Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.
Associate Clinical Professor of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Ann Glob Health. 2016 Jul-Aug;82(4):634-638. doi: 10.1016/j.aogh.2016.08.003.
There is a dire need for more surgical services as part of improving global health. Conditions treatable with surgery account for 11% of the global burden of disease, with a disproportionate burden affecting low- and middle-income countries (LMICs). Less than 6% of the world's operations are performed in LMICs, with relief organizations performing nearly 250,000 operations annually in LMICs in addition to each country's domestic surgical capacity. Currently, surgical needs are not adequately met by the existing patchwork of federal and nongovernmental organizations' surgical services and surgical mission trips. Improving coordination between mission trips may have synergistic benefits for maximizing the efficacy of the individual trips and improving the overall quality of care.
To establish whether cooperation between surgical mission trips can lead to operational efficiency and to identify obstacles to cooperation.
In order to establish the veracity of cooperation translating into efficiency and to identify obstacles that prevent cooperation, a 50-question survey was created (see Supplement 1). The survey was sent to surgical program directors of the 147 major surgical programs in the United States and Canada with a follow-up telephone survey of 18 randomly selected programs.
The survey response rate was 14%. Although 90% of respondent programs mount at least 1 mission trip per year, only one-third confirmed the existence of global health or surgical global health programs at their institution (33%). There was significant interest in cooperating with programs at other institutions (80%). When asked why they do not communicate with humanitarian aid organizations doing similar work, 53% of respondents reported a "lack of knowledge of how to find similar organizations to mine doing similar work." An additional 21% of respondents were "unaware that coordination is possible."
A minority of respondent surgery programs host formal, organized surgical global health programs with a structured leadership based at academic medical centers. Although most institutions have individuals leading international humanitarian missions to LMICs, these leaders do not function in an integrated fashion with their departments, institutions, or other academic medical programs. The majority of respondents were interested in coordinating their surgical trips with other groups. Respondents suggested the creation of a central database that would allow trip organizers to share information about upcoming trips, site logistics, and personnel or supply needs.
作为改善全球健康的一部分，非常需要更多的外科服务。可通过手术治疗的疾病占全球疾病负担的 11%，而中低收入国家（LMICs）的负担不成比例。世界上只有不到 6%的手术是在 LMICs 进行的，除了每个国家的国内外科能力外，救援组织每年在 LMICs 还要进行近 25 万例手术。目前，联邦和非政府组织的外科服务以及外科使命之旅并没有充分满足现有的零碎的外科需求。改善使命之旅之间的协调可以为最大限度地提高个别旅行的效果并提高整体护理质量带来协同效益。
确定外科使命之旅之间的合作是否可以提高运营效率，并确定合作的障碍。
为了确定合作转化为效率的真实性，并确定阻碍合作的障碍，我们创建了一个包含 50 个问题的调查（见附录 1）。该调查发送给了美国和加拿大的 147 个主要外科项目的外科项目主任，并对随机选择的 18 个项目进行了后续电话调查。
调查的回复率为 14%。尽管 90%的受访者项目每年至少进行一次使命之旅，但只有三分之一的受访者确认其所在机构存在全球健康或外科全球健康计划（33%）。受访者非常有兴趣与其他机构的计划合作（80%）。当被问及为什么他们不与从事类似工作的人道主义援助组织进行沟通时，53%的受访者表示“缺乏寻找类似组织以开展类似工作的知识”。另外 21%的受访者表示“不知道协调是可能的”。
少数受访者的外科项目在学术医疗中心设立了正式的、有组织的外科全球健康计划，并由结构化的领导层负责。尽管大多数机构都有人领导前往 LMICs 的国际人道主义任务，但这些领导人并没有以整合的方式与他们的部门、机构或其他学术医疗项目合作。大多数受访者有兴趣与其他团体协调他们的外科旅行。受访者建议创建一个中央数据库，允许旅行组织者共享有关即将到来的旅行、现场后勤以及人员或供应需求的信息。
