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Global Health Challenges: Why the Four S's Are Not Enough
Nathan M Novotny1,2,3,4, Shadi Hamouri2,5, Donna Kayal3
1Beaumont Children's, Section of Pediatric Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USA.
Insights
Introducing advanced thoracoscopy in low- and middle-income countries (LMICs) requires addressing challenges in staff, stuff, space, and systems. A fifth element, socialization, is crucial for successful adoption of these pediatric procedures.
Area of Science:
- Global Health
- Surgical Innovation
- Pediatric Surgery
Background:
- Advanced thoracoscopy adoption is limited in low- and middle-income countries (LMICs).
- No prior pediatric advanced thoracoscopy had been documented in LMICs.
- The four "S"s (Staff, Stuff, Space, Systems) are critical for healthcare delivery.
Purpose of the Study:
- To report challenges in introducing advanced thoracoscopic procedures in two LMIC hospitals.
- To identify factors promoting the adoption of advanced thoracoscopy in resource-limited settings.
- To explore the role of a fifth "S" - Socialization - in surgical innovation.
Main Methods:
- A visiting surgeon introduced advanced thoracoscopic procedures in two LMIC hospitals.
- Challenges related to instrumentation, staff availability, and cultural acceptance were documented.
- The impact of local surgeon and anesthesiologist engagement was assessed.
Main Results:
- Significant obstacles were overcome, including reliance on donated supplies and limited specialist staff.
- The introduction of advanced thoracoscopy faced challenges in complex thoracic pathology cases.
- Successful implementation was facilitated by the acceptance of the visiting surgeon's expertise.
Conclusions:
- The traditional four "S"s are insufficient for introducing advanced thoracoscopy in LMICs.
- A fifth "S", Socialization, encompassing local buy-in and eagerness to learn, is integral.
- Collaboration and acceptance of external expertise pave the way for advanced surgical procedures in resource-limited environments.
Abstract:
A well-known tenant of global health is the need for the four-S's to be successful in providing care in any context; Staff, Stuff, Space and Systems. Advanced thoracoscopy is slow to gain traction in low- and middle-income countries (LMICs). To our knowledge, no pediatric advanced thoracoscopy had been attempted previously in either LMIC. Therefore, we report the challenges associated with the adoption of the first advanced thoracoscopic procedures in two LMIC hospitals by a visiting surgeon. To further identify aspects of care in promoting the introduction of advanced thoracoscopy, we added a fifth S as an additional category-Socialization. A key to accomplishing goals for the patients as a visiting surgeon, particularly when introducing an advanced procedure, is acceptance into the culture of a hospital. Despite facing significant obstacles in caring for complex thoracic pathology with heavy reliance on disposable and reusable instrumentation provided through donation and limitations in staff such as access to neonatologists and pediatric surgeons, many obstacles have been overcome. In this perspective article, we show that a "fifth S" is also integral-having local surgeons and anesthesiologists eager to learn with acceptance of the visiting surgeon's expertise opens a path towards attempting advanced procedures in limited-resource settings.
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