Unifying Children’s Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda

Abstract

Background There is a significant unmet need for children's surgical care in low-and middle-income countries (LMICs). Multidisciplinary collaboration is required to advance the surgical and anesthesia care of children's surgical conditions such as congenital conditions, cancer and injuries. Nonetheless, there are limited examples of this process from LMICs. We describe the development and 3-year outcomes following a 2015 stakeholders' meeting in Uganda to catalyze multidisciplinary and multi-institutional collaboration. Methods The stakeholders' meeting was a daylong conference held in Kampala with local, regional and international collaborators in attendance. Multiple clinical specialties including surgical subspecialists, pediatric anesthesia, perioperative nursing, pediatric oncology and neonatology were represented. Key thematic areas including infrastructure, training and workforce retention, service delivery, and research and advocacy were addressed, and shortterm objectives were agreed upon. We reported the 3-year outcomes following the meeting by thematic area. Results The Pediatric Surgical Foundation was developed following the meeting to formalize coordination between institutions. Through international collaborations, operating room capacity has increased. A pediatric general surgery fellowship has expanded at Mulago and Mbarara hospitals supplemented by an international fellowship in multiple disciplines. Coordinated outreach camps have continued to assist with training and service delivery in rural regional hospitals. Conclusion Collaborations between disciplines, both within LMICs and with international partners, are required to advance children's surgery. The unification of stakeholders across clinical disciplines and institutional partnerships can facilitate increased children's surgical capacity. Such a process may prove useful in other LMICs with a wide range of children's surgery stakeholders.

Access to pediatric surgery delivered by general surgeons and anesthesia providers in Uganda: Results from 2 rural regional hospitals

“…Although the number of fellowship-trained pediatric surgeons and pediatric anesthesiologists is slowly increasing, attention must still be directed at supporting general surgeons and their perioperative teams to deliver pediatric surgical care, through ongoing education, support, and outreach. 20,24 We report the delivery of pediatric surgical care at 2 regional hospitals by general surgeons and their associated perioperative teams. Our data demonstrate that the general surgery teams at Soroti and Lacor are performing approximately 300 cases/year of elective and emergency pediatric surgery.…”

“…23,24 A national children's surgery stakeholders' meeting was held in Kampala, Uganda in 2015. 20 At the meeting, a major area of focus was to increase pediatric surgical capacity at regional referral hospitals. Both Soroti Regional Referral Hospital and St Mary's Lacor Regional Referral Hospital had representatives at the meeting.…”

“…Each hospital had general surgeons with long-standing relationships with both national and international children's surgery teams. 20 Both hospitals also represented tertiary care facilities and the major referral hospitals for their respective regions. At the meeting, stakeholders agreed to prioritize partnerships with international stakeholders and rural outreach to these hospitals to increase regional pediatric surgical capacity.…”

A comparative study of L4-L5-S1 and L5-S1 vertebral fusion in high-grade L5-S1 spondylolisthesis

“…Spondylolisthesis refers to degenerative changes in the spine that are often treated with supportive therapies and in severe cases requires surgical intervention[ 26 ] and remains a challenge for orthopedic surgeons, neurosurgeons and pediatrics[ 27 ] The optimal treatment of high-grade spondylolisthesis is a controversial issue. It is well known that symptomatic high-grade slip, resistant to conservative management requires surgical stabilization.…”

Lessons from developing, implementing and sustaining a participatory partnership for children’s surgical care in Tanzania

“…To date, the Tanzania partnership has generated 14 publications in peer-reviewed journals and 54 abstracts presented at international research meetings, 18 book chapters, 4 international fellowships in children’s surgery and 5 scholarships for training in better resourced parts of Africa 5 17–31. The Tanzanian research team are actively collaborating on the multi-site Global Paedsurg sub-Saharan African research21 and are one of four centres implementing the gastroschisis care bundle 20.…”