Manske Mary Claire B, Rios Roque Jairo J, Zelaya Gabriel Ramos, James Michelle A
Shriners Hospital for Children Northern California, Sacramento, CA, USA.
Hospital Infantil Manuel de Jesus Rivera "la Mascota", Managua, Nicaragua.
Front Public Health. 2017 Apr 11;5:75. doi: 10.3389/fpubh.2017.00075. eCollection 2017.
Recent reports have demonstrated that nearly two-thirds of the world's population do not have access to adequate surgical care, a burden that is borne disproportionately by residents of resource-poor countries. Although the reasons for limited access to surgical care are complex and multi-factorial, among the most substantial barriers is the lack of trained surgical providers. This is particularly true in surgical subspecialties that focus on life-improving, rather than life-saving, treatments, such as pediatric hand and upper extremity surgery, which manages such conditions as congenital malformations, trauma and post-traumatic deformities including burns, and neuromuscular conditions (brachial plexus birth palsy, spinal cord injury, and cerebral palsy). Many models of providing surgical care in resource-limited environments have been described and implemented, but few result in sustainable models of health-care delivery. We present our experience developing a pediatric hand and upper extremity surgery training program in Nicaragua, a resource-limited nation, that grew out of a collaboration of American and Nicaraguan orthopedic surgeons. We compare this experience to that of surgeons undergoing subspecialty training in pediatric upper limb surgery in the US, highlighting the similarities and differences of these training programs. Finally, we assess the results of this training program and identify areas for further growth and development.
最近的报告表明，世界上近三分之二的人口无法获得足够的外科护理，资源匮乏国家的居民承受着不成比例的负担。尽管获得外科护理受限的原因复杂且多方面，但最主要的障碍之一是缺乏训练有素的外科医疗人员。在专注于改善生活而非挽救生命的治疗的外科亚专业中尤其如此，比如小儿手部和上肢外科，该领域处理诸如先天性畸形、创伤以及包括烧伤在内的创伤后畸形，还有神经肌肉疾病（臂丛神经产伤、脊髓损伤和脑瘫）等病症。在资源有限的环境中提供外科护理的许多模式已被描述和实施，但很少能形成可持续的医疗保健提供模式。我们介绍了我们在资源有限的国家尼加拉瓜开展小儿手部和上肢外科培训项目的经验，该项目源于美国和尼加拉瓜整形外科医生的合作。我们将这一经验与在美国接受小儿上肢外科亚专业培训的外科医生的经验进行比较，突出这些培训项目的异同。最后，我们评估该培训项目的成果，并确定进一步发展的领域。
