From Short-term Surgical Missions Towards Sustainable Partnerships

• Sponsor: Global Surgery Amsterdam (Other)
• Overall Status: Completed
• CT.gov ID: NCT04450823
• Collaborator: (none)
• Enrollment: 61
• Location: 1
• Actual Duration (Months): 5
• Patients Per Site Per Month: 12.3

Study Details

Study Description

Brief Summary

Introduction: Recently, the devastating consequences of neglected surgical care in global health became apparent with an estimated five billion people lacking access to safe surgical and anesthesia care. Traditionally, short-term surgical missions were the predominant strategy how surgical care was supported in Low- and Middle-Income Countries. Although surgical missions have been criticized in recent literature they are still being performed on a large scale. The aim of this study is to provide recommendations for persons and organizations involved in surgical mission on how to strengthen surgical care in LMICs in the future.

Method: An online survey was developed for members of foreign teams. Data was collected on 5 topics, consisting of: 1) basic characteristics of the missions, 2) main activities, 2) follow-up and reporting, 3) the local registration process for foreign teams and 4) collaboration with local stakeholders.

Condition or Disease	Intervention/Treatment	Phase
Global Surgery; Medical Missions	Other: no intervention

Study Design

• Study Type: Observational
• Actual Enrollment: 61 participants
• Observational Model: Other
• Time Perspective: Cross-Sectional
• Official Title: From Short-term Surgical Missions Towards Sustainable Partnerships. A Survey Among Members of Foreign Teams
• Actual Study Start Date: Jun 1, 2019
• Actual Primary Completion Date: Oct 30, 2019
• Actual Study Completion Date: Oct 30, 2019

Outcome Measures

Primary Outcome Measures

1. Q7: Country Where the Last Mission Took Place [approximately 20 minutes]

   Answer on the question: What was the country where your last mission took place?

2. Q8: Name of the Place and Hospital Where the Last Mission Took Place [approximately 20 minutes]

   List with names of the places and hospitals where the last mission took place

3. Q9: Number of Participants Per Organization [approximately 20 minutes]

   Name of the organization that supported the last mission of the participant

4. Q10: Countries Where the NGOs Are Based [approximately 20 minutes]

   List of countries where the supporting NGOs of the last mission are based

5. Q11: Importance of Potential Activities [approximately 20 minutes]

   Points provided (1-4) for four potential activities of a visiting team (more points = more important activity) The points provided by all participants are summed per specific activity and the total scores are compared The four potential activities are: Treat patients yourself Provide surgical equipment and consumables for the local team Provide free treatment Facilitate teaching of local staff Scale with importance of potential activities. Maximum score: 4x58 = 232

6. Q12: Activities That Where Missing in Question 11. [approximately 20 minutes]

   Respondents that were missing this activity as an option in question 11 Total number of respondents that were missing an activity: 29 Activities that were missing: Financial collaboration Advocacy Academic collaboration Sustainability Collaboration with local staff Follow-up

7. Q13. Medical Registration is Required in the Host Country [approximately 20 minutes]

   Medical registration in the host country is required for specialists performing short-term reconstructive missions Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

8. Q14: The Process of Obtaining Medical Registration Was Straightforward [approximately 20 minutes]

   The Process of Obtaining Medical Registration Was Straightforward Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

9. Q15: Collaboration [approximately 20 minutes]

   What can you say about the collaboration between authorities in LMICs and visiting surgical teams? Participants of the survey were asked to choose one of the following answers on this question: collaboration is present but improvement is needed there is no collaboration and it should be developed as a priority collaboration has no benefits nor disadvantages collaboration will likely be more harmful than beneficial for the mission

10. Q16. What Should Have a Higher Priority in the Hospital of Your Last Mission? [approximately 20 minutes]

    What should have a higher priority in the hospital of your last mission ? Respondents were asked to choose on the these two answers: Teaching in anesthesia care or teaching in surgical care

11. Q17. A Structured Follow-up Strategy is Required [approximately 20 minutes]

    A structured follow-up strategy (>6 months) of patients is required for short-term reconstructive surgical missions. Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

12. Q18. One Month After the Mission, an Official Report is Recommended [approximately 20 minutes]

    One month after the mission, an official report on the outcome including all complications encountered is recommended for all missions. Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

13. Q19. A Written Long-term Strategy is Recommended at the Start of a New Project. [approximately 20 minutes]

    A written long-term strategy (>5 years) with clear goals, developed by the visiting team and the local actors together, is recommended at the start of a new project. Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

14. Q20. Suggestions to Improve the Impact of Short Term Reconstructive Missions. [approximately 20 minutes]

    What would you suggest to improve the impact of short term reconstructive missions? The answers were categorized and the three most mentioned categories are: Teaching of local staff Follow-up Building sustainable partnerships The three activities were mentioned in total 68 times in the comments The distribution among the three categories is shown below

Eligibility Criteria

Criteria

• Ages Eligible for Study: N/A and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

Members of foreign teams, that did participate in at least one short-term surgical mission in a hospital in a LMIC

Exclusion Criteria:

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Global surgery amsterdam	Amsterdam	Noord Holland	Netherlands	1105BD

Sponsors and Collaborators

• Global Surgery Amsterdam

Investigators

None specified.

Study Documents (Full-Text)

• Study Protocol - May 15, 2019

More Information

Publications

None provided.

• Responsible Party: Matthijs Botman, Principal investigator, Global Surgery Amsterdam
• ClinicalTrials.gov Identifier: NCT04450823
• Other Study ID Numbers: 2020-01
• First Posted: Jun 30, 2020
• Last Update Posted: Dec 19, 2020
• Last Verified: Nov 1, 2020

• Individual Participant Data (IPD) Sharing Statement: Yes
• Plan to Share IPD: Yes
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Study Results

Participant Flow

Recruitment Details	Recruitment was June through October of 2019

Arm/Group Title	Experts
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Period Title: Overall Study
STARTED	61
COMPLETED	58
NOT COMPLETED	3

Baseline Characteristics

Arm/Group Title	All Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Overall Participants	58
Age (years) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [years]	43
Sex: Female, Male (Count of Participants)
Female	20 34.5%
Male	38 65.5%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	NA NaN
Asian	NA NaN
Native Hawaiian or Other Pacific Islander	NA NaN
Black or African American	NA NaN
White	NA NaN
More than one race	NA NaN
Unknown or Not Reported	NA NaN
Nationality (Count of Participants)
Dutch	33 56.9%
German	5 8.6%
British	4 6.9%
American	4 6.9%
Australian	2 3.4%
South African	2 3.4%
Tanzanian	1 1.7%
Lebanese	1 1.7%
Nigerian	1 1.7%
Danish	1 1.7%
Indian	1 1.7%
Haitian	1 1.7%
Ethiopian	2 3.4%
Profession (Count of Participants)
plastic surgeons	23 39.7%
orthopedic surgeons	9 15.5%
general surgeons	4 6.9%
local doctors/surgeons in training	12 20.7%
anaesthetists	5 8.6%
nurses	2 3.4%
physiotherapists	2 3.4%
NGO executive officer	1 1.7%
Number of missions performed (missions) [Mean (Full Range) ]
Mean (Full Range) [missions]	6

Outcome Measures

1. Primary Outcome

Title	Q7: Country Where the Last Mission Took Place
Description	Answer on the question: What was the country where your last mission took place?
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Burkino fase	2 3.4%
Bangladesh	2 3.4%
Cambodia	1 1.7%
Ecuador	1 1.7%
Ethiopia	3 5.2%
Gaza	1 1.7%
Guinea	9 15.5%
Guinee Bissau	2 3.4%
Haiti	1 1.7%
Indonesia	2 3.4%
Laos	1 1.7%
Lebanon	1 1.7%
Malawi	1 1.7%
Morocco	2 3.4%
Nigeria	3 5.2%
Peru	1 1.7%
Rwanda	1 1.7%
Senegal	2 3.4%
Sierra Leone	3 5.2%
Sri LAnka	1 1.7%
Tanzania	13 22.4%
Uganda	4 6.9%
Vietnam	1 1.7%

2. Primary Outcome

Title	Q8: Name of the Place and Hospital Where the Last Mission Took Place
Description	List with names of the places and hospitals where the last mission took place
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Paul VI, Ouaga	1 1.7%
Sekou Toure Regional Referral hospital	1 1.7%
Harapan, pematang Siantar, Sumatera Bissau Hospita	1 1.7%
Haydom Lutheran Hospital, Haydom	9 15.5%
St Josephs, Kitgum	1 1.7%
Comprehensive Health Centre, totoro Abeokuta.	1 1.7%
Sengerema hospital, sengerema	3 5.2%
Masanga Hospital	3 5.2%
Pius VI, Ouagadougou	1 1.7%
St Francis hospital Mutolere	1 1.7%
Pemantang siantar, rumah sakit harapan	1 1.7%
Virgen de la puerta	1 1.7%
Gatagara	1 1.7%
Rach Gia	1 1.7%
Yekatit 12 hospital, Addis Ababa	1 1.7%
Guercif, Morocco;	1 1.7%
Munshiganj, Bangladesh	1 1.7%
Ambroseli Hospital Kalongo	2 3.4%
Conakry, Port. Mercy Ships	1 1.7%
Mahossot Hospiatl Vientiane	1 1.7%
Vavuniya General Hospital	1 1.7%
Guayaquil	1 1.7%
Bekhazi Medical Center, Beirut	1 1.7%
Bissau teaching hospital	1 1.7%
Conakry	5 8.6%
Malamulo Hospital	1 1.7%
Dhaka Medical College Hospital, Dhaka	1 1.7%
Yekatit 12	1 1.7%
CSC, Phnom Penh	1 1.7%
Africa Mercy	1 1.7%
Mercships	1 1.7%
Hopital National Donka, Conakry	1 1.7%
Africa Mercy, Conakry	1 1.7%
Exeter	1 1.7%
Mangu Hospital, Mangu Plateau state	1 1.7%
Cocin, Mangu	1 1.7%
University Hospital Basel, Switzerland	1 1.7%
Yekatit 12 Hospital, Addis Ababa	1 1.7%
Shifa Hospital, Gaza City	1 1.7%
MSF burn hospital in Port-au-Prince, Haiti	1 1.7%

3. Primary Outcome

Title	Q9: Number of Participants Per Organization
Description	Name of the organization that supported the last mission of the participant
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Bridge the Gap Foundation	1 1.7%
B-first	1 1.7%
Doctors of the World	11 19%
Global Smile Foundation	3 5.2%
Harapan Jaya	2 3.4%
Ka Dounia Dia	2 3.4%
MAP	1 1.7%
Mercy Ships	12 20.7%
Mission Restore	1 1.7%
MSF	1 1.7%
Njokuti	3 5.2%
Operation Hernia	1 1.7%
Orthopaedic Outreach	1 1.7%
Pan-African Academy of Christian Surgeons	1 1.7%
Project Harar	2 3.4%
Resurge	1 1.7%
Interplast Holland	6 10.3%
Simba Health	2 3.4%
Stichting 'Op Gelijke Voet'	1 1.7%
Trinitas Health Care Partners	1 1.7%
Mission without a supporting NGO	4 6.9%

4. Primary Outcome

Title	Q10: Countries Where the NGOs Are Based
Description	List of countries where the supporting NGOs of the last mission are based
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Netherlands	29 50%
USA	17 29.3%
No supporting NGO	4 6.9%
UK	4 6.9%
Australia	1 1.7%
France	1 1.7%
Nigeria	1 1.7%
Sierra Leone	1 1.7%

5. Primary Outcome

Title	Q11: Importance of Potential Activities
Description	Points provided (1-4) for four potential activities of a visiting team (more points = more important activity) The points provided by all participants are summed per specific activity and the total scores are compared The four potential activities are: Treat patients yourself Provide surgical equipment and consumables for the local team Provide free treatment Facilitate teaching of local staff Scale with importance of potential activities. Maximum score: 4x58 = 232
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Treat patients yourself	157
Provide surgical equipment and consumables for the	153
Provide free treatment	175
Facilitate teaching of local staff	210

6. Primary Outcome

Title	Q12: Activities That Where Missing in Question 11.
Description	Respondents that were missing this activity as an option in question 11 Total number of respondents that were missing an activity: 29 Activities that were missing: Financial collaboration Advocacy Academic collaboration Sustainability Collaboration with local staff Follow-up
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

Question 12 was asked to all participants but only 29 stated that an activity was missing in question 11

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	29
Financial collaboration	1 1.7%
Advocacy	2 3.4%
Academic collaboration	4 6.9%
Sustainability	5 8.6%
Collaboration with local staff	8 13.8%
Follow up	9 15.5%

7. Primary Outcome

Title	Q13. Medical Registration is Required in the Host Country
Description	Medical registration in the host country is required for specialists performing short-term reconstructive missions Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Strongly agree	28 48.3%
Agree	16 27.6%
Neither agree nor disagree	7 12.1%
Disagree	7 12.1%
Strongly disagree	0 0%

8. Primary Outcome

Title	Q14: The Process of Obtaining Medical Registration Was Straightforward
Description	The Process of Obtaining Medical Registration Was Straightforward Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Strongly agree	8 13.8%
Agree	19 32.8%
Neither agree nor disagree	16 27.6%
Disagree	10 17.2%
Strongly disagree	5 8.6%

9. Primary Outcome

Title	Q15: Collaboration
Description	What can you say about the collaboration between authorities in LMICs and visiting surgical teams? Participants of the survey were asked to choose one of the following answers on this question: collaboration is present but improvement is needed there is no collaboration and it should be developed as a priority collaboration has no benefits nor disadvantages collaboration will likely be more harmful than beneficial for the mission
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
collaboration is present but improvement is neede	39 67.2%
there is no collaboration and it should be develop	16 27.6%
collaboration has no benefits nor disadvantages	3 5.2%
-collaboration has no benefits nor disadvantages	1 1.7%

10. Primary Outcome

Title	Q16. What Should Have a Higher Priority in the Hospital of Your Last Mission?
Description	What should have a higher priority in the hospital of your last mission ? Respondents were asked to choose on the these two answers: Teaching in anesthesia care or teaching in surgical care
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

5 respondents did't make a choice In the comments section 9 respondents declared that preferable both should be equally addressed

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	53
Surgical care	31 53.4%
Anaesthesia care	22 37.9%

11. Primary Outcome

Title	Q17. A Structured Follow-up Strategy is Required
Description	A structured follow-up strategy (>6 months) of patients is required for short-term reconstructive surgical missions. Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Strongly agree	37 63.8%
Agree	17 29.3%
Neither agree nor disagree	4 6.9%
Disagree	0 0%
Strongly disagree	0 0%

12. Primary Outcome

Title	Q18. One Month After the Mission, an Official Report is Recommended
Description	One month after the mission, an official report on the outcome including all complications encountered is recommended for all missions. Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Strongly agree	39 67.2%
Agree	16 27.6%
Neither agree nor disagree	2 3.4%
Disagree	1 1.7%
Strongly disagree	0 0%

13. Primary Outcome

Title	Q19. A Written Long-term Strategy is Recommended at the Start of a New Project.
Description	A written long-term strategy (>5 years) with clear goals, developed by the visiting team and the local actors together, is recommended at the start of a new project. Participants of the survey were asked what they think of this statement: Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Strongly agree	37 63.8%
Agree	17 29.3%
Neither agree nor disagree	4 6.9%
Disagree	0 0%
Strongly disagree	0 0%

14. Primary Outcome

Title	Q20. Suggestions to Improve the Impact of Short Term Reconstructive Missions.
Description	What would you suggest to improve the impact of short term reconstructive missions? The answers were categorized and the three most mentioned categories are: Teaching of local staff Follow-up Building sustainable partnerships The three activities were mentioned in total 68 times in the comments The distribution among the three categories is shown below
Time Frame	approximately 20 minutes

Outcome Measure Data

Analysis Population Description

the 58 participants mentioned the top three activities 68 times

Arm/Group Title	All Included Participants of the Study
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
Measure Participants	58
Teaching of local staff	24
Follow-up	10
Building sustainable partnerships	34

Adverse Events

Time Frame	5 months
Adverse Event Reporting Description	Adverse Events data was not collected. Because this study is a survey, there is no intervention group
Arm/Group Title	Experts
Arm/Group Description	Included were English speaking experienced members of foreign teams and local team members from LMIC, that did participate in at least one short-term surgical mission in a hospital in a LMIC.
All Cause Mortality
	Experts
	Affected / at Risk (%)	# Events
Total	0/0 (NaN)
Serious Adverse Events
	Experts
	Affected / at Risk (%)	# Events
Total	0/0 (NaN)
Other (Not Including Serious) Adverse Events
	Experts
	Affected / at Risk (%)	# Events
Total	0/0 (NaN)

Limitations/Caveats

An important limitation of this study is that most of the respondents are medical doctors from HICs. Another possible 'selection bias' that could have occurred concerns (over-) representation of experts from the Netherlands.

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.