Decolonizing Global Surgery

TL;DR: Indigenous Peoples have strong motivators for pursuing bariatric surgery, and the first to qualitatively explore the bariatric experience of Indigenous Peoples in Canada found an overall positive experience with the bari atric pathway.

Abstract: Study conception and design was guided by an Indigenous Advisory Committee (IAC), which included a community Elder. Urban Indigenous Manitobans with obesity and T2DM were recruited to participate in 2 sacred sharing circles and individual interviews. Audio transcripts were analyzed for themes using inductive thematic analysis. Results: Sacred sharing circles were led by an Elder with 4 participants and the IAC. Themes generated included experiencing hardship/ challenges, reflecting on the importance of supports, understanding relationships with food and healing/recovering. The participants described an overall supportive and positive experi ence with the bariatric pathway. Participants expressed interest in more culturally diverse supports in the clinic itself, as well as Indigenous peer mentorship. Conclusion: Indigenous Peoples have strong motivators for pursuing bariatric surgery, and we found an overall positive experience with the bari atric pathway. Suggestions for improvement of the clinic pathway included culturally relevant supports and Indigenous peer mentorship. This study is the first to qualitatively explore the bariatric experience of Indigenous Peoples in Canada. Further research will continue to explore the health care encoun-ter in detail and will provide the opportunity for development of culturally relevant materials and interventions. at the Central Hospital of Yaoundé were retrospectively reviewed to identify postoperative urological complications. The χ 2 test was used to assess bivariate data relationships, odds ratios (ORs) were calculated when appropriate, and results were considered significant at p < 0.05. Results: Eighteen women were identified: 17 had had a hysterectomy and 1 had had a cesarean section. Only 3 (16.7%) patients had had abdominal surgeries in the past, 16 (88.9%) had an American Society of Anesthesiologists score of 2 or less, and 7 (38.9%) presented urological symptoms before postoperative day 7. Five patients (27.8%) could not afford imaging and 5 others had bilateral hydronephrosis. Most patients (55.6%) were managed more than a month after their diagnosis, and 7 (38.9%) had a hospital stay longer than 7 days following treatment of the urological complication. Hysterectomy patients were more likely to have poor outcomes (OR 1.2, 95% confidence interval 1.0–1.5). Conclusion: As we advocate for increased access to surgery worldwide, it is essential that we do not compromise safety and quality of care for our patients. This study highlights the need for quality improvement in low-resource settings. it affects 505 million, and 10%–20% of those affected present severe symptoms. Our objective was to assess access to routine otolaryngology care in the Democratic Republic of Congo. We used AR as a proxy of routine care based on its prevalence and straightforward diagnosis and management. Methods: We conducted a retrospective chart review of patients with AR admitted between 2015 and 2020 at Centre Hospitalier Mère et Enfant Monkole in Kinshasa. Sociodemo-graphic, clinical, therapeutic and prognostic data were collected. Summary descriptive and bivariable ( χ 2 ) data analyses were performed using SPSS v. 26. Results: During the study period, 120 patients, mostly female (65.8%), were admitted with AR. The patients were aged 30.2 ± 15.1 years, and 54 (45.0%) were uneducated. The majority (81.7%) reported having symptoms more than 4 days per week, 9 (7.5%) had sleep-ing disorders, 16 (13.3%) reported their symptoms prevented them from exercising, 17 (14.2%) reported their hobbies were affected by the AR symptoms, and 64 (53.3%) reported their symptoms adversely affected their professional life. On average, patients waited 4.2 ± 3.4 years to consult a specialist. Instead, patients self-medicated because they lacked health insurance and wanted to avoid the financial burden of getting specialized care. Conclusion: Access to routine otolaryngology care is limited in the Democratic Republic of Congo because patients face significant hurdles when seeking care. Our study findings highlight the need for further research and intervention by the global otolaryngology community. care. surgical activity patient outcomes. The objectives of the study to determine the common procedures done for TBI patients and to identify postoperative complications and treatment outcomes of surgically treated patients. Methods: All surgically treated TBI patients at the 4 teaching hospitals in Addis Ababa, Ethiopia, were prospectively registered from October 2012 to December 2016. Data registration included types of surgical procedures, complications, reoperations, discharge outcomes and mortality. Results: A total of 1087 patients were included in the study. The most common surgical procedures were elevation of depressed skull fractures (DSF; 49.5%) and craniotomy (47.9%). Epidural hematoma was the most frequent indi-cation for a craniotomy (74.7%). Most (77.7%) patients underwent surgery within 24 hours of admission. Patients undergoing elevation of a DSF or a craniotomy stayed a median of 4 days in hospital. Decompressive craniectomy was done in only 10 patients. Postoperative complications were seen in 17% of patients, and only 3% were reoperated. Cere-brospinal fluid leak was the most common complication (7.9%). Only 5.6% of craniotomy patients and 0.4% of patients undergoing elevation of a DSF required blood trans-fusion. The overall mortality was 8.2%. Age, admission Glasgow Coma Scale (GCS) score and length of hospital stay were significantly associated with mortality ( p ≤ 0.005). Diagnosis, admission GCS score, surgical procedure and complications were significant predictors of discharge GCS score ( p < 0.01). Conclusion: The injury panorama, surgical activity and outcome are significantly influenced by patient selection due to deficits within both prehospital and hospital care. Still, the neurosurgical services a large number of patients Addis Ababa region qualitatively com-parable high-income Primary outcomes included total number of anesthesiologists and their gender, age, country of practice, current work location, country of origin, and country where they received their initial anesthesia qualification. Results: We identified 411 qualified anesthesiologists (0.19 per 100 000 population). The median age was 41. One-third were female, with younger anesthesiologists more likely to be female. The majority (67.5%) were based in urban areas with a population greater than 1 million people, and most were employed by government institutions (61.6%). Most anesthesiologists in the region were trained (89.1%) and currently work (95.1%) in their home country. The numbers of anesthesiologists in CANECSA member countries are extremely low — about 5% of minimum recommended numbers. The workforce is expanding, although population growth reduces the impact of this expansion. Challenges include the maldistribution of anesthesiologists relative to the population. Opportunities include the increasing percentage of women in the anesthesiology workforce and increasing numbers of female medical school graduates. Conclusion: Our findings suggest that an expansion of high-quality anesthesiology training across the region is required. Background: Mismatched surgeon:anesthesiologist ratios often exist in low-resource settings, making safe essential and emergency surgical care challenging. We performed an audit of essential and emergency procedures performed for lower-limb (LL) musculoskeletal disorders (MSDs) when an anesthesiologist was unavailable. Our objective was to identify options for the delivery of safe essential and emergency orthopedic/trauma surgical care in austere settings lacking anesthesiologist support, with emphasis on resource optimization, audit and risk mitiga-tion. Methods: We conducted a 5-year retrospective audit of emergency and essential LL orthopedic procedures performed at a remote mission hospital in central India. Out of necessity, a regional anesthesia (RA) protocol was developed in collaboration with anesthesiologists familiar with the setting. The incidence of intraoperative surgical and perioperative anesthesia complications when RA was administered by a surgeon was evaluated. Results: During the study period, 766 emergency and essential procedures were performed for LL MSDs. An anesthesiologist was available for only 6 of 766. RA was administered by a surgeon for 283 of 766. This included spinal anesthesia (SA) for 267 of 283 patients, and peripheral nerve blocks for 16 of 283. Local infiltration and/or sedation was administered to 477 of 766 patients. There were 17 intraoperative surgical complications. Anesthesia-related complications included multiple attempts to localize subarachnoid space in 37 of 267 patients and SA failure in 9 of 267 patients, all of whom had successful readministration of anesthesia. Additional sedation and infiltration of local anesthetic was required in 5 of 267 patients. Conclusion: In health care facilities where there are no trained anesthesia providers, surgeons can be upskilled to deliver safe anesthesia services. The highest-yield procedures for emergency orthopedic care are spinal anesthesia and local anesthesia with sedation. Orthopedic surgery training programs should consider including those skills in their curriculum. access dimensions, investigated spatial autocorrelations across districts using the Moran I statistic and checked for associa-tions between ZVASCI and SDG Index for 90 aspirational districts needing developmental push. Results: ZVASCI was estimated for rural regions of 587 districts and 36 states/ union territories (UTs). Among districts, Bhopal in Madhya Pradesh had the highest index value of 92.68, while North and Middle Andaman in Andaman and Nicobar Islands had the lowest value of 0. Most districts had ZVASCI below 60. Among states/UTs, Chandigarh had the highest value of 77.29, while Andhra Pradesh had a null value. Most sta