Uganda I: Nationwide Public and Private Surgical Capacity Assessment
During 2016 and 2017, PGSSC conducted baseline surgical capacity assessments of the public and the private health sectors in Uganda. Both assessments were based on randomized, stratified samples of hospitals and were conducted in collaboration with the Ugandan Ministry of Health. These projects gathered facility-level surgical data through hospital walk-throughs, assessment of operative logbooks, and interviews with medical superintendents at a total of 33 hospitals catering for the majority of Uganda’s population. The public sector results have been published (2018) and the private sector data are currently undergoing analysis.
Uganda II: Surgical QUality Assurance Database
The Surgical QUality Assurance Database (SQUAD) was established at Mbarara Regional Referral Hospital (MRRH) in 2013, as a collaboration between Massachusetts General Hospital, MRRH, and Mbarara University of Science and Technology (MUST) in Mbarara, Western Uganda. It is an electronic medical records system for surgical, obstetric, and pediatric conditions at MRRH. As one of the only validated electronic surgical outcomes databases in low resource settings, SQUAD offers unique opportunities to assess the state of surgical care and outcomes in western Uganda. Several research projects will utilize this database for research, quality improvement, and policy-informing projects. Current projects include burns epidemiology and outcomes, neurotrauma, and the burden of road traffic incidents.
As an example of the PGSSC’s engagement with the Harvard Medical School Center for Global Health Delivery–Dubai, the PGSSC currently collaborates with Pakistani colleagues on several research projects. The majority of projects are based at the Indus Hospital in Karachi, but expansions throughout Pakistan are currently underway. Currently, three main topics of research are: cost and outcome of total knee surgery, surgical site infection screening and innovations to strengthen patient-based infection monitoring, and a nationwide collection of the core surgical indicators recommended by the Lancet Commission on Global Surgery: operative volume, surgical/anesthesia/obstetrics specialist density, two-hour access to surgical facility, perioperative mortality rate, and the risk for catastrophic and impoverishing expenditure.
Hôpital Universitaire de Mirebalais
Partners In Health is constructing a 205,000-square foot, 300-bed facility, with six operating theatres in central Haiti that will fill a huge void locally and nationally for people who previously had limited access to quality healthcare. The hospital will provide primary care services to about 185,000 people in Mirebalais and two nearby communities. However, patients from a much wider area—all of central Haiti and areas in and around Port-au-Prince—also will be able to receive secondary and tertiary care. Clinical and research Fellows and associates are involved in technically supporting the Zanmi Lasante team for surgical service structuring and operating procedures. This collaboration is implemented within a framework set by the principles of accompaniment and development of local capacity.
Global Anesthesia Fellowship
The Boston Children's Hospital Department of Anesthesiology, Perioperative and Pain Medicine has started the first Global Pediatric Anesthesiology Fellowship. The program is designed for individuals who have completed their clinical training in pediatric anesthesiology who have a strong interest in becoming academic leaders in global pediatric anesthesiology. The fellowship is for 12 months with at least six months spent on the faculty at Boston Children's Hospital and the remainder engaged in an academic project in a lower resourced country to be determined mutually between the fellow and the fellowship director. The current fellow, Dr. Denise Chan, will be spending six months in Rwanda as of July 2013 as part of the Human Resources for Health program. Interested parties should contact Dr. Craig McClain.
MGH-Mbarara Anesthesia Collaboration
The academic collaboration between the anesthesia departments at the Massachusetts General Hospital and Mbarara Regional Referral Hospital aims to find innovative ways to build capacity and improve surgical and anesthetic outcomes in low-income settings. We are building an electronic surgical database at Mbarara to establish quality improvement initiatives. Education initiatives include a weekly Skype lecture series linking residents and the MGH and Mbarara, and a program to introduce ultrasound-guided regional anesthesia to Uganda.
Rwanda Human Resources for Health (HRH) Program
The Rwanda HRH program is an ambitious seven-year long, US Federally-funded, collaborative program of the Rwanda Ministry of Health and thirteen US academic medical centers and universities that seeks to expand and improve Rwanda’s health care workforce via strengthening national training programs of specialized physicians, nurses, oral health providers, and hospital managers by recruiting US faculty educators to join the National University of Rwanda (NUR) training faculty. In year one of the program (August 2012–July 2013), Brigham and Women's Hospital/Harvard Medical School contributed the largest number of physician educators to the program, recruiting 40% of the US HRH physician faculty, including six surgeons. These surgeons have worked closely with their Rwandan faculty counterparts to restructure and organize the NUR surgery residency program including development of curriculum, organizing didactic and clinical teaching, and greatly strengthening resident supervision and mentorship.
Orthopaedic Training in Haiti
Haiti’s devastating earthquake in January 2010, created an unprecedented orthopaedic catastrophe, with hundreds of thousands of serious skeletal injuries occurring at once, even as the infrastructure for caring for them was simultaneously wiped away. In response, in 2011, we established an orthopaedic training initiative, operated in conjunction with Partners In Health (PIH) and sponsored by a generous grant from the American Academy of Orthopaedic Surgeons. Our objective has been to provide support to Haitian orthopaedic trainees, attending surgeons, and allied health professionals. We have organized a rotating faculty of foreign surgeons who work and mentor surgeons in three sites in Haiti. The academic aspects of the program have been coordinated through the PGSSC.