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ABSTRACT: Sarah MacFarlane and colleagues share their lessons engaging in educational reform and faculty development with the Muhimbili University of Health and Allied Sciences in Tanzania and the University of California San Francisco.
PLoS Medicine 08/2012; 9(8):e1001284. · 16.27 Impact Factor
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ABSTRACT: The creation of the University of California Global Health Institute represents a paradigm shift in structure and function. Its 3 centers of expertise (Migration and Health, One Health, and Women's Health and Empowerment) not only involve all 10 of the University of California campuses but also bring together a wide range of disciplines from both the health and nonhealth sciences. They have created truly interdisciplinary and transdisciplinary programs that are addressing complex global health challenges of the twenty-first century, training future global health leaders, and forging international academic partnerships.
Infectious disease clinics of North America 09/2011; 25(3):499-509, vii. · 2.29 Impact Factor
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Haile T Debas
Asia-Pacific Journal of Public Health 07/2010; 22(3 Suppl):12S-13S. · 1.06 Impact Factor
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Margaret E Kruk,
Andreas Wladis,
Naboth Mbembati,
S Khady Ndao-Brumblay,
Renee Y Hsia,
Moses Galukande,
Sam Luboga,
Alphonsus Matovu,
Helder de Miranda,
Doruk Ozgediz,
Ana Romàn Quiñones,
Peter C Rockers,
Johan von Schreeb,
Fernando Vaz, Haile T Debas,
Sarah B Macfarlane
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ABSTRACT: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries.
We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals.
African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.
PLoS Medicine 01/2010; 7(3):e1000242. · 16.27 Impact Factor
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Moses Galukande,
Johan von Schreeb,
Andreas Wladis,
Naboth Mbembati,
Helder de Miranda,
Margaret E Kruk,
Sam Luboga,
Alphonsus Matovu,
Colin McCord,
S Khady Ndao-Brumblay,
Doruk Ozgediz,
Peter C Rockers,
Ana Romàn Quiñones,
Fernando Vaz, Haile T Debas,
Sarah B Macfarlane
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ABSTRACT: Surgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub-Saharan African countries.
In a retrospective descriptive study, field data were collected from eight district hospitals in Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population.
The findings of this study clearly indicate low levels of surgical care provision at the district level for the hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable morbidity and mortality. Please see later in the article for the Editors' Summary.
PLoS Medicine 01/2010; 7(3):e1000243. · 16.27 Impact Factor
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Sam Luboga,
Sarah B Macfarlane,
Johan von Schreeb,
Margaret E Kruk,
Meena N Cherian,
Staffan Bergström,
Paul B M Bossyns,
Ernest Denerville,
Delanyo Dovlo,
Moses Galukande, [......],
Charles A Mkony,
Pascoal Mocumbi,
Jean Bosco Ndihokubwayo,
Pierre Ngueumachi,
Gebreamlak Ogbaselassie,
Evariste Lodi Okitombahe,
Cheikh Tidiane Toure,
Fernando Vaz,
Charlotte M Zikusooka, Haile T Debas
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ABSTRACT: In this Policy Forum, the Bellagio Essential Surgery Group, which was formed to advocate for increased access to surgery in Africa, recommends four priority areas for national and international agencies to target in order to address the surgical burden of disease in sub-Saharan Africa.
PLoS Medicine 12/2009; 6(12):e1000200. · 16.27 Impact Factor
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ABSTRACT: The University of California, San Francisco (UCSF) established Global Health Sciences (GHS) as a campus-wide initiative in 2003. The mission of GHS is to facilitate UCSF's engagement in global health across its four schools by (1) creating a supportive environment that promotes UCSF's leadership role in global health, (2) providing education and training in global health, (3) convening and coordinating global health research activities, (4) establishing global health outreach programs locally in San Francisco and California, (5) partnering with academic centers, especially less-well-resourced institutions in low- and middle-income countries, and (6) developing and collaborating in international initiatives that address neglected global health issues.GHS education programs include a master of science (MS) program expected to start in September 2008, an introduction to global health for UCSF residents, and a year of training at UCSF for MS and PhD students from low- and middle-income countries that is "sandwiched" between years in their own education program and results in a UCSF Sandwich Certificate. GHS's work with partner institutions in California has a preliminary focus on migration and health, and its work with academic centers in low- and middle-income countries focuses primarily on academic partnerships to train human resources for health. Recognizing that the existing academic structure at UCSF may be inadequate to address the complexity of global health threats in the 21st century, GHS is working with the nine other campuses of the University of California to develop a university-wide transdisciplinary initiative in global health.
Academic Medicine 03/2008; 83(2):173-9. · 3.52 Impact Factor
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Haile T Debas
Surgery 10/2006; 140(3):359-61. · 3.10 Impact Factor
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ABSTRACT: The role of surgery as a preventive strategy in public health needs to be studied and measured far more extensively than is currently the case. Another key reason for this study is that virtually all countries are developing their economies, and as a result, developing nations are increasingly facing a double burden—that is, the infectious diseases that have historically been so relevant and the conditions that emerge with economic development (for example, trauma from motorcycle, truck, and car accidents). The inclusion of a surgery chapter in this book recognizes that surgical services may have a cost-effective role in population-based health care. Recent studies (for instance, McCord and Chowdhury 2003) show that basic hospital service, which requires no sophisticated care, can be cost-effective, with a cost per disability-adjusted life year (DALY) that is much lower than might have been expected, and can be on a par with other well-accepted preventive procedures, such as immunization for measles and tetanus and home care for lower respiratory infections (Armandola 2003; Dayan and others 2004; Moalosi and others 2003; Ruff 1999). We have identified four types of surgically significant interventions with a potential public health dimension: (a) the provision of competent, initial surgical care to injury victims, not only to reduce preventable deaths but also to decrease the number of survivable injuries that result in personal dysfunction and impose a significant burden on families and communities; (b) the handling of obstetrical complications (obstructed labor, hemorrhage); (c) the timely and competent surgical management of a variety of abdominal and extra-abdominal emergent and life-threatening conditions; and (d) the elective care of simple surgical conditions such as hernias, clubfoot, cataract, hydroceles, and otitis media.
01/2006; , ISBN: 0821361791
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ABSTRACT: The objective of medicine is to address people's unavoidable needs for emotional and physical healing. The discipline has evolved over millennia by drawing on the religious beliefs and social structures of numerous indigenous peoples, by exploiting natural products in their environments, and more recently by developing and validating therapeutic and preventive approaches using the scientific method. Public health and medical practices have now advanced to a point at which people can anticipate—and even feel entitled to—lives that are longer and of better quality than ever before in human history. Yet despite the pervasiveness, power, and promise of contemporary medical science, large segments of humanity either cannot access its benefits or choose not to do so. More than 80 percent of people in developing nations can barely afford the most basic medical procedures, drugs, and vaccines. In the industrial nations, a surprisingly large proportion of people opt for practices and products for which proof as to their safety and efficacy is modest at best, practices that in the aggregate are known as complementary and alternative medicine (CAM) or as traditional medicine (TM). Much of this book considers the formidable challenges to advancing human health through the further dispersion of effective and economical medical practices. This chapter considers both proven and unproven but popular CAM and TM approaches and attempts to portray their current and potential place in the overall practice of medicine. With globalization, the pattern of disease in developing countries is changing. Unlike in the past, when communicable diseases dominated, now 50 percent of the health burden in developing nations is due to noncommunicable diseases, such as cardiovascular diseases, diabetes, hypertension, depression, and use of tobacco and other addictive substances. Because lifestyle, diet, obesity, lack of exercise, and stress are important contributing factors in the causation of these noncommunicable diseases, CAM and TM approaches to these factors in particular will be increasingly important for the development of future health care strategies for the developing world.
01/2006; , ISBN: 0821361791
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Haile T Debas,
Barbara L Bass,
Murray F Brennan,
Timothy C Flynn,
J Roland Folse,
Julie A Freischlag,
Paul Friedmann,
Lazar J Greenfield,
R Scott Jones,
Frank R Lewis,
Mark A Malangoni,
Carlos A Pellegrini,
Eric A Rose,
Ajit K Sachdeva,
George F Sheldon,
Patricia L Turner,
Andrew L Warshaw,
Richard E Welling,
Michael J Zinner
Annals of Surgery 02/2005; 241(1):1-8. · 7.49 Impact Factor
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Surgery 12/2004; 136(5):953-65. · 3.10 Impact Factor
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Annals of Surgery 11/2004; 240(4):565-72. · 7.49 Impact Factor
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ABSTRACT: In 1975, a trend began in which applications of MDs to the National Institutes of Health for research funding became less successful than applications from PhDs or MD/PhDs. MD/PhDs were the most successful applicants. Concomitantly, proposals for clinical research were less successful than nonclinical proposals. Since 1975, surgeons have fared disproportionately worse than researchers in other clinical disciplines in obtaining funding from the National Institutes of Health. Despite the efforts of surgical organizations, surgeons continue to fall farther behind in getting National Institutes of Health support for research. The most likely cause of this problem is that the surgical profession has failed to develop and sustain an adequate research workforce.
Annals of Surgery 11/2004; 240(4):573-7. · 7.49 Impact Factor
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Archives of Surgery 10/2003; 138(9):977-86. · 4.24 Impact Factor
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ABSTRACT: The Academy of Medical Educators at the University of California, San Francisco (UCSF), was established in 2000 to (1) foster excellence in teaching, (2) support teachers of medicine, and (3) promote curricular innovation. A membership organization, it recognizes five categories of educational activity: direct teaching, curriculum development and assessment of learner performance, advising and mentoring, educational administration and leadership, and educational research. Excellent medical student teaching and outstanding accomplishment in one or more areas of educational activity qualify a teacher for membership. Candidates prepare a portfolio that is reviewed internally and by national experts in medical education. Currently 37 faculty members, 3% of the entire school of medicine faculty, belong to the academy. The academy's innovations funding program disburses one-year grants to support curricular development and comparisons of pedagogical approaches; through this mechanism, the academy has funded 20 projects at a total cost of $442,300. Three fourths of expended funds support faculty release time. Faculty development efforts include promotion of the use of an educator's portfolio and the establishment of a mentoring program for junior faculty members built around observation of teaching. The Academy of Medical Educators vigorously supports expanded scholarship in education; the academy-sponsored Education Day is an opportunity for educators to present their work locally. Recipients of innovations-funding program grants are expected to present their work in an appropriate national forum and are assisted in doing this through quarterly scholarship clinics. The Academy of Medical Educators has been well received at UCSF and is enhancing the status of medical education and teachers.
Academic Medicine 08/2003; 78(7):666-72. · 3.52 Impact Factor
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Haile T Debas
Annals of Surgery 10/2002; 236(3):263-9. · 7.49 Impact Factor
