World journal of surgery
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World journal of surgery · Mar 2010
Ten years of experience training non-physician anesthesia providers in Haiti.
Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. ⋯ Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings.
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World journal of surgery · Mar 2010
Improving surgical care in low- and middle-income countries: a pivotal role for the World Health Organization.
In response to increasing evidence that surgical conditions are an important global public health problem, and data suggesting that essential surgical services can be delivered in a cost-effective manner in low- and middle-income countries, the World Health Organization (WHO) has expanded its interest in surgical care. In 2004, WHO established a Clinical Procedures Unit within the Department of Essential Health Technologies. ⋯ In what maybe the most important development, surgical care is included in WHO's new comprehensive primary health care plan. Given these rapid developments, surgical care at WHO may be approaching a critical "tipping point." Lobbying for a World Health Assembly resolution on emergency and essential surgical care, and developing "structured collaborations" between WHO and various stakeholders are potential ways to ensure that the global surgery agenda continues to move forward.
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World journal of surgery · Mar 2010
Global anesthesia workforce crisis: a preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices.
The burden of disease, disability, and mortality that could be averted by surgery is growing. However, few low and middle income countries (LMICs) have the infrastructure or capacity to provide surgical services to meet this growing need. Equally, few of these countries have been assessed for key infrastructural capacity including surgical and anesthesia providers, equipment, and supplies. These assessments are critical to revealing magnitude of the evolving surgical and anesthesia workforce crisis, related morbidity and mortality, and necessary steps to mitigate the impact of the crisis. ⋯ This pilot study revealed that the number of anesthesia providers available per capita of population is markedly reduced in low and lower middle income countries compared to developed countries. As anesthesia providers are an integral part of the delivery of safe and effective surgical care, it is essential that more data is collected to fully understand the deficiencies in workforce and capacity in low and middle income countries.
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World journal of surgery · Mar 2010
Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care.
Surgical care is emerging as a crucial issue in global public health. Methodology is needed to assess the impact of surgical care from a public health perspective. ⋯ Methodology is described for estimating the burden of surgical conditions and unmet need for surgical care. Using this approach it will be feasible to estimate the global burden of surgical conditions and help clarify where surgery fits among other global health priorities. These methods need to be validated using population-based data.
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World journal of surgery · Mar 2010
Impact of parallel anesthesia and surgical provider training in sub-Saharan Africa: a model for a resource-poor setting.
The lack of appropriate numbers of anesthesia and surgical care providers in many resource-poor countries around the world, especially in rural populations, prevents adequate care of the large numbers of patients who require surgery in these settings. ⋯ This model can be applied to other similar situations in LIC, where the anesthesia and surgical care can be coupled and then customized for the unique clinical rural setting.