Pediatric solid organ transplantation (SOT) is a preferred treatment for medically suitable children with end-stage organ failure. Still, many of them have no access to transplantation owing to socioeconomic constraints or lack of transplant facilities in low- and middle-income countries (LMIC). Establishing pediatric SOT programs in LMIC offers children the opportunities to receive transplant care in more familiar home environments as well as help curtail transplant tourism and improve transplant outcomes as pediatric transplantation would be performed ethically and legally. The International Pediatric Transplant Association (IPTA) is a professional organization aiming to promote safe, ethical, and high-quality pediatric transplantation worldwide. This society paper describes major obstacles to pediatric SOT in LMIC and provides guidance on developing and/or expanding pediatric SOT programs in such countries. We also summarize available resources from the IPTA Outreach Program to help establish and support pediatric SOT programs in LMIC.
Global surgery and global health: One size does not fit all
Global surgery is interpreted differently and may lack an in-depth understanding which is complicated by socio-economy and culture. Global surgery and global health have become part of health care service following the report of the Lancet Commission. Sustainability, ethical principles, and decolonization are some important ongoing issues for recipient societies. Incorporating societal dimensions, socio-cultural values, patients’ needs, and affordability requires a tailored approach and not blindly pursuing the best technology. The recent COVID-19 has exposed the unethical and inequity in terms of equitable healthcare, vaccine rollout and its access, and unprecedented high mortality observed in some societies. Surgery has been a neglected stepchild of global health and in addition global surgery must not be a slave of technology for the promotion of the ‘gold standard’, especially corporate-led commercialized services because a sustainable and effective surgical service at a reduced cost is desirable for all, be resource-rich or poor. Global surgery and global health include health security and universal health coverage. Stakeholders of global surgery need to be aware that ‘one size does not fit all’ and are required to consider the diverse conditions.
War, Politics, Pandemic, and a Failed Assassination: 117 Years of World Congresses of Surgery
I am fascinated by history. As an undergraduate English major, I loved poetry, novels, and short stories. As a 20-year old, I thought history dull, dim, and irrelevant. Oh, how wrong I was! The drama created by real-life stories are far more unpredictable and riveting than fiction. In holding 48 previous world congresses, the International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC) has participated in a few stories I’d like to share with you.
Many of the stories of the ISS/SIC are a little like the story of Switzerland, the home of our beloved society, an oasis of neutrality surrounded by a chaotic world, punctuated with pandemics, wars, and global politics. Our Swiss leaders, whether their last names were deQuervain, Nissen, Allgower, Harder, or Givel, have served as neutral intermediaries in many critical negotiations over the years, holding this society together against strong global currents and nationalistic ideology which—in some circumstances—led to major wars between nations and created rifts between close professional friends within our society. Yes, there was even an attempted assassination of a world leader at a World Congress of Surgery, one that would have changed the 20th century, had it been successful. So hang on and bear with me for a few minutes.
Let’s start 130 years ago, here in this most beautiful city of Vienna. Most of you know of Theodor Billroth, the patriarch of Viennese surgery depicted in the famous painting by Adalbert Seligmann (Fig. 1). Billroth attracted surgeons from around the world to his operating theater, many of whom would later become surgical giants in their home countries. From the USA, William Stewart Halstead spent time in Billroth’s theater, also appearing in the Seligmann painting to the left of the cabinet of instruments. Halsted returned to Baltimore and—with William Osler—started the first university-based program of medical education in the USA, at Johns Hopkins in Baltimore, Maryland.
Additionally, Billroth was a good friend of Johannes Brahms, whose music you heard as you came in this morning. I thought about focusing my address on music and medicine, but would a violin concerto in d major capture your attention as well as the story an Irishwoman attempting the assassination of a tyrant? Or waves of global epidemics and pandemics forcing the cancelation of two world congresses in Asia, 16 years apart? Or controversies over which surgeons from which countries would be invited to the World Congress, the result of two great 20th century world wars.
With apologies to our Viennese hosts, the story of the ISS/SIC does not start in Vienna, and Billroth wasn’t even a member of our society. Nonetheless, Vienna has played an important role in our history, never so important as today, when Albert Tuchmann and a dedicated team from the ISS/SIC office (thank you Mike, Chris, Laurie, and Denise!) committed to bringing us back together in this lovely city, our first in person meeting since 2019, in Krakow. It was only 3 years ago, but so much has happened. It’s hard to remember.
Much of the history that I will be recounting here comes from a book by Dorothea Liebermann-Meffert  (Fig. 2). If you want to learn more of the history, the ISS/SIC office still has copies of Dr Liebermann-Meffert’s book, also available through our website. The more recent history, in the 21st century, has been collected and collated by our former secretary general, Felix Harder and former executive director, Victor Bertschi of Basel. Many of the early papers and letters are in the hands of Professor Ulrich Tröhler and Professor Hubert Steinke of Berne. To them, I owe a great debt of gratitude for helping me with this address.
Embracing robotic surgery in low- and middle-income countries: Potential benefits, challenges, and scope in the future
Robotic surgery has applications in many medical specialties, including urology, general surgery, and surgical oncology. In the context of a widespread resource and personnel shortage in Low- and Middle-Income Countries(LMICs), the use of robotics in surgery may help to reduce physician burnout, surgical site infections, and hospital stays. However, a lack of haptic feedback and potential socioeconomic factors such as high implementation costs and a lack of trained personnel may limit its accessibility and application. Specific improvements focused on improved financial and technical support to LMICs can help improve access and have the potential to transform the surgical experience for both surgeons and patients in LMICs. This review focuses on the evolution of robotic surgery, with an emphasis on challenges and recommendations to facilitate wider implementation and improved patient outcomes.
Healthcare Services for the Physically Challenged Persons in Africa: Challenges and Way Forward
This chapter is based on persons with physical disabilities in Africa, their challenges, and how it affects their health-seeking behaviors. We noticed that physical challenge has a substantial long-term adverse effect on one’s ability to carry out normal day-to-day activities. Both the causes and the consequences of physical disability vary throughout the world, especially in Africa. Environmental, technical, and attitudinal barriers and consequent social exclusion reduce the opportunities for physically challenged persons to contribute productively to the household and the community and further increase the risk of falling into poverty and poor healthcare services. The inability of the physically challenged persons to perceive the lack of points of interest of government has intensified to make significant recommendations and possible solutions. This is appalling because the rate to which a community provides and funds restoration is a way of grading how much interest it has, and importance it connects to the quality of life of its citizens. We advocate and recommend swift actions and disability inclusiveness to accommodate persons with physical disabilities in Africa for them to have a good perception of life.
Directly observed and reported respectful maternity care received during childbirth in public health facilities, Ibadan Metropolis, Nigeria
Respectful maternity care (RMC) is believed to improve women’s childbirth experience and increase health facility delivery. Unfortunately, few women in low- and middle-income countries experience RMC. Patient surveys and independent observations have been used to evaluate RMC, though seldom together. In this study, we assessed RMC received by women using two methodologies and evaluated the associated factors of RMC received. This was a cross-sectional study conducted in nine public health facilities in Ibadan, a large metropolis in Nigeria. We selected 269 pregnant women by cluster sampling. External clinical observers observed them during childbirth using the 29-item Maternal and Child Health Integrated Program RMC observational checklist. The same women were interviewed postpartum using the 15-item RMC scale for self-reported RMC. We analysed total RMC scores and RMC sub-category scores for each tool. All scores were converted to a percentage of the maximum possible to facilitate comparison. Correlation and agreement between the observed and reported RMC scores were determined using Pearson’s correlation and Bland-Altman analysis respectively. Multiple linear regression was used to identify factors associated with observed RMC. No woman received 100% of the observed RMC items. Self-reported RMC scores were much higher than those observed. The two measures were weakly positively correlated (rho = 0.164, 95%CI: 0.045–0.278, p = 0.007), but had poor agreement. The lowest scoring sub-categories of observed RMC were information and consent (14.0%), then privacy (28.0%). Twenty-eight percent of women (95%CI: 23.0% -33.0%) were observed to be hit during labour and only 8.2% (95%CI: 4.0%-18.0%) received pain relief. Equitable care was the highest sub-category for both observed and reported RMC. Being employed and having completed post-secondary education were significantly associated with higher observed RMC scores. There were also significant facility differences in observed RMC. In conclusion, the women reported higher levels of RMC than were observed indicating that these two methodologies to evaluate RMC give very different results. More consensus and standardisation are required in determining the cut-offs to quantify the proportion of women receiving RMC. The low levels of RMC observed in the study require attention, and it is important to ensure that women are treated equitably, irrespective of personal characteristics or facility context.
Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety
Recognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities.
The study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model.
The majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise. Conclusion Promoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.
Assessment of Knowledge, Skills, and Preparedness of General-Duty Police on Prehospital Care of Road Traffic Accident Victims in Abuja, Nigeria
Prompt prehospital care (PHC) is essential for improving outcomes of road traffic accident victims. Previous studies in Nigeria show that little or no PHC is delivered to trauma victims by first responders. This study was conducted to assess police officers’ experience with FA/BLS, to identify gaps in their FA/BLS knowledge and skills, and assess police stations’ FA/BLS equipment capacity for PHC of road traffic accident victims.
This cross-sectional study was conducted among 428 GD police in Abuja between November and December 2018. Respondents were selected using stratified random sampling with proportional allocation method. Data were collected using self-administered electronic semi-structured questionnaires. Data analysis was done using STATA v 14.0 (StataCorp, College Station, TX). Chi-square and multivariate logistic regression were used to assess associations.
We analyzed data from 419 respondents. Almost all (90.2%) of the police were aware of FA/BLS. The proportion of police with poor, fair, and good knowledge and skills on FA/BLS were 15.3%, 79.0%, and 5.7%, respectively. Tertiary (OR = 3.35, 95% CI: 1.01-11.11, P = 0.048) and postgraduate (OR = 6.89, 95% CI: 1.63-29.19, P = 0.009) levels of education had statistically significant association with good knowledge and skills.
This highlights the need to implement an educational intervention to increase FA/BLS competencies within the first responder population
Putting global health high on the agenda of medical schools
In this opinion paper, we reflect on global health and global health education as well as challenges that the coming generation are likely to face. As the field is rapidly changing, it is vital to critically reflect categories of “global south” and “global north” as geographical boundaries, and rather think in terms of inequalities that are present in all countries. Global perspectives on health are useful to analyze structural challenges faced in all health care systems and help understand the diversity of cultures and patients’ concepts of disease. We first discuss burning questions and important challenges in the field and how those challenges are tackled. Rather than going into detail on topical issues, we reflect on approaches and attitudes that we think are important in global health education and present opportunities and challenges for young scholars who are interested in working in this field.
Capacity Building During Short-Term Surgical Outreach Trips: A Review of What Guidelines Exist
While short-term surgical outreach trips improve access to care in low- and middle-income countries (LMIC), there is rising concern about their long-term impact. In response, many organizations seek to incorporate capacity building programs into their outreach efforts to help strengthen local health systems. Although leading organizations, like the World Health Organization (WHO), advocate for this approach, uniform guidelines are absent.
We performed a systematic review, using search terms pertaining to capacity building guidelines during short-term surgical outreach trips. We extracted information on authorship, guideline development methodology, and guidelines relating to capacity building. were classified according to the Global-QUEST framework, which outlines seven domains of capacity building on surgical outreach trips. Guideline development methodology frequencies and domain classifications frequencies were calculated; subsequently, guidelines were aggregated to develop a core guideline for each domain.
A total of 35 studies were included. Over 200 individual guidelines were extracted, spanning all seven framework domains. Guidelines were most frequently classified into Coordination and Community Impact domains and least frequently into the Finance domain. Less than half (46%) of studies collaborated with local communities to design the guidelines. Instead, guidelines were predominantly developed through author trip experience.
As short-term surgical trips increase, further work is needed to standardize guidelines, create actionable steps, and promote collaborations in order to promote accountability during short-term surgical outreach trips.