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Experts in surgery and anesthesia exchange experiences, resources, and expert knowledge to promote initiatives that address the challenges of surgical care in resource-poor settings.

Discussion Briefs

Surgical Training in Resource-Limited Settings

Surgical interventions can address leading causes of mortality and morbidity in resource-limited settings, but surgical services are poorly available due to lack of skilled professionals, infrastructure, and equipment (Chu et al. 2009). To address the surgical workforce shortage and improve access to surgical services in resource-limited settings, countries are exploring various strategies in training physicians and non-physicians to perform surgical procedures. As new surgical training programs are developed and implemented, careful consideration of local priorities will be crucial to creating innovative and sustainable solutions.

A GHDonline Expert Panel discussion on surgical training in resource-limited settings took place in February 2012. Managers, physicians, and students involved in these training efforts discussed how to implement contextually appropriate surgical training programs, how to ensure local training needs are prioritized, the challenges of providing surgical training for non-physicians, creating incentives for clinicians to train in surgery, and generating and sustaining political commitment to surgical training.
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Enhancing Training Capacity for Prehospital Trauma Care in Developing Countries

Emergency medical conditions such as traumatic injury, acute medical illness and obstetric complications are major causes of death and disability worldwide. With advances in medical care, conceptions of emergency medical services (EMS) have expanded to include prehospital care and transport. Yet, EMS often is given a low priority, particularly in resource-limited settings. Interest in disaster response and management often takes precedence over system-wide improvements to EMS infrastructure, which are necessary for long-term improvements in morbidity and mortality (Kobusingye et al. 2006). Proper training for EMS providers can improve patient outcomes and bolster the sustainability and efficiency of prehospital care (Kobusingye et al. 2006). Of note, improvements to EMS systems extend beyond training programs and include efficient, high quality care at receiving hospitals, an informed public capable of recognizing and acting upon medical emergencies, and public infrastructure able to provide proper and swift transportation (Baez et al. 2009). Nonetheless, informed consideration of costs, resources, efficacy and local context in developing EMS training programs are a central component to improving emergency medical care in the developing world.

In a GHDonline panel discussion in June 2011, managers, physicians, technicians and paramedics discussed the importance of and prerequisites for successful prehospital training programs. Drawing from examples of successful and unsuccessful attempts to provide prehospital care in numerous countries, they suggested methods for evaluating and tracking training programs, as well as ensuring their success and long-term sustainability.
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Building Sustainable Partnerships to Strengthen Surgery and Anesthesia Capacity in Resource-Poor Settings

Strengthening capacity for surgery and perioperative care in resource-poor settings is necessary to address the growing burden of surgical conditions in low- and middle-income countries. Many different approaches have evolved to meet global surgical needs, some through faith or non faith-based medical missions, other through infrastructure and supplies delivery and development, some specific disease-based, and others broader. Recently, a growing number of academic medical centers and nongovernmental organizations in high-income countries have developed partnerships with teaching hospitals overseas to assist local training programs (Gosselin, 2011). Ideally, some of the elements of successful partnerships are that they benefit the visiting and host institutions equally, address local training needs, value collaboration in research, and adopt a multidisciplinary approach (Riviello 2010).

In this GHDonline panel discussion, a host of clinicians working in such programs described the characteristics of successful, egalitarian partnerships, the infrastructure required, and common challenges. They offered suggestions to develop and measure sustainable, equitable training and research partnerships to enable to delivery of quality surgery and perioperative care in resource-limited settings.
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