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Operating in a Resource-Constrained Environment: Lessons Learned from Surgical Missions to Haiti
*Michael Hall1, Mark Maxfield1, *Frantz Paul2, Walter Longo1, Robert Udelsman1, *Richard Garvey3
1Yale University School of Medicine, New Haven, CT;2Johns Hopkins Bayview Medical Center, Baltimore, MD;3Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT

OBJECTIVE
Discuss the feasibility and practicality of a small team, low cost, short duration surgical mission to a resource-constrained environment.
DESIGN
Review the outcomes of a uniquely constructed surgical mission to Haiti on yearly 1-week trips in 2012-2015.
SETTING
Surgical team held clinic in a mountain village in Haiti, screening patients for surgical pathologies that were amenable for surgery. Operations were performed in a small nearby city hospital that provided an OR, personnel, and minimal resources.
PATIENTS
Patients travelled by foot to the town parish where they were evaluated with help of medical interpreters. H&P was performed on all patients.
INTERVENTIONS
Over 200 patients were evaluated & 83 operations were booked over four 6-day periods between 2012 and 2015. Patients were evaluated post-operatively during the week and as needed thereafter with nun-driven nursing care.
MAIN OUTCOME MEASURES
Successful completion of 4 surgical missions treating lifestyle-limiting ailments that otherwise would be left untreated.
RESULTS
Patient ages ranged from 2 to 80, with 69% male. Of 80 completed operations, there were 44 hernias/hydroceles, 22 soft tissue lesions, and 14 others, including 2 hysterectomies, 1 mastectomy, 1 circumcision, and 1 burn contracture release. Complication rate was 5%, including intraoperative bladder injury during inguinal hernia repair, two instances of urinary retention, and one hematoma. Average annual cost of the surgical mission was <\,000.
CONCLUSIONS
This model is ideal for individual practitioners, is feasible for both academic and private surgeons, and an ideal environment for surgical resident training. Limitations include difficult long-term follow up. Increased frequency of missions with enhanced communication between individual teams performing missions would improve surgical infrastructure through resource-sharing and improve follow up to populations in need.


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