Outreach Mission Research Articles

Secondary Cleft Nasolabial Deformities

Secondary or residual cleft lip and nasal deformities following primary unilateral or bilateral cleft lip repair are common. Many classification systems have been proposed to describe congenital cleft lip and palate deformities before repair. This article proposes a one-of-a-kind classification system for residual cleft deformities and describes its application to 136 cleft lip revision cases from cleft outreach missions worldwide. Patients' demographics and deformities were classified preoperatively, and a database of the classification was created. Postoperatively, the type of surgery performed was added to the database and comparison was done using an independent t test. Kappa coefficient was 0.92 and showed excellent agreement between the type assigned preoperatively to the patient and the type of procedure done. This system proves to provide good descriptions of the deformities, is user friendly, facilitates the planning of the corrective surgical procedure, and enhances the communicative lingo between surgeons and members of cleft multidisciplinary care teams. It is broadly applicable in outreach missions with limited resources and cleft referral centers with considerable load.

Paediatric Surgical Outreach to Papua New Guinea: Initial Experience

This is a report of our early experience in establishing a Paediatric surgical outreach program to Papua New Guinea (PNG) to build capacity and improve care. A Paediatric surgical outreach mission was initiated about 4 years ago in collaboration with Singhealth and PNG along with the multidisciplinary team of health care professionals from Cardiology, Cardiothoracic Surgery, Orthopaedics, Urology, Plastics and Anaesthesia. On each mission trip of 4 - 7 days duration, Singhealth doctors supervise or perform surgeries for complex cases, conduct patient consultations and give lectures to impart knowledge and transfer skills to the local health care community in PNG. In addition, a 6 - 12 months training program in Singapore for PNG doctors has been started. For complex cases which cannot be managed in PNG, there is provision for transfer of patients to Singapore under KKROK fund for further treatment. So far 4 mission trips have been conducted in past 4 years for paediatric surgical unit in Port Moresby General Hospital of PNG focussing on teaching and training of local Paediatric surgeons. Based on evaluation of the Singhealth medical team, there is severe shortage of medical manpower, surgical skill and specialised expertise. Due to lack of intensive care facility, adequate medications and proper medical equipment in the hospital, there are many conditions being left untreated causing high morbidity and mortality among infants and neonates. Such humanitarian work inspires Singhealth towards its global health mission of promoting health equity in responding to the medical needs of PNG through training and leveraging on strength through partnership. In addition, our doctors gain invaluable learning from the exposure, hone their skill as they treat a diversity of cases and are innovative in their treatment options by working in an environment with limited resources.

Competency-Based Education in Low Resource Settings: Development of a Novel Surgical Training Program

BackgroundThe unmet burden of surgical disease represents a major global health concern, and a lack of trained providers is a critical component of the inadequacy of surgical care worldwide. Competency-based training has been advanced in high-income countries, improving technical skills and decreasing training time, but it is poorly understood how this model might be applied to low- and middle-income countries. We describe the development of a competency-based program to accelerate specialty training of in-country providers in cleft surgery techniques.MethodsThe program was designed and piloted among eight trainees at five international cleft lip and palate surgical mission sites in Latin America and Africa. A competency-based evaluation form, designed for the program, was utilized to grade general technical and procedure-specific competencies, and pre- and post-training scores were analyzed using a paired t test.ResultsTrainees demonstrated improvement in average procedure-specific competency scores for both lip repairs (60.4–71.0%, p < 0.01) and palate (50.6–66.0%, p < 0.01). General technical competency scores also improved (63.6–72.0%, p < 0.01). Among the procedural competencies assessed, surgical markings showed the greatest improvement (19.0 and 22.8% for lip and palate, respectively), followed by nasal floor/mucosal approximation (15.0%) and hard palate dissection (17.1%).ConclusionSurgical delivery models in LMICs are varied, and trade-offs often exist between goals of case throughput, quality and training. Pilot program results show that procedure-specific and general technical competencies can be improved over a relatively short time and demonstrate the feasibility of incorporating such a training program into surgical outreach missions.

Cost-Effectiveness of a Locally Organized Surgical Outreach Mission: Making a Case for Strengthening Local Non-Governmental Organizations.

Many low- and middle-income countries (LMICs) have a high prevalence of unmet surgical need. Provision of operations through surgical outreach missions, mostly led by foreign organizations, offers a way to address the problem. We sought to assess the cost-effectiveness of surgical outreach missions provided by a wholly local organization in Ghana to highlight the role local groups might play in reducing the unmet surgical need of their communities. We calculated the disability-adjusted life years (DALY) averted by surgical outreach mission activities of ApriDec Medical Outreach Group (AMOG), a Ghanaian non-governmental organization. The total cost of their activities was also calculated. Conclusions about cost-effectiveness were made according to World Health Organization (WHO)-suggested parameters. We analyzed 2008 patients who had been operated upon by AMOG since December 2011. Operations performed included hernia repairs (824 patients, 41%) and excision biopsy of soft tissue masses (364 patients, 18%). More specialized operations included thyroidectomy (103 patients, 5.1%), urological procedures (including prostatectomy) (71 patients, 3.5%), and plastic surgery (26 patients, 1.3%). Total cost of the outreach trips was $283,762, and 2079 DALY were averted; cost per DALY averted was 136.49 USD. The mission trips were "very cost-effective" per WHO parameters. There was a trend toward a lower cost per DALY averted with subsequent outreach trips organized by AMOG. Our findings suggest that providing surgical services through wholly local surgical mission trips to underserved LMIC communities might represent a cost-effective and viable option for countries seeking to reduce the growing unmet surgical needs of their populations.

Establishing a surgical outreach program in the developing world: pediatric strabismus surgery in Guatemala City, Guatemala

To report our experince in establishing a sustainable pediatric surgical outreach mission to an underserved population in Guatemala for treatment of strabismic disorders. A pediatric ophthalmic surgical outreach mission was established. Children were evaluated for surgical intervention by 3 pediatric ophthalmologists and 2 orthoptists. Surgical care was provided at the Moore Pediatric Surgery Center, Guatemala City, over 4 days. Postoperative care was facilitated by Guatemalan physicians during the second year. In year 1, patients 1-17 years of age were referred by local healthcare providers. In year 2, more than 60% of patients were prescreened by a local pediatric ophthalmologist. We screened 47% more patients in year 2 (132 vs 90). Diagnoses included congenital and acquired esotropia, consecutive and acquired exotropia, congenital nystagmus, Duane syndrome, Brown syndrome, cranial nerve palsy, dissociated vertical deviation, and oblique muscle dysfunction. Overall, 42% of the patients who were screened underwent surgery. We performed 21 more surgeries in our second year (58 vs 37), a 57% increase. There were no significant intra- or postoperative complications. Surgical outreach programs for children with strabismic disorders in the developing world can be established through international cooperation, a multidisciplinary team of healthcare providers, and medical equipment allocations. Coordinating care with local pediatric ophthalmologists and medical directors facilitates best practice management for sustainability.

Leaders learning from leaders as an emergent action learning strategy

This account of practice describes what three executive leaders in a professional association have learned about action learning and their own practices of organizational renewal. Data are approached narratively and stories are told from the perspectives of diverse educators’ experiences, agency, and expertise. Mature organizations can be revitalized and diversified through the action learning of executive leaders who integrate a new and diverse faculty body into the governance structure and decision-making process. The goal of facilitating diversity goals for established organizations has relevance for universities, schools, businesses, and other learning environments. Public conversations can strengthen the diversity-oriented outreach missions of professional organizations.

Use of Safety Measures, Including the Modified World Health Organization Surgical Safety Checklist, During International Outreach Cleft Missions

International surgical outreach missions have become increasingly common within the surgery community. Untoward events in this setting, although rare, can be prevented by careful planning and the use of quality assurance guidelines designed to prevent such complications. The surgical safety checklist is widely accepted in most developed health care practices, but is used variably by international mission groups. This article outlines the quality assurance guidelines used, including a modified World Health Organization safety checklist and illustrated patient instruction forms, to provide a standardized means of delivering sound surgical care in the setting of short-term international cleft lip and/or palate missions.

Survey of Nongovernmental Organizations Providing Pediatric Cardiovascular Care in Low- and Middle-Income Countries

Nearly 90% of the children with heart disease in low- and middle-income countries (LMICs) cannot access cardiovascular (CV) services. Limitations include inadequate financial, human, and infrastructure resources. Nongovernmental organizations (NGOs) have played crucial roles in providing clinical services and infrastructure supports to LMICs CV programs; however, these outreach efforts are dispersed, inadequate, and lack coordination. A survey was sent to members of the World Society for Pediatric and Congenital Heart Society and PediHeart. A clearinghouse was created to provide information on NGO structures, geographic reach, and scope of services. The survey identified 80 NGOs supporting CV programs in 92 LMICs. The largest outreach efforts were in South and Central America (42%), followed by Africa (18%), Europe (17%), Asia (17%), and Asia-Western Pacific (6%). Most NGOs (51%) supported two to five outreach missions per year. The majority (87%) of NGOs provided education, diagnostics, and surgical or catheter-based interventions. Working jointly with LMIC partners, 59% of the NGOs performed operations in children and infants; 41% performed nonbypass neonatal operations. Approximately a quarter (26%) reported that partner sites do not perform interventions in between missions. Disparity and inadequacy in pediatric CV services remain an important problem for LMICs. A global consensus and coordinated efforts are needed to guide strategies on the development of regional centers of excellence, a global outcome database, and a CV program registry. Future efforts should be held accountable for impacts such as growth in the number of independent LMIC programs as well as reduction in mortality and patient waiting lists.

ETEA cumple 50 años

Esta nota presenta sintéticamente la historia de la institución cordobesa ETEA con ocasión de su cincuentenario (1963–2013) y, a partir de ella, una breve consideración de su misión educativa universitaria y social, a la que caracteriza como “misión de alcance”, subrayando especialmente dos aspectos: la investigación agraria y la comunidad humana universitaria que ha existido en la institución en este período.

Strategic design for pediatric neurosurgery missions across the Western Hemisphere

Background:With growing interest in global health, surgeons have created outreach missions to improve health care disparities in less developed countries. These efforts are mainly episodic with visiting surgeons performing the operations and minimal investment in local surgeon education. To create real and durable advancement in surgical services in disciplines that require urgent patient care, such as pediatric neurosurgery, improving the surgical armamentarium of the local surgeons must be the priority.Methods:We propose a strategic design for extending surgical education missions throughout the Western Hemisphere in order to transfer modern surgical skills to local neurosurgeons. A selection criteria and structure for targeted missions is a derivative of logistical and pedagogical lessons ascertained from previous missions by our teams in Peru and Ukraine.Results:Outreach programs should be applied to hospitals in capital cities to serve as a central referral center for maximal impact with fiscal efficiency. The host country should fulfill several criteria, including demonstration of geopolitical stability in combination with lack of modern neurosurgical care and equipment. The mission strategy is outlined as three to four 1-week visits with an initial site evaluation to establish a relationship with the hospital administration and host surgeons. Each visit should be characterized by collaboration between visiting and host surgeons on increasingly complex cases, with progressive transfer of skills over time.Conclusion:A strategic approach for surgical outreach missions should be built on collaboration and camaraderie between visiting and local neurosurgeons, with the mutual objective of cost-effective targeted renovation of their surgical equipment and skill repertoire.

The relationship between trauma and forgiveness in post-conflict Sierra Leone.

The decade-long civil war in Sierra Leone was declared over in 2002, but the psychological impact of the conflict remains. The purpose of this study was to determine if forgiveness is related to improved adjustment to trauma and for what demographic groups it is most useful in postwar Sierra Leone. Data were collected as part of the Association for Trauma Outreach and Prevention of Meaningfulworld’s humanitarian outreach mission to Sierra Leone in March of 2009. Participants were administered a sociodemographic questionnaire that included gender, age, religion, education, and employment variables. Trauma exposure and posttraumatic symptomatology were assessed using Parts 1 and 3 of the Harvard Trauma Questionnaire. Forgiveness was assessed using the Enright Forgiveness Inventory, which provides scores for total forgiveness and subscores for forgiving affect, behavior, and cognition. The role of gender and age were examined, and several significant relationships between forgiveness and trauma emerged. Trauma exposure and traumatic stress were significantly correlated, although traumatic stress showed a stronger relationship to forgiveness variables. Salient differences emerged between men and women and among older and younger participants. The strongest relationship between traumatic stress and forgiveness emerged in older women.

Geospatial Data Curation at the University of Idaho

The management and curation of digital geospatial data has become a central concern for many academic libraries. Geospatial data is a complex type of data critical to many different disciplines, and its use has become more expansive in the past decade. The University of Idaho Library maintains a geospatial data repository called the Interactive Numeric and Spatial Information Data Engine for Idaho (INSIDE Idaho) to support the land-grant research and outreach mission of the university. INSIDE Idaho-enabled research projects show that curating geospatial data requires a flexible, continuing partnership with researchers. First, changing access formats and data publishing protocols lead to cases in which the data are frequently disseminated in new ways. Second, researchers’ changing expectations about data reuse, as well as their own practices, require a repository to be both responsive and communicative. A strong curatorial process involves enabling new research and applications to be developed from the repository's data collections. Third, the experience with INSIDE Idaho suggests building a culture of data management awareness at an institution can be as valuable a use of a library's time as working to curate the data; that is, developing the local culture improves the efficiency of the curation process, most notably in the case of metadata. The experiences described in this article support the idea that academic libraries must develop infrastructure, policies, skills, and relationships to manage and curate research data successfully.

Ethical considerations in targeted paediatric neurosurgery missions

Within the context of global health development approaches, surgical missions to provide care for underserved populations remain the least studied interventions with regard to their methodology. Because of the unique...

Pediatric Neurosurgery Outreach: Sustainability Appraisal of a Targeted Teaching Model in Kiev, Ukraine

This study evaluates the efficacy of operative skill transfer in the context of targeted pediatric outreach missions completed in Kiev, Ukraine. In addition the ability to create sustainable surgical care improvement is investigated as an efficient method to improve global surgical care. Three 1-week targeted neurosurgical missions were performed (2005-2007) to teach neuroendoscopy, which included donation of the necessary surgical equipment, so the host team can deliver newly acquired surgical skills to their citizens after the visiting mission team departs. The neuroendoscopy data for the 4 years after the final mission in 2007 was obtained. After performing pediatric neurosurgery missions in 2005-2007, with a focus on teaching neuroendoscopy, the host team demonstrated the sustainability of our educational efforts in the subsequent 4 years by performing cases independently for their citizens. Since the last targeted mission of 2007, neuroendoscopic procedures have continued to be performed by the trained host surgeons. In 2008, 33 cases were performed. In 2009 and 2010, 29 and 22 cases were completed, respectively. In 2011, local neurosurgeons accomplished 27 cases. To date, a total of 111 operations have been performed over the past 4 years independent of any visiting team, illustrating the sustainability of educational efforts of the missions in 2005-2007. Effective operative skill transfer to host neurosurgeons can be accomplished with limited international team visits using a targeted approach that minimizes expenditures on personnel and capital. With the priority being teaching of an operative technique, as opposed to perennially performing operations by a visiting mission team, sustainable surgical care was achieved and perpetuated after missions officially concluded.

Targeted neurosurgical outreach: 5-year follow-up of operative skill transfer and sustainable care in Lima, Peru

This study evaluates the efficacy of operative skill transfer in the context of targeted pediatric outreach missions. In addition, the ability to implement surgical care improvements that are sustainable is investigated. Three 1-week targeted neurosurgical missions were performed (2004-2006) to teach neuroendoscopy, which included donation of the necessary equipment so newly acquired surgical skills could be performed by local neurosurgeons in between and after the departure of the mission team. After the targeted missions were completed, 5 years of neuroendoscopy case follow-up data were obtained. After performing pediatric neurosurgery missions in 2004-2006, with a focus on teaching neuroendoscopy, the host team demonstrated the sustainability of our didactic efforts in the subsequent 5 years by performing cases independently for their citizens. To date, a total of 196 operations have been performed in the past 5 years independent of any visiting team. Effective operative skill transfer to host neurosurgeons can be accomplished with limited international team visits utilizing a targeted approach that minimizes expenditures on personnel and capital. With the priority being teaching of an operative technique, as opposed to perennially performing operations by the mission team, sustainable surgical care was achieved after missions officially concluded.

International Healthcare and Women: The Roles and Challenges of Women in Sustainable Humanitarian Outreach

Program Description: Humanitarian aid offers human, technological, and financial resources to vulnerable people throughout the world. As health care providers, we strive to provide not only quality medical care, but to establish sustainable programs through our global outreach endeavors. Equipped with the proper resources, women have the power to help whole families and entire communities. Women are at the heart of many community-based efforts to improve basic education, prevent the spread of disease, and increase access to medical care. This miniseminar focuses on the role of women in the international community as otolaryngologists, educators, community leaders, and patients. Panelists will discuss the challenges, both locally and abroad, facing women in promoting and administering outreach in developing nations. The importance of empowering women around the world by providing support through resources and education will be explored. Successful outreach missions and partnership programs will be presented to highlight the significance of establishing lasting access to health care through education. Panelists will relate their experiences from disparate areas of the world: the Middle East, Haiti, Africa, India, and Central America. Introduction by AAO-HNS President J. Regan Thomas, MD. Sonya Malekzadeh, MD, and Gregory W. Randolph, MD, will moderate the session which will include four panelists. Educational Objectives: 1) Comprehend the challenges of women physicians providing sustainable humanitarian aid. 2) Appreciate what it means to be a woman patient in a developing country. 3) Understand the relationship between a US program and a developing country educational program.

An Assessment of Agriculture and Natural Resource Extension Program Needs on American Indian Reservations in Idaho, Nevada, Oregon, and Washington

This article summarizes the results of a needs assessment involving American Indians and outreach professionals on reservations in Idaho, Nevada, Oregon and Washington. The survey featured 36 questions about agricultural and natural resource issues that may pose challenges on reservation lands. A comparison between reservation residents and outreach professionals indicates that issue perceptions differ significantly for 23 of the 36 issues. Acknowledging these perceptual differences can help Extension to identify program gaps and opportunities with tribal nations. It can also increase Extension's appreciation for cultural diversity, thereby improving its capacity to execute its outreach mission on American Indian reservations.

Increasing Effectiveness of Cooperative Extension's Master Gardener Volunteers

Extension Master Gardener (EMG) volunteers are key to effective dissemination of horticultural information to the public. The goal of this workshop was to identify techniques to increase the capacity and effectiveness of EMG volunteers. The workshop focused on projects and tools that reduce the administrative burden of managing volunteers, increase the scope of issues that volunteers are prepared to address, and pool volunteer efforts and resources across county lines. Two online systems for managing and reporting EMG volunteer activities were described. Both systems are intuitive, user-friendly, and updated without the assistance of web managers. Regional web-based, advanced training on specific topics was used to expand educational messages of EMG volunteers and eliminate the costs associated with face-to-face training. Presentations were made using distance learning technologies and resources were shared online. Hosting agents tailored hands-on supporting activities to meet local needs. Volunteers expanded extension outreach by answering noncommercial landscape and garden telephone questions. Many of the administrative, logistical, and resource burdens associated with the EMG helpline phone service were overcome by working across county lines, standardizing training, centralizing supporting resources, and clustering volunteers into regional telephone helpline offices. Other projects and tools presented in the workshop focused on the need to affirm and/or foster the volunteers' connection with the university and the outreach mission of Cooperative Extension.

Cosmopolitan charismatics? Transnational ways of belonging and cosmopolitan moments in the religious practice of New Mission Churches

During the 1990s, migrants from West Africa developed New Pentecostal Mission Churches as they settled in European metropoles. These churches are characterized by intense transnational connections and aim to incorporate their members into a global Christendom. Focusing on the Christian Church Outreach Mission International (CCOMI), a church founded by Ghanaians in Hamburg, this article explores when and how transnational competences, and interactions beyond linguistic, cultural and ethnic boundaries, can be described as cosmopolitan sociabilities. It asks whether we can use the term ‘cosmopolitanism’ as an analytical tool, beyond ‘benign universalisms’, to shed light on cosmopolitan moments which can emerge as side-effects of Christian moral missions. It also asks how precisely Pentecostal churches create transnational ways of being and belonging, and how far the politics of locality play into the intensity of connections.

Evolution of a Humanitarian Dental Mission to Madagascar from 1999 to 2008

In this article, we report on the evolution of a series of dental outreach missions sponsored by Stony Brook University to remote areas of Madagascar over a nine-year period. The project evolved from one dental resident performing only dental extractions in 1999 to a team comprised of two dentists, six third-year dental students, and two dental assistants performing dental restorations, extractions, and endodontic procedures using digital radiographic equipment in 2008. The ability during the latest mission to utilize digital radiography in remote areas lacking running water, electricity, and dental facilities significantly enhanced the range and efficacy of dental procedures. This long-term project offered senior dental students and residents from Stony Brook University's School of Dental Medicine an educationally valuable opportunity to engage in international dental outreach and to make a significant contribution to the improvement of oral health in the underserved rural communities of Madagascar.