Establishment of a sustainable and collaborative cardiac surgery outreach program in Central America
Alejandro E. Murillo1, Jacob Scherba1, Hugo Orellana2, Carmelo Milano1, Adam R. Williams1.
1Duke University, Durham, NC, USA, 2Instituto Nacional Cardiopulmonar, Tegucigalpa, Honduras.
OBJECTIVE: Efforts in global cardiac surgery have increased in recent decades to improve surgical care for patients in resource-limited settings, focused primarily on increasing surgical volume during a short mission and educating local surgeons and staff. We sought to establish such a program in Tegucigalpa, Honduras, founded on the core principles of collaboration, interdisciplinarity, and patient-centered surgical care. METHODS: Candidate patient cases were identified by local cardiac surgeons and presented at joint teleconferences in the months preceding the mission. Conferences included local and visiting surgeons, anesthesiologists, perfusionists, and nurses to assess patient candidacy and build the surgical schedule. Once on-site, operations were performed with local and visiting team members in each facet of the case to maximize interdisciplinary education.RESULTS: Across two surgical mission trips (2019,2022), cardiac surgery was performed on 24 patients. In the process, expertise and education were shared with local attending and resident surgeons and anesthesiologists, perfusionists, operating room nurses and operating room technicians, biomedical engineers, and intensive care physicians and nurses. Post-operative management was overseen by both teams as well.
CONCLUSIONS: Success of global surgery missions is dependent on the culture established between the visiting and local medical teams, importantly avoiding a paternalistic approach that devalues the expertise of the local providers. For surgical subspecialties with long operative times such as cardiac surgery, the principal focus of global surgical missions should be on education and empowerment of local experts rather than focus on increasing surgical volume for the duration of the trip.
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