A. V. Gore1, C. M. McGreevy1, M. K. Gyakobo2, Z. C. Sifri1 1Rutgers – NJMS,Newark, NJ, USA 2Tetteh Quarshie Memorial Hospital,Mampong-Akuapem, AKUAPEM NORTH DISTRICT, Ghana
Introduction: Lack of access to surgical care in low-income countries (LIC) creates an enormous burden of surgical disease, contributing to preventable death and disability. The impact of short-term surgical missions (STSM) on the delivery of surgical care to communities in LIC is largely unknown. We sought to investigate the relative contributions of repeat STSM to the total surgical care delivery at a district hospital in eastern Ghana.
Methods: Retrospective review of case logs from two 10-day STSM sponsored by the International Surgical Health Initiative (ISHI) in September 2013 and August 2014 were compared to those from Tetteh Quarshie Memorial Hospital (TQMH) over the intervening months. Data collected included age, sex, operation(s) performed, findings, type of anesthesia, and emergent cases. Data presented as mean ± SD or percentage of total as appropriate; p<0.05 considered significant.
Results: Over this 1-year period, a total of 225 procedures were performed on 187 patients at TQMH. ISHI teams performed 100 procedures on 94 patients and local teams performed 125 procedures on 93 patients. ISHI teams operated on significantly more females, (47% vs. 31%; p= 0.028) and older patients (46±17 vs. 40±20 years; p = 0.027). 24% of cases undertaken by local surgeons involved multiple procedures, as compared to 6% of ISHI cases (p=0.0009). Local teams performed 21 emergent operations (23%) as compared to 1 (1%) by ISHI team (p = 0.00005). The three most common case types were inguinal hernia repair (45%), mass excision (22%), and ventral hernia repair (15%) for ISHI teams and inguinal hernia repair (39%), ventral hernia repair (12%), and appendectomy (10%) for local teams.
Conclusion: Repeat STSM to a district hospital can contribute about 50% of the surgical care provided to the local community. While the types of cases performed by both teams were similar, the international team performed more surgeries on older patients and more women, whereas the local team performed more emergency and multi-procedure cases. While STSM may not permanently increase the capability of local practitioners to alleviate the surgical burden seen in LIC, they make a significant and immediate impact on these communities. Long-term sustainable solutions are needed to support these surgical efforts, potentially doubling the surgical care delivery in rural communities and allowing for the dissemination of surgical skills and knowledge.