The Development of a Surgical Mission in the Peruvian Amazon: A 15-Year Expedition.

Musculoskeletal disorders and injuries represent a substantial proportion of the global burden of disease. This burden is particularly prevalent in low and middle-income countries that already have insufficient health-care resources. The purpose of this paper is to highlight the vision, the history, the implementation, and the challenges in establishing an orthopaedic surgical mission in a developing nation to help address the epidemic of musculoskeletal trauma.Scalpel At The Cross (SATC) is a nonprofit Christian orthopaedic surgical mission organization that sends teams of 10 to 20 members to Pucallpa, Peru, a rural town in the Amazon, to evaluate patients with musculoskeletal conditions, many that require surgery. The organization employs 4 full-time staff members and has included over 400 medical volunteers in 32 surgical campaigns since 2005. SATC has provided approximately 8.1 million U.S. dollars in total medical care, while investing approximately 2.2 million U.S. dollars in implementation and overhead.Given the projected increase in trauma in low and middle-income countries, the SATC model may be increasingly relevant as a possible blueprint for other medical professionals to take on similar endeavors. This paper also highlights the importance of continued research into the effectiveness of various organizational models to advance surgical services in these countries.

A Patient Follow-up Program for Short-Term Surgical Mission Trips to a Developing Country.

BACKGROUND: We describe a follow-up program for patients undergoing surgical procedures with documented results from short-term surgical mission trips to the developing world. The surgical procedures were all performed at a government hospital in Pucallpa, Peru, a remote city in the Amazon. METHODS: Between July 2007 and January 2012, ten surgical mission trips were completed with a mean time of six days on location and a mean number of 2.3 surgeons (range, two to five surgeons) per trip. A Peruvian general surgeon conducted postoperative visits at time intervals of two to four weeks, five to sixteen weeks, four to seven months, and eight to twelve months. Each visit included the completion of a patient outcome form, radiographs, and functional range-of-motion photographs. Patient demographic characteristics; type of surgical procedure; completed follow-up; complications including infection, malunion, or nonunion; and clinical results were analyzed. RESULTS: Of the 127 patients eligible for analysis, twenty-three patients were lost to follow-up, leaving a follow-up rate of 81.9% (104 of 127 patients). Patients were predominantly male (63.5%) and had a mean age of 37.0 years (range, ten months to 93.4 years). The mean length of follow-up was 11.8 months, with a mean number of 3.7 postoperative encounters. Orthopaedic trauma fixation was the predominant surgical procedure (57%), with forty-two procedures (40%) being open reduction and internal fixation. In the 104 patients, successful wound-healing occurred in 101 (97%) and 100 (96%) had a functional outcome deemed to be good or fair by the in-country physician. The infection rate was 2.9% (three patients), with 97% (fifty-seven of fifty-nine) of fractures united. There was one nerve injury in a pediatric patient treated for supracondylar humeral malunion, and two cases of prominent implant necessitating removal. The mean direct cost of the follow-up program was $20,041 in U.S. dollars per year. CONCLUSIONS: It is possible to develop a sustainable surgical patient follow-up program with robust results and to achieve acceptable outcomes for orthopaedic conditions, even in an austere medical environment.