Person:

Hagander, Lars

Global cleft surgery missions have provided much-needed care to millions of poor patients worldwide. Still, surgical capacity in low- and middle-income countries is generally inadequate. Through surgical missions, global cleft care has largely ascribed to a vertical model of healthcare delivery, which is disease specific, and tends to deliver services parallel to, but not necessarily within, the local healthcare system. The vertical model has been used to address infectious diseases as well as humanitarian emergencies. By contrast, a horizontal model for healthcare delivery tends to focus on long-term investments in public health infrastructure and human capital and has less often been implemented by humanitarian groups for a variety of reasons. As surgical care is an integral component of basic healthcare, the plastic surgery community must challenge itself to address the burden of specific disease entities, such as cleft lip and palate, in a way that sustainably expands and enriches global surgical care as a whole. In this paper, we describe a diagonal care delivery model, whereby cleft missions can enrich surgical capacity through integration into sustainable, local care delivery systems. Furthermore, we examine the applications of diagonal development to cleft care specifically and global surgical care more broadly.

Little is known about pediatric surgical disease in resource-poor countries. This study documents the surgical care of children in central Haiti and demonstrates the influence of the 2010 earthquake on pediatric surgical delivery. Methods. We conducted a retrospective review of operations performed at Partners in Health/Zanmi Lasante hospitals in central Haiti. Results. Of 2,057 operations performed prior to the earthquake, 423 were pediatric (20.6%). Congenital anomalies were the most common operative indication (159/423 opera- tions; 33.5%). Pediatric surgical volume increased signi cantly a er the earthquake, with524 Pediatric surgical care in Haiti 670 operations performed (23.0% post-earthquake v. 20.6% pre-earthquake, p5.03). Trauma and burns became the most common surgical diagnoses a er the disaster, and operations for non-traumatic conditions decreased signi cantly (p,.01). Conclusion. Congenital anomalies represent a signi cant proportion of baseline surgical need in Haiti. A natural disaster can change the nature of pediatric surgical practice by signi cantly increasing demand for operative trauma care for months afterward.