Volunteers in Plastic Surgery Guidelines for Providing Surgical Care for Children in the Less Developed World: Part II. Ethical Considerations
ABSTRACT Many international volunteer groups provide free reconstructive plastic surgery for the poor and underserved in developing countries. An essential issue in providing this care is that it meets consistent guidelines for both quality and safety-a topic that has been addressed previously. An equally important consideration is how to provide that care in an ethical manner. No literature presently addresses the various issues involved in making those decisions.
With these ethical considerations in mind, the Volunteers in Plastic Surgery Committee of the American Society of Plastic Surgeons/Plastic Surgery Foundation undertook a project to create a comprehensive set of guidelines for volunteer groups planning to provide this type of reconstructive plastic surgery in developing countries. The committee worked in conjunction with the Society for Pediatric Anesthesia on this project.
The Board of the American Society of Plastic Surgeons/Plastic Surgery Foundation has approved the ethical guidelines created for the delivery of care in developing countries. The guidelines address the variety of ethical decisions that may be faced by a team working in an underdeveloped country. These guidelines make it possible for a humanitarian effort to anticipate the types of ethical decisions that are often encountered and be prepared to deal with them appropriately.
Any group seeking to undertake an international mission trip in plastic surgery should be able to go to one source to find a detailed discussion of the perceived needs in providing ethical humanitarian care. This document was created to satisfy that need and is a companion to our original guidelines addressing safety and quality.
SourceAvailable from: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: Interest in global health and international mission trips among medical student and resident trainees is growing rapidly. How these electives and international mission experiences affect future practice is still being elucidated. No study has identified if participation in international surgical missions during residency is a predictor of participation in international surgical missions in practice after training completion. All trainees of our plastic surgery residency program from 1990 to 2011, during the implementation of optional annual international surgical missions, were surveyed to determine if the graduate had gone on a mission as a resident and as a plastic surgeon. Data were compared between graduates who participated in missions as residents and graduates who did not, from 1990 to 2011 and 1990 to 2007. Of Plastic Surgery graduates from 1990 to 2011 who participated in international missions as residents, 60% participated in missions when in practice, versus 5.9% of graduates participating in missions in practice but not residency (P<0.0001). When excluding last 5 years, graduates participating in international missions in practice after doing so as residents increases to 85.7%, versus 7.41% who participate in practice but not residency P<0.002. Results reveal plastic surgeons who participate in international surgical missions as residents participate in international surgical missions in practice at higher rates than graduates who did not participate in missions during residency. International missions have significant intrinsic value both to trainee and international communities served, and this opportunity should be readily and easily accessible to all plastic surgery residents nationwide.03/2015; 42(2):159-63. DOI:10.5999/aps.2015.42.2.159
[Show abstract] [Hide abstract]
ABSTRACT: IntroductionAttention to surgical conditions in low- and middle-income countries (LMICs) has increased in recent years. Because half of the population in the world’s poorest countries are children , paediatric surgical conditions compose a significant proportion of the global burden of disease (BoD), and there are critical shortages in workforce and skills to treat these diseases in LMICs. Several population-based studies have highlighted the magnitude of the need for paediatric surgery and the limited capacity, both in human resources and in infrastructure, to tackle the problem [2, 3]. Africa, in particular, has a grave shortage of paediatric surgeons. The number of fully trained paediatric surgeons ranges from 1 in Malawi (population 13 million) to 120 in Egypt (population of 80 million). In more than half of African countries, no full-time paediatric surgeon is available [4, 5]. LMICs in other world regions have a similar challenge. The problem is not only limited to a poor rati ...World Journal of Surgery 10/2014; 39(2). DOI:10.1007/s00268-014-2843-1 · 2.35 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: To explore the perspectives of Ethiopian and international neurosurgeons on the development of a sustainable academic neurosurgery teaching unit in Addis Ababa, Ethiopia. METHODS: A qualitative case study methodology was employed. RESULTS: Ethiopian and international surgeons describe a rewarding cross-cultural experience. Areas in need of improvement include communication, educational infrastructure, and structured morbidity and mortality discussions. Data collection that aims to understand better the burden of neurosurgical disease in Ethiopia along with rapidly expanding Ethiopian government initiatives to improve the health care system will lead to improved patient care. CONCLUSIONS: Genuine partnerships between surgeons who have trained and worked in well-developed neurosurgical centers and those that are working within the confines of limited resources have the mutual desire to improve neurosurgical care. Understanding each other's perspective is an important aspect of program development.World Neurosurgery 09/2014; 82(6). DOI:10.1016/j.wneu.2014.09.001 · 2.42 Impact Factor