The Alliance for Patient Safety estimates there are 7 million disabling surgical complications and 1 million surgical-related deaths worldwide each year. They identify three primary problems with surgical safety: 1) It is unrecognized as a public health issue.
There is a lack of data on surgery and outcomes (especially in developing countries). There is a failure to use existing safety know-how.
One point I have tried to make over the years is that global health programs will build confidence in the local health workers, or they will diminish it. The amount of direction and ownership that the local health system has over the global health project determines the resulting outcome.
Christian Mission hospitals and health programs account for about 50% of all healthcare delivered in Sub-Saharan Africa (Olivier, et al., 2015). That figure is probably closer to 70% of the truly functional healthcare services delivered. Sadly however, many of these facilities have closed, those that remain are fighting for survival.
Creating empowering partnerships cross-culturally that are based on mutual design sounds easy, but nothing could be further from the truth. Mutual design based on community participation is one of the most difficult and complex aspects of designing and implementing global health initiatives. Avoiding Manipulation in Community Development If done well,
Ensuring adherence to clinical practice guidelines, clinical pathways, and other evidence-based recommendations could not have more value than it does in short-term surgical initiatives. Few if any global health initiatives have as much to offer as surgical initiatives, however they also represent the highest potential for adverse outcomes.
Are we prepared to care for surgical patients in developing countries. Have we thought about the challenges of operating on malnourished children, the delayed healing process from poor nutrition, need for longer post operative admission because patients will often need to walk home, or be transported long distances across challenging terrain etc.
In designing and planning global health initiatives, figuring out who the stakeholders are is a critical first step. Each community has leaders and influencers, and those involved in healthcare are critical for this kind of project. Partnership begins with identifying stakeholders and assessing their needs.
I believe patient safety is an achievable goal in medical missions, even in short-term work. But how?
Vertical and horizontal approaches to health have some fundamental differences. Vertical programs often have a preventive focus but they stem from a curative care model. As such they employ a western problem solving approach, and are often disease or health issue specific, such as AIDS or malaria. In essence, they
PLA Participatory Learning and Action has long been the foundation of best practices in community development. However, I believe it has practical application across all cross-cultural and global health work; in the community and in the hospital.
