How not to do global surgeryBy Mark Shrime
<Cross-posted from here>
It is with more than a little bit of trepidation that I write this piece. I am an otolaryngologist by training, and otolaryngologic problems are legion in low- and middle-income countries, from head and neck tumors to clefts to chronic ear disease—things that are “minor issues” here in the developed world are large sources of global disease burden elsewhere. So the fact that otolaryngologists are involved in global surgery, and are talking about it, is a great thing.
But then: just this month, ENT Today published an interview by Gretchen Henkel of six otolaryngologists doing global surgical missions.
Buried in the article is this:
Q: Many otolaryngologists express satisfaction when they have the ability to train their colleagues at the host site, feeling as if they’re closer to the goal of increasing the sustainability of treatments. Do you agree? Dr. Buckmiller: I have mixed feelings about surgical training [in the host country]. Of course you want a country to be self-sufficient in the way it cares for different types of problems. The unfortunate thing is that cleft surgery is such a complex and precise group of procedures. I have completed eight years of training to be able to do these with the same standard of care. I sometimes hesitate to show someone how to do it and then have them do a very bad job at it the rest of the time. If there is a situation where that group of local people can continue training over long periods of time so that they become proficient, then I’m all for it.
Q: You often do several cases in one day, for many days in a row. This must make for some long days. How do you deal with fatigue?
Dr. Molin: The jet lag can be really hard. Fatigue and sleep deprivation are sometimes worse than [what we went through] in residency. Depending on the site, we may have been up for 24 hours when we arrive in the host country. Many times, the hosts feel obliged to wine and dine us. It is their way of showing their gratitude and hospitality, but our surgical team has to get up at 5 a.m. the next morning to do cleft palate and lip repairs.
Mixed feelings about training people in the countries you’re going to? Because they’re simply not as good as you are at fixing cleft lips? Because otolaryngologists with eight years of training are the only people qualified to fix a condition that affects up to 1 in 500 people? (Think about it—that’s 14 million people).
An implication that the only real surgical missions we can do are two-week helicopter missions in which we get wined and dined, in which we might bring along surgical residents because, despite the fact that they are slow, maybe it’s worth exposing them to surgical missions so that they can “get the bug”?
This is how not to do global surgery.