Patel Pratik B, Hoyler Marguerite, Maine Rebecca, Hughes Christopher D, Hagander Lars, Meara John G
Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA ; Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA.
Plast Surg Int. 2012;2012:892437. doi: 10.1155/2012/892437. Epub 2012 Dec 20.
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.
全球唇腭裂手术援助行动为全球数百万贫困患者提供了急需的治疗。然而，低收入和中等收入国家的手术能力总体上仍然不足。通过手术援助行动，全球唇腭裂治疗在很大程度上采用了一种垂直的医疗服务模式，这种模式是针对特定疾病的，并且倾向于在当地医疗系统之外并行提供服务，而非必然纳入其中。垂直模式已被用于应对传染病以及人道主义紧急情况。相比之下，横向医疗服务模式往往侧重于对公共卫生基础设施和人力资本的长期投资，并且由于各种原因，人道主义组织较少采用这种模式。由于外科治疗是基本医疗保健的一个组成部分，整形外科学界必须自我挑战，以一种可持续地扩展和丰富全球整体外科治疗的方式，来应对诸如唇腭裂等特定疾病实体带来的负担。在本文中，我们描述了一种对角线医疗服务模式，通过这种模式，唇腭裂援助行动可以通过融入可持续的当地医疗服务系统来增强手术能力。此外，我们具体考察了对角线发展模式在唇腭裂治疗中的应用，以及更广泛地在全球外科治疗中的应用。
