© Springer International Publishing Switzerland 2016
Mamta Swaroop and Sanjay Krishnaswami (eds.)Academic Global SurgerySuccess in Academic Surgery10.1007/978-3-319-14298-2_77. How to Set Up for an Ideal Long Term Clinical Interaction
(1)
Division of Trauma Surgery, Department of Surgery, McGill University Health Center, Montreal General Hospital, Montreal, QC, H3G 1A4, Canada
(2)
Division of Pediatric Surgery, University of Nebraska Medical Center, Children’s Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA
(3)
Division of Acute Care Surgery, Department of surgery, Boonshoft School of MediciNE Wright State University, Dayton, OH 45409, USA
Keywords
Global healthNeeds assessmentLong term clinical interactionInternational surgical rotationsBarriers for international missionsIntroduction
Over the last several years there has been a heightened interest in the surgical community in participating in international surgery. Several explanations for this increased interest have been proffered – including an enhanced awareness of the world at large via print and electronic media, the proliferation of social media interactions and a deeper sense of social responsibility. With regard to trainees, a recent survey indicated that at least a fifth of graduating US medical students had participated in international activities related to global health. Another survey among American College of Surgeons Resident Members demonstrated a majority of responders were interested in international rotations and had plans to incorporate some form of international volunteerism into their future practice. Surgical Residency program directors in a recent poll were found to be largely supportive of such international rotations, and over half of US programs already had some form of an informal rotation. It is clear that interest in global health, especially in younger surgeons, is growing.
Regardless of the reasons for the increased focus on global surgery, it is recognized that formulating a productive clinical international surgical experience is shouldered on the adequate development and long-term sustenance of an effective model for optimal clinical interaction. Naturally, unique challenges arise with the creation of such processes. Fortunately, there are a number of existing models, as well as others being developed that have enjoyed varying degrees of success. These can serve as repositories of information for programs attempting to forge new relationships. Many of these programs are currently in countries in Sub-Saharan Africa, Asia and South America.
In this chapter, we discuss some of the important considerations for setting up ongoing clinical interactions. Potential pitfalls and barriers to success will be also briefly mentioned.
Basic Considerations
Pre-deployment Preparation
Some basic preparations can go a long way in making global health experiences worthwhile. A prime consideration is a structured pre-departure training course. Such courses provide a comprehensive overview of the necessary planning required to participate in global surgery experiences. These should cover issues such as visa requirements, travel safety, cultural sensitivity training, and health advice – including immunizations, personal protective equipment, how to access post-exposure prophylaxis and access to medical care when needed. Most curricula also provide strategies to deal with ethically challenging situations and link the participant with a global health mentor who can serve as an advisor during the initial trip. These courses, available in many US and Canadian medical schools, are typically open to all medical professionals. In lieu of such a course, several online modules are available for participants to learn about global health endeavors prior to their departure.
It is crucial to start planning global health experiences early, at a minimum of 6 months ahead of the planned date of departure. This includes obtaining necessary visas, finding adequate accommodation, getting the necessary permissions to join clinical rotations, purchasing airline tickets, identifying a potential local mentor and taking care of health and immunization issues.
Needs Assessment
Prior to initiating a trip to a new destination, a needs assessment must take place. This can be as simple as knowledge borne through a prior trip by organizers to the proposed destination but can be formalized easily in a more structured survey. Additionally, meeting with local leaders, both medical and non-medical, can help one understand the local needs. Just showing up and planning to work can be offensive locally and inefficient for participants volunteering their time. It is especially important to learn how this trip will be perceived in the local community. If there is not acceptance with “local buy-in,” the trip is doomed to fail. It is particularly critical from the outset to outline the care plan for patients in an emergent situation and for dealing with complications that develop after returning home.
A careful evaluation of the medical system while there and an ongoing assessment of needs can also be done over months. Depending on the goals of the relationship, this might involve an extended time period, with evaluations of the population, available material and human resources including other available volunteer organizations in the area, and interviews with community medical and non-medical leaders. A critical bilateral trust in the partnership is developed through these meetings, and from asking the community what their primary interests are from the ongoing relationship. This process can be lengthy, but gives a foundation for a long-lasting and successful interaction. This often leads to a formalized relationship, such as a Memorandum of Understanding (MOU) between institutions, Universities or Ministries of Health.
The initial trip to perform surgery in an LMIC might be less productive then organizers hope. This should be clearly understood. Initial trips are always a time of tremendous learning with uncovering of unforeseen barriers. Participants on the initial trip need to be prepared for this ahead of time or well-intended volunteers may become frustrated and detract from the opportunity. Finally, the initial trip needs a careful debriefing at the end to plan for future interactions and to how to optimize this new experience. This might even mean finding that the particular setting is not acceptable for ongoing interactions.
Clear Goals of the Experience
Defining the objectives of a planned international clinical experience is an essential key to success. Programs that have clearly defined goals and a reasonable plan for implementation will be more successful. For some, this may be an opportunity to experience surgery in a low-resource setting, but often it can also involve initiating a long-term partnership between programs and institutions centering on local capacity building, educational exchanges and research. Experiences with a long-term vision are often more fruitful for both the participant and the host.
Related posts:
Balancing Global Surgery with Traditional Career and Life Demands
Guidelines and Parameters for Ideal Short-Term Interactions: Disaster Relief
Developing Educational Opportunities for Trainees on Both Sides
The Role of Educational Research in the Global Setting
Tools Useful for the Academic Global Surgeon
Academic Global Surgery: Current Research Needs and Priorities
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