From short-term surgical missions towards sustainable partnerships. A survey among members of visiting teams

Introduction
An estimated five billion people lack access to safe surgical care across the globe. Traditionally, providing short-term surgical missions has been the main strategy for health professionals from high-income countries to support surgical care in low- and middle-income countries. However, traditional missions have come under criticism because evidence of their sustainable value is lacking, along with any robust documentation and application of recommendations by participants of ongoing surgical missions. Using survey data collection and analysis, this study aims to provide a framework on how to improve the use of visiting surgical teams to strengthen surgical services in resource-poor settings.

Method
An online survey was conducted among members of foreign teams to collect data on five specific areas: basic characteristics of the mission, main activities. follow-up and reporting, the local registration process and collaboration with local actors. The survey included 58 respondents from 13 countries, and representing 20 organizations.

Results
During surgical missions, training activities were considered most impactful, and reporting on outcome/s, along with long-term follow-up were strongly recommended. According to almost all participants (94 percent), the focus should be on establishing collaborative practices with local actors, and encourage strategic, long-term changes under their leadership.

Conclusion
Building sustainable partnerships within local healthcare systems is the way forward for foreign surgical parties that aim to improve surgical care in low- and- middle income countries. When foreign help is offered, local stakeholders should be in the lead.

Freedom of choice, expressions of gratitude: Patient experiences of short-term surgical missions in Guatemala.

Lack of surgical care has been highlighted as a critical global health problem, and short-term medical missions (STMMs) have become a de facto measure to address this shortfall. Participation in STMMs is an increasingly popular activity for foreign medical professionals to undertake in low- and middle-income countries (LMICs) where their clinical skills may be in short supply. While there is emerging literature on the STMM phenomenon, patient experiences of surgical missions are underrepresented. This research addresses this gap through thirty-seven in-depth interviews with patients or caregivers who received care from a short-term surgical mission within the three years prior to the four-week data collection period in July and August 2013. Interviews were conducted in Antigua, Guatemala and nearby communities, and participants came from 9 different departments of the country. These first-hand accounts of health-seeking through a surgical mission provide important insights into the benefits and challenges of STMMs that patients encounter, including waiting time, ancillary costs, and access to care. Patient agency in care-seeking is considered within the pluralistic, privatized health care context in Guatemala in which foreign participants deliver STMM care.