Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership

Background: An epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable diseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the population is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards of care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported by humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about three-years Partnership between the University of Chieti- Pescara, Italy and the University of Gezira, Sudan to upgrade standard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year visited GNCPS. The Program was financed by the Italian Agency for Development Cooperation.
Methods: The state of local infrastructure, current standard of care, analysis of caseload, surgical activity and results are reported. Methods utilized to assess local needs and to develop Partnership activities are described.
Results: Main surgical task of the visiting Team were advancements in Colorectal procedures, Epispadias/Exstrophy Complex management and Hypospadias surgery (20% of major surgical procedures at the GNCPS). Intensive care facilities and staff to assist more complex cases (i.e. neonates) are still defective. Proctoring, training on the job of junior surgeons, anaesthetists and nurses, collaboration in educational programs, advisorship in hospital management, clinical governance, maintenance of infrastructure together with training opportunities in Italy were included by the Program. Despite on-going efforts, actions have not yet been followed by the expected results. More investments are needed on Healthcare infrastructures to increase health workers motivation and prevent brain drain.
Conclusions: The key role that an Academic Partnership can play, acting through expatriated Teams working in the same constrained contest with the local workforce, must be emphasized. Besides clinical objectives, these types of Global Health Initiatives address improvement in management and clinical governance. The main obstacles to upgrade standard of care and level of surgery met by the Visiting Team are scarce investments on health infrastructure and a weak staff retention policy, reflecting in poor motivation and low performance.

Rehabilitation of an Irradiated Marginal Mandibulectomy Patient Using Immediately Loaded Basal Implant-Supported Fixed Prostheses and Hyperbaric Oxygen Therapy: A 2-year Follow-Up

Introduction: The prosthetic rehabilitation of mandibular defects owing to tumor resection is challenging, especially when the patient has undergone subsequent radiotherapy.

Presentation of case: A 46-year old male presented with a marginal mandibular resection. Following surgery, the patient received adjunctive radiation therapy with a total dose of 70 grays. On clinical examination, the patient presented with severely resorbed edentulous jaws, with an anterior marginal mandibular resection and an obliterated vestibular sulcus. The panoramic radiograph showed a hypocellularity of the maxillary and mandibular bones. A multidisciplinary team was formed, and a treatment plan was formulated which involved the construction of a vestibuloplast stent, and the application of 20 hyperbaric oxygen sessions before implant treatment and 10 more sessions after implant insertion. A total of 16 basal cortical screw implants were inserted to support the fixed prostheses, and a vestibuloplasty was performed to improve esthetics. No complications were observed, and at the 2-year follow-up, the patient presented with excellent peri-implant soft tissue health; increased bone-implant contact; and stable, well-functioning prostheses.

Discussion: The construction of a stable, retentive, well-supported removable prosthesis may be complicated in cases of comprehensive mandibular resection. Basal implants can eliminate the need for bone grafting, and reduce the treatment period required for providing a fixed prosthesis.

Conclusion: To our knowledge this is the first evidence reporting the use of fixed basal implant-supported prostheses in irradiated bone, in conjunction with hyperbaric oxygen therapy. A treatment modality that significantly improves the peri-implant tissue health, and ensures an excellent implant-bone contact.

The role of diaspora and non-governmental organization in helping Sudanese children with congenital heart diseases: 6 years’ paediatric cardiac surgery camps experience

Background: Sudan one of the largest countries in Africa. In recent survey by Sudan Ministry of Health, congenital heart disease (CHD) was found to be one of the top eight diseases that lead to death of children in Sudan. The cost of surgical operation, follow up and diagnosis are expensive and this may result some children present with complications. The aim of this study is to assess the role of diaspora and non-governmental organization (NGO) in helping Sudanese children with CHD.
Methods: We assess the 6 years’ experience in charitable initiative established by Sudanese consultant pediatric intensivist and cardiologist working in Doha, Qatar in partnership with NGO in Gulf countries and Sudan. Examples of these organizations were Patient Helping Fund (PHF) the largest medical charity in Sudan, Eid Althani charity association in Qatar with collaboration of the Federal Ministry of Health (FMH), Ministry of Health in Khartoum and Gazira states. We established the program of providing suitable care for in need children.
Result: A total of 104 out of the 222 complex defects were considered for surgery, 118 underwent cardiac catheter interventions. The 30-days post-operative mortality was 14/222 (6.3%). The most essential post-surgical complications were postpericardiotomy syndrome, bleeding, and sepsis. Malnutrition poor socioeconomic status is significant factors negatively impact the outcomes. All surviving patients (n=208) remain in good clinical condition, and most are asymptomatic without any medications.
Conclusions: The collaboration of Sudanese pediatrician living outside Sudan with local and international NGOs can significantly improve child health in Sudan.