AK. The role of Smile Train and the partner hospital model in surgical safety, collaboration, and quality in the developing world. J Craniofac Surg. 2015;26(4):1129–33.
Marck RM, Huijing M, Vest D, et al. Early outcome of facial reconstructive surgery abroad: a comparative study. Eur J Plast Surg. 2010;33(4):193–7.
Cook M, Howard BM, Yu A, et al. A consortium approach to surgical education in a developing country educational needs assessment. JAMA Surg. 2015;150(11):1074–8.
Cadotte DW, Sedney C, Djimbaye H, Bernstein M. A qualitative assessment of the benefits and challenges of international neurosurgical teaching collaboration in Ethiopia. World Neurosurg. 2014;82(6):980–6.
Gordon TA, Bowman HM, Bass EB, et al. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg. 1999;189(1):46–56.
Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.
Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94(2):145–61.
Rhee D, Papandria D, Yang J, et al. Comparison of pediatric surgical outcomes by the surgeon’s degree of specialization in children. J Pediatr Surg. 2013;48(8):1657–63. doi:10.1016/j.jpedsurg.2012.12.048.
Snow BW. Does surgical subspecialty care come with a higher price? Curr Opin Pediatr. 2005;17(3):407–8.
Rossell-Perry P, Segura E, Salas-Bustinza L, Cotrina-Rabanal O. Comparison of two models of surgical care for patients with cleft lip and palate in resource-challenged settings. World J Surg. 2015;39:47–53.
White RE, Abnet CC, Mungatana CK, Dawsey SM. Oesophageal cancer: a common malignancy in young people of Bomet District, Kenya. Lancet. 2002;360(9331):462–3.
Chao TE, Mandigo M, Opoku-Anane J, Maine R. Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg Endosc. 2015; doi:10.1007/s00464-015-4201-2.
Galukande M, Jombwe J. Feasibility of laparoscopic surgery in a resource-limited setting: cost containment, skills transfer, and outcomes. East Central African J Surg. 2011;16(2):112–7.
Hewitson J, Brink J, Zilla P. The challenge of pediatric cardiac services in the developing world. Semin Thorac Cardiovasc Surg. 2002;14(4):340–5.
Mocumbi AOH. The challenges of cardiac surgery in Africa: review article. Cardiovasc J Africa. 2012;23(3):165–7.
Rao SG. Pediatric cardiac surgery in developing countries. Pediatr Cardiol. 2007;28:144–8.
Patel PB, Hoyler M, Maine R, et al. An opportunity for diagonal development in global surgery: cleft lip and palate care in resource-limited settings. Plast Surg Int. 2012;2012:892437.
The PLoS Medicine Editors. A crucial role for surgery in reaching the UN millennium development goals. PLoS Med. 2008;5:e182.
Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World J Surg. 2008;32:533–6.
Farmer PE, Mukherjee J. Ebola’s front lines. Boston: Boston Globe; 2014.
Tagny CT, Owusu-Ofori S, Mbanya D, Deneys V. The blood donor in sub-Saharan Africa: a review. Transfus Med. 2010;20:1–10.
Vasan A, Hudelson CE, Greenberg SL, Ellner AE. An integrated approach to surgery and primary care systems strengthening in low- and middle-income countries: building a platform to deliver across the spectrum of disease. Surgery. 2015;157(6):965–70.
Mollura DJ, Shah N, Mazal J, Group RADAIDCW, and the RAD-AID Conference Writing Group. White paper report of the 2013 RAD-AID Conference: improving radiology in resource-limited regions and developing countries. J Am Coll Radiol. 2014;11:913–19.
LeBrun DG, Chackungal S, Chao TE, et al. Prioritizing essential surgery and safe anesthesia for the post-2015 development agenda: operative capacities of 78 district hospitals in 7 low- and middle-income countries. Surgery. 2014;155:365–73.
Perry L, Malkin R. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world? Med Biol Eng Comput. 2011;49:719–22.
Raykar NP, Yorlets RR, Liu C, et al. A qualitative study exploring contextual challenges to surgical care provision in 21 LMICs. Lancet. 2015;385(Global Surgery special issue):S15.
Kim JY, Farmer PE, Porter ME. Redefining global health-care delivery. Lancet. 2013;382(9897):1060–9.
MacLeod J, Jones T, Aphivantrakul P, Chupp M, Poenaru D. Evaluation of fundamental critical care course in Kenya: knowledge, attitude, and practice. J Surg Res. 2011;167(2):223–30.
Søreide K, Alderson D, Bergenfelz A, Beynon J, Connor S, Deckelbaum DL, Dejong CH, Earnshaw JJ, Kyamanywa P, Perez RO, Sakai Y. Strategies to improve clinical research in surgery through international collaboration. Lancet. 2013;382(9898):1140–51.
Derbew M, Beveridge M, Howard A, Byrne N. Building surgical research capacity in Africa: the Ptolemy project. PLoS Med. 2006;3(7):e305.
Goldstein SD, Papandria D, Linden A, et al. A pilot comparison of standardized online surgical curricula for use in low- and middle-income countries. JAMA Surg. 2014;149(4):341–6.
Adisa AO, Lawal OO, Arowolo OA, Alatise OI. Local adaptations aid establishment of laparoscopic surgery in a semiurban Nigerian hospital. Surg Endosc. 2013;27(2):390–3.
Vargas J, Mayegga E, Nuwas E, et al. Brain surgery in the bush: adapting techniques and technology to fit the developing world. World Neurosurg. 2013;80(5):e91–4.
O’Hara NN. Is safe surgery possible when resources are scarce? BMJ Qual Saf. 2015;24(7):432–4. doi:10.1136/bmjqs-2015-004377.
White RE, Mungatana C, Topazian M. Esophageal stent placement without fluoroscopy. Gastrointest Endosc. 2001;53(3):348–51.
Parker RK, White RE, Topazian M, et al. Stents for proximal esophageal cancer: a case-control study. Gastrointest Endosc. 2011;73(6):1098–105.
Brox-Jimenez A, Ruiz-Luque V, Torres-Arcos C, Parra-Membrives P, Diaz-Gomez D, Gomez-Bujedo L, et al. Experience with the Bogotá bag technique for temporary abdominal closure. Cir Esp. 2007;82(3):150–4. doi:10.1016/S0009-739X(07)71690-1.
Warf BJ. Comparison of 1-year outcomes for the Chhabra and Codman-Hakim micro precision shunt systems in Uganda: a prospective study in 195 children. J Neurosurg. 2005;102:358–62.
Ruit S, Paudyal G, Gurung R, Tabin G, Moran D, Brian G. An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation. Clin Exp Ophthalmol. 2000;28(4):274–9. doi:10.1046/j.1442-9071.2000.00316.x.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
White, R.E., Parker, R.K. (2017). Delivery of Subspecialty Surgical Care in Low-Resource Settings. In: Park, A., Price, R. (eds) Global Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-49482-1_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-49482-1_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-49480-7
Online ISBN: 978-3-319-49482-1
eBook Packages: MedicineMedicine (R0)