Surgical ‘Safari’ vs. Educational Program: Experience with International Cardiac Surgery Missions in Nigeria

Abstract

Introduction In any country, the development and growth of open-heart surgery parallel stable political climate, economic growth, good leadership, and prudent fiscal management. These were lacking in Nigeria, which was under a military rule. The enthronement of democratic rule, in 1999, has caused desirable changes. The objective of this study is to report our experience with foreign cardiac teams that visited the National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, for seven years, in order to restart its open-heart surgery program. Methods To achieve the desired open-heart surgery training, our center received regular and frequent visits from foreign cardiac teams who would perform open-heart surgery with the local team. Results During the period of seven years, a total of 266 open-heart operations involving both adults and children were performed, with a mean of 38 cases per year; 150 (54.4%) males and 116 (43.6%) females were treated, with a ratio of 1.0:0.8. Six different teams visited the center at different periods. Conclusion After these years of cardiac missions to our center, the experience of the local team, especially the surgeons, is far from desirable because each team visit usually lasted about a week or two and each team, with exception of the CardioStart International/William Novick Global Cardiac Alliance, adopted the surgical ‘safari’ method.

Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries

“… 35 For example, during 7 years of cardiac surgical visits in Nigeria, no local surgeon led an open-heart surgery case, and the most common role was third assistant. 35 In one study, trainees reported that international groups had a neutral or negative impact on patient care (40%) and on their training (25%). 27 …”

“…Twenty-five studies (83%) described advantages with visiting surgical teams,17 19–42 further subgrouped into skills improvement, immediate clinical patient care, system-level strengthening, academic and career benefits and broader collaboration opportunities.…”

“…One of the most reported benefits of visiting surgical teams related to skill transfers (n=16, 53%)19–22 24–27 30 32–38 including both surgical techniques of advanced procedures, non-technical skills including ‘personal professionalism’, decision-making and a positive ‘cultural change’,19 22 25 26 31 which was emphasised by an attending surgeon in Ethiopia:…”

“…Potential areas of contention associated with visiting surgical teams were highlighted in 22 (73%) studies 17 18 21 22 25–27 29 31 33 35–46. These were further subgrouped as ethical dilemmas and inequity, insufficient knowledge transfers, poor quality of care, administrative and financial issues, competition and language barriers.…”

Ethical Considerations for Global Pediatric Cardiac Surgical Assistance Programs

“…Those teams that provide services only and allowing only limited participation by the local team are not upholding the promise and as such trust will not be developed and a rapid disconnect will occur, thus dooming program development. There are few times and places where the local team cannot be developed, and the visiting team simply provides all the care without education [5]. Beneficence cannot be directed at only the children receiving operation at the time of a visit, this is only a part of truly doing good work.…”