Leodoro Basil M, Beasley Spencer W, Maoate Kiki
Department of Surgery, Vila Central Hospital, Port Vila, Vanuatu, and Fiji National University, Suva, Fiji.
University of Otago, Christchurch, New Zealand; Department of Paediatric Surgery, Canterbury District Health Board, Christchurch, New Zealand.
J Pediatr Surg. 2015 May;50(5):829-32. doi: 10.1016/j.jpedsurg.2015.02.003. Epub 2015 Feb 8.
Conventional surgical aid to emerging countries often does little to build capacity or infrastructure. An evolving model in the South Pacific has been designed to promote local expertise by training local surgeons to a high standard and helping establish sustainable pediatric surgical services in those regions. This review identifies the key elements required to improve and expand local specialist pediatric surgical capacity in Vanuatu. It highlights some of the challenges that face external agencies in helping to create sufficient local infrastructure to achieve these goals and describes how the impediments can be overcome.
We conducted a review of the program that provides a sustainable pediatric surgical service to the small and poor Pacific nation of Vanuatu through the involvement and support of the Pacific Island Project administered by the Royal Australasian College of Surgeons.
A needs assessment must be done from the recipient's perspective and can be achieved by collaboration between an external agency and existing local surgeons. The key to a sustainable service is identifying and training high quality young indigenous doctors early and providing mentorship and support, including after their return. A sustainable and viable service requires an adequately resourced position for the new surgeons(s) within a framework of a long term strategic plan for the specialty and adequate infrastructure in place on their return. Development of rapport with government and influencing strategic health priorities is a prerequisite of a new national specialty service.
(1) Establishing long term viable pediatric surgical capability can only be achieved through the local health system with local leadership and ownership. (2) Internal capability includes governance, alignment with ministry of health priorities and policies, and effective clinical leadership. (3) Selection of person(s) to be trained is best done early, and he/she must be supported throughout training and afterwards. (4) Long term dependence on a single person makes the service vulnerable. (5) Ultimately, a service configuration that ensures children have timely access to quality specialist advice and which reflects the needs of the population is the main determinant of clinical outcomes.
向新兴国家提供的传统外科援助往往对能力建设或基础设施建设作用甚微。南太平洋地区正在发展一种模式，旨在通过将当地外科医生培训至高标准并帮助在这些地区建立可持续的儿科外科服务来提升当地专业水平。本综述确定了提高和扩大瓦努阿图当地儿科外科专科能力所需的关键要素。它突出了外部机构在帮助建立足够的当地基础设施以实现这些目标时所面临的一些挑战，并描述了如何克服这些障碍。
我们对通过澳大利亚皇家外科学院管理的太平洋岛屿项目的参与和支持，为贫穷小国瓦努阿图提供可持续儿科外科服务的项目进行了综述。
必须从受援方的角度进行需求评估，这可以通过外部机构与当地现有外科医生合作来实现。可持续服务的关键是尽早识别并培训高素质的年轻本土医生，并提供指导和支持，包括他们回国后。一项可持续且可行的服务需要在该专科的长期战略计划框架内为新外科医生提供资源充足的职位，并且他们回国时要有适当的基础设施。与政府建立融洽关系并影响战略卫生重点是新的国家专科服务的先决条件。
（1）只有通过当地卫生系统，由当地领导并自主掌控，才能建立长期可行的儿科外科能力。（2）内部能力包括治理、与卫生部优先事项和政策保持一致以及有效的临床领导。（3）最好尽早选定接受培训的人员，并且在整个培训过程及之后都必须为其提供支持。（4）长期依赖单一人员会使服务变得脆弱。（5）最终，确保儿童能够及时获得高质量专科建议并反映民众需求的服务配置是临床结果的主要决定因素。
