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Introduction: Recently, the devastating consequences of neglected surgical care in global health became apparent with an estimated five billion people lacking access to safe surgical and anesthesia care. Traditionally, short-term surgical missions were the predominant strategy how surgical care was supported in Low- and Middle-Income Countries. Although surgical missions have been criticized in recent literature they are still being performed on a large scale. The aim of this study is to provide recommendations for persons and organizations involved in surgical mission on how to strengthen surgical care in LMICs in the future.
Method: An online survey was developed for members of foreign teams. Data was collected on 5 topics, consisting of: 1) basic characteristics of the missions, 2) main activities, 2) follow-up and reporting, 3) the local registration process for foreign teams and 4) collaboration with local stakeholders.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| no intervention | Other | no intervention study, survey amongst health workers |
| Measure | Description | Time Frame |
|---|---|---|
| Q7: Country Where the Last Mission Took Place | Answer on the question: What was the country where your last mission took place? | approximately 20 minutes |
| Q8: Name of the Place and Hospital Where the Last Mission Took Place | List with names of the places and hospitals where the last mission took place | approximately 20 minutes |
| Q9: Number of Participants Per Organization | Name of the organization that supported the last mission of the participant | approximately 20 minutes |
| Q10: Countries Where the NGOs Are Based | List of countries where the supporting NGOs of the last mission are based | approximately 20 minutes |
| Q11: Importance of Potential Activities | Points provided (1-4) for four potential activities of a visiting team (more points = more important activity) The points provided by all participants are summed per specific activity and the total scores are compared The four potential activities are:
Scale with importance of potential activities. Maximum score: 4x58 = 232 | approximately 20 minutes |
| Q12: Activities That Where Missing in Question 11. | Respondents that were missing this activity as an option in question 11 Total number of respondents that were missing an activity: 29 Activities that were missing:
|
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Inclusion Criteria:
Members of foreign teams, that did participate in at least one short-term surgical mission in a hospital in a LMIC
Exclusion Criteria:
-
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An international group of members of foreign teams, that did participate in at least one short-term surgical mission in a hospital in a LMIC
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Global surgery amsterdam | Amsterdam | North Holland | 1105BD | Netherlands |
Individual participant data will be shared anonymously on this platform as requested by the journal of submission (int,. journal of surgery)
ASAP
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Recruitment was June through October of 2019
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| ID | Title | Description |
|---|---|---|
| FG000 | Experts | Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | All Participants of the Study | Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Q7: Country Where the Last Mission Took Place | Answer on the question: What was the country where your last mission took place? | Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
5 months
Adverse Events data was not collected.
Because this study is a survey, there is no intervention group
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Experts | Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC. |
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An important limitation of this study is that most of the respondents are medical doctors from HICs.
Another possible 'selection bias' that could have occurred concerns (over-) representation of experts from the Netherlands.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr Matthijs Botman | Global Surgery Amsterdam | 0031648073683 | matthijsbotman@gmail.com |
| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | May 15, 2019 | Aug 3, 2020 | Prot_000.pdf |
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| approximately 20 minutes |
| Q13. Medical Registration is Required in the Host Country | Medical registration in the host country is required for specialists performing short-term reconstructive missions Participants of the survey were asked what they think of this statement:
| approximately 20 minutes |
| Q14: The Process of Obtaining Medical Registration Was Straightforward | The Process of Obtaining Medical Registration Was Straightforward Participants of the survey were asked what they think of this statement:
| approximately 20 minutes |
| Q15: Collaboration | What can you say about the collaboration between authorities in LMICs and visiting surgical teams? Participants of the survey were asked to choose one of the following answers on this question:
| approximately 20 minutes |
| Q16. What Should Have a Higher Priority in the Hospital of Your Last Mission? | What should have a higher priority in the hospital of your last mission ? Respondents were asked to choose on the these two answers: Teaching in anesthesia care or teaching in surgical care | approximately 20 minutes |
| Q17. A Structured Follow-up Strategy is Required | A structured follow-up strategy (>6 months) of patients is required for short-term reconstructive surgical missions. Participants of the survey were asked what they think of this statement:
| approximately 20 minutes |
| Q18. One Month After the Mission, an Official Report is Recommended | One month after the mission, an official report on the outcome including all complications encountered is recommended for all missions. Participants of the survey were asked what they think of this statement:
| approximately 20 minutes |
| Q19. A Written Long-term Strategy is Recommended at the Start of a New Project. | A written long-term strategy (>5 years) with clear goals, developed by the visiting team and the local actors together, is recommended at the start of a new project. Participants of the survey were asked what they think of this statement:
| approximately 20 minutes |
| Q20. Suggestions to Improve the Impact of Short Term Reconstructive Missions. | What would you suggest to improve the impact of short term reconstructive missions? The answers were categorized and the three most mentioned categories are:
The three activities were mentioned in total 68 times in the comments The distribution among the three categories is shown below | approximately 20 minutes |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | We did not register Race as a variable in this study | Count of Participants | Participants |
|
| Nationality | in the survey provided answer on the question what is your nationality: | Count of Participants | Participants |
|
| Profession | Count of Participants | Participants |
|
| Number of missions performed | by the respondent provided number of surgical missions performed in the past by the respondent him- or herself | Mean | Full Range | missions |
|
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| Primary | Q8: Name of the Place and Hospital Where the Last Mission Took Place | List with names of the places and hospitals where the last mission took place | Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
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| Primary | Q9: Number of Participants Per Organization | Name of the organization that supported the last mission of the participant | Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
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| Primary | Q10: Countries Where the NGOs Are Based | List of countries where the supporting NGOs of the last mission are based | Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q11: Importance of Potential Activities | Points provided (1-4) for four potential activities of a visiting team (more points = more important activity) The points provided by all participants are summed per specific activity and the total scores are compared The four potential activities are:
Scale with importance of potential activities. Maximum score: 4x58 = 232 | Posted | Number | score on a scale | approximately 20 minutes |
|
|
|
| Primary | Q12: Activities That Where Missing in Question 11. | Respondents that were missing this activity as an option in question 11 Total number of respondents that were missing an activity: 29 Activities that were missing:
| Question 12 was asked to all participants but only 29 stated that an activity was missing in question 11 | Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q13. Medical Registration is Required in the Host Country | Medical registration in the host country is required for specialists performing short-term reconstructive missions Participants of the survey were asked what they think of this statement:
| Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q14: The Process of Obtaining Medical Registration Was Straightforward | The Process of Obtaining Medical Registration Was Straightforward Participants of the survey were asked what they think of this statement:
| Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q15: Collaboration | What can you say about the collaboration between authorities in LMICs and visiting surgical teams? Participants of the survey were asked to choose one of the following answers on this question:
| Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q16. What Should Have a Higher Priority in the Hospital of Your Last Mission? | What should have a higher priority in the hospital of your last mission ? Respondents were asked to choose on the these two answers: Teaching in anesthesia care or teaching in surgical care | 5 respondents did't make a choice In the comments section 9 respondents declared that preferable both should be equally addressed | Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q17. A Structured Follow-up Strategy is Required | A structured follow-up strategy (>6 months) of patients is required for short-term reconstructive surgical missions. Participants of the survey were asked what they think of this statement:
| Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q18. One Month After the Mission, an Official Report is Recommended | One month after the mission, an official report on the outcome including all complications encountered is recommended for all missions. Participants of the survey were asked what they think of this statement:
| Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q19. A Written Long-term Strategy is Recommended at the Start of a New Project. | A written long-term strategy (>5 years) with clear goals, developed by the visiting team and the local actors together, is recommended at the start of a new project. Participants of the survey were asked what they think of this statement:
| Posted | Count of Participants | Participants | approximately 20 minutes |
|
|
|
| Primary | Q20. Suggestions to Improve the Impact of Short Term Reconstructive Missions. | What would you suggest to improve the impact of short term reconstructive missions? The answers were categorized and the three most mentioned categories are:
The three activities were mentioned in total 68 times in the comments The distribution among the three categories is shown below | the 58 participants mentioned the top three activities 68 times | Posted | Number | answers mentioning this activity | approximately 20 minutes |
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| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
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| Title | Measurements |
|---|
|
| Haydom Lutheran Hospital, Haydom |
|
| St Josephs, Kitgum |
|
| Comprehensive Health Centre, totoro Abeokuta. |
|
| Sengerema hospital, sengerema |
|
| Masanga Hospital |
|
| Pius VI, Ouagadougou |
|
| St Francis hospital Mutolere |
|
| Pemantang siantar, rumah sakit harapan |
|
| Virgen de la puerta |
|
| Gatagara |
|
| Rach Gia |
|
| Yekatit 12 hospital, Addis Ababa |
|
| Guercif, Morocco; |
|
| Munshiganj, Bangladesh |
|
| Ambroseli Hospital Kalongo |
|
| Conakry, Port. Mercy Ships |
|
| Mahossot Hospiatl Vientiane |
|
| Vavuniya General Hospital |
|
| Guayaquil |
|
| Bekhazi Medical Center, Beirut |
|
| Bissau teaching hospital |
|
| Conakry |
|
| Malamulo Hospital |
|
| Dhaka Medical College Hospital, Dhaka |
|
| Yekatit 12 |
|
| CSC, Phnom Penh |
|
| Africa Mercy |
|
| Mercships |
|
| Hopital National Donka, Conakry |
|
| Africa Mercy, Conakry |
|
| Exeter |
|
| Mangu Hospital, Mangu Plateau state |
|
| Cocin, Mangu |
|
| University Hospital Basel, Switzerland |
|
| Yekatit 12 Hospital, Addis Ababa |
|
| Shifa Hospital, Gaza City |
|
| MSF burn hospital in Port-au-Prince, Haiti |
|
| Measurements |
|---|
|
| Global Smile Foundation |
|
| Harapan Jaya |
|
| Ka Dounia Dia |
|
| MAP |
|
| Mercy Ships |
|
| Mission Restore |
|
| MSF |
|
| Njokuti |
|
| Operation Hernia |
|
| Orthopaedic Outreach |
|
| Pan-African Academy of Christian Surgeons |
|
| Project Harar |
|
| Resurge |
|
| Interplast Holland |
|
| Simba Health |
|
| Stichting 'Op Gelijke Voet' |
|
| Trinitas Health Care Partners |
|
| Mission without a supporting NGO |
|
| UK |
|
| Australia |
|
| France |
|
| Nigeria |
|
| Sierra Leone |
|
| Title | Measurements |
|---|---|
|
| Facilitate teaching of local staff |
|
| Title | Measurements |
|---|---|
|
| Sustainability |
|
| Collaboration with local staff |
|
| Follow up |
|
| Title | Measurements |
|---|---|
|
| Disagree |
|
| Strongly disagree |
|
| Title | Measurements |
|---|---|
|
| Disagree |
|
| Strongly disagree |
|
|
| -collaboration has no benefits nor disadvantages |
|
| Title | Measurements |
|---|---|
|
| Disagree |
|
| Strongly disagree |
|
| Title | Measurements |
|---|---|
|
| Disagree |
|
| Strongly disagree |
|
| Title | Measurements |
|---|---|
|
| Disagree |
|
| Strongly disagree |
|
| Title | Measurements |
|---|---|
|