Department of Anesthesiology and Perioperative Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
The University Teaching Hospital of Kigali, Kigali, Rwanda.
Paediatr Anaesth. 2024 Sep;34(9):851-857. doi: 10.1111/pan.14913. Epub 2024 May 15.
A lack of anesthesia and surgical capacity leaves approximately 1.7 billion children per annum without access to surgical and anesthetic care.
Over the past 50 years, the predominant strategy to address this lack of access has been to provide surgical capacity primarily from high-income countries (HICs) to low and middle-income countries (LMICs) in the form of short-term surgical missions. More recently, the international medical community has recognized the need to build sustainable surgical capacity in resource-constrained settings. This article reviews three models of surgical aid: the vertical model (short-term surgical missions); the horizontal model (system-wide capacity building); and the diagonal model, which is a hybrid of the first two. At their core, medical aid interventions exist on a spectrum ranging from providing surgical capacity to building surgical capacity.
The skills, attitudes, and behaviors that drive success in providing medical capacity are fundamentally different from those that drive success in building medical capacity. The root cause of this difference is a shift in the moral duty of the visiting physician from a duty solely to the patient in front of them (based on the primacy of the doctor-patient relationship) to include a duty to the local physicians and the local medical system, and by extension to the next 10 000 patients in need of care.
Failure to address the conflicts engendered by this fundamental moral shift risks undermining capacity-building efforts in all models of medical aid.
每年约有 17 亿儿童无法获得手术和麻醉护理，原因是缺乏麻醉和手术能力。
在过去的 50 年里，解决这种手术机会缺乏的主要策略是通过短期手术任务，主要由高收入国家（HICs）向中低收入国家（LMICs）提供手术能力。最近，国际医学界认识到有必要在资源有限的环境中建立可持续的手术能力。本文综述了三种外科援助模式：垂直模式（短期手术任务）；水平模式（全系统能力建设）；以及对角线模式，这是前两种模式的混合。核心是，医疗援助干预措施存在于从提供手术能力到建立手术能力的连续体上。
提供医疗能力的成功所依赖的技能、态度和行为，与建立医疗能力的成功所依赖的技能、态度和行为截然不同。造成这种差异的根本原因是，访问医生的道德责任从仅仅对他们面前的病人（基于医患关系的首要地位）转变为包括对当地医生和当地医疗系统的责任，进而延伸到下一个需要治疗的 10000 名病人。
未能解决这一根本道德转变所引发的冲突，可能会破坏所有医疗援助模式中的能力建设努力。
