The Paul Farmer Global Surgery Fellowship Team is engaged in various clinical and research projects around the world to promote excellence and equity in global surgical care delivery. The following highlights will provide insight into some of the projects on which we are currently working in conjunction with the BCH, PGSSC, and PIH, and our in-country colleagues in Haiti, Rwanda and Liberia.
Oncology: The 2010 Global Burden of Disease data demonstrates that cancer is a substantial and growing cause of morbidity and mortality on a global scale. The PGSSC, in conjunction with the Dana-Farber Cancer Institute, is working with PIH and our Haitian colleagues to build and maintain comprehensive, hospital-based registries and treatment programs for breast, head and neck and cervical cancer. These care programs provide cancer treatment previously unavailable to residents of rural Haiti, and the registries allow us to analyze and assess many aspects of patient care, with the goal of increasing quality healthcare delivery.
Surgery and Poverty: Lack of surgical care is intimately linked with poverty, and income inequality is a consistent predictor of mortality in both high- and low-income countries. The availability of surgical services is unequally distributed around the world, with the poor disproportionately affected by lack of surgical care. Untreated surgical conditions can perpetuate the cycle of poverty and dependency, leading to grave personal, societal and economic impacts. Our research and clinical work is focused exclusively on these low-resource settings. With a goal of improving healthcare for the world’s poorest populations, our team is investigating and working to ensure that a lack of surgical services does not contribute to ongoing poverty.
Pediatric Surgery: Children comprise a significant portion of the population in low- and middle-income countries and are frequently afflicted by conditions amenable to surgical intervention such as injuries, burns and congenital anomalies. We have multiple projects aimed at decreasing the morbidity and mortality of surgical disease suffered by children, including assessment of pediatric surgical capacity in low-resource settings and decision analysis modeling of treatment methods for urologic disease.
Barriers to Surgical Care:Through a variety of research methods, our team is analyzing ways to address the various cultural, socioeconomic and structural barriers that patients face in accessing surgical care in low- and middle-income countries. Specific current projects focus on care delivery in the fields of orthopedic surgery, pediatric surgery, general surgery and oncologic care.
Orthopedic Surgery: Musculoskeletal abnormalities are a growing and frequent cause of morbidity in low- and middle-income countries. In conjunction with orthopedic specialists from Brigham and Women’s Hospital, our team is engaged in multiple projects to improve the delivery of quality orthopedic surgical care to patients in rural Haiti. Working closely with orthopedic surgeons on-the-ground in Haiti, our current projects focus on education, outcomes improvement, and care delivery expansion for orthopedic surgery and rehabilitation initiatives.
Trauma: Trauma is a leading cause of preventable death in low-resource settings. In collaboration with numerous experts and institutions around the world, we are focused on multiple projects aimed at decreasing morbidity and mortality from traumatic disease, including evaluation of trauma systems in Rwanda, development of a trauma training and management program in rural Haiti, and assessment of outcomes with different trauma education systems in low- and middle-income countries.
Health Systems Strengthening: Safe delivery of quality surgical care requires the reliable presence of many different factors. Our team works with our local colleagues to develop surgical delivery systems in areas of greatest need. A few of these projects include the implementation of surgical services at the new Hopital Universitaire Mirebalais with PIH in Haiti, evaluation of transport mechanisms in Rwanda, employing community health workers to follow post-operative patients in the community in Haiti and Rwanda, and support and analysis of surgical care in Liberia.
Education: Education is a crucial factor leading to creation of sustainable improvements to surgical care delivery in low-resource settings. Much of our work is focused on surgical education and the establishment and support of postgraduate surgical training programs in low- and middle-income countries with our partners in Rwanda, Haiti, Liberia and the United States. This includes work with Rwanda’s Human Resources for Health, collaborations with the Global Health Service Corps, work in course curriculum development with partners in Kenya and the Harvard School of Public Health, curriculum development for OPENPediatrics, and development of surgical training programs with Zanmi Lasante.
Cost-Benefit Models of Surgery: Global surgery has yet to garner the attention of many large-scale funders, global health groups or ministries of health. Many people falsely argue that surgical care is too expensive to provide. One component of our research agenda is assessing the financial cost of surgical care delivery in relation to the clinical and economic benefit such care can provide.
Anesthesia:In partnership with the Department of Anesthesiology, Pain and Perioperative Medicine at Boston Children’s Hospital, the PGSSC has created a Global Anesthesia Fellowship in order to create a collaborative academic exchange of clinical and research capacity relative to anesthesia delivery in low-resource settings. Our group is also working on research projects with our Haitian partners, such as assessing post-operative pain management in rural Haiti.
Global Surgical Workforce Assessment: There is a significant shortage and inequitable distribution of healthcare providers in low- and middle-income countries. We have multiple projects aimed at assessing global surgical and anesthetic workforce capacity, constitution and migration.
Technology: Technology can play a significant role in healthcare delivery and is an emerging field in global health. In conjunction with Partners in Health, we are working to develop a surgical electronic medical record (EMR) for a new hospital in Mirebalais, Haiti. We also have several endeavors focused on mobile technology including piloting a mobile health application to assess post-operative surgical outcomes. In addition, we are working with technology teams at Boston Children’s Hospital and Zanmi Lasante to improve our cancer registries in Haiti. These projects aid in outcomes-based clinical research that ensures improved patient care and quality improvement.
Safe Surgery: In collaboration with the Center for Surgery and Public Health at Brigham and Women’s Hospital, the Canadian Anesthesiologists' Society International Education Foundation, Lifebox Foundation, and the Rwandan Societies for Surgery and Anesthesia, participants from the PGSSC have started to measure outcomes before and after the implementation of a national surgical safety program in all Rwandan district hospitals.
Advocacy: The global burden of surgical disease is vast and significantly hinders the health and well-being of the world community. Surgery is one of the cornerstones on which health systems must be built and is a perquisite for global improvement in healthcare. We work to advocate for a prominent place for surgery in the dialogue of global health and development.