Collecting data for global surgical indicators: a collaborative approach in the Pacific Region.

In 2015, the Lancet Commission on Global Surgery (LCoGS) recommended six surgical metrics to enable countries to measure their surgical and anaesthesia care delivery. These indicators have subsequently been accepted by the World Bank for inclusion in the World Development Indicators. With support from the Royal Australasian College of Surgeons and the Pacific Islands Surgical Association, 14 South Pacific countries collaborated to collect the first four of six LCoGS indicators. Thirteen countries collected all four indicators over a 6-month period from October 2015 to April 2016. Australia and New Zealand exceeded the recommended LCoGS target for all four indicators. Only 5 of 13 countries (38%) achieved 2-hour access for at least 80% of their population, with a range of 20% (Papua New Guinea and Solomon Islands) to over 65% (Fiji and Samoa). Five of 13 (38%) countries met the target surgical volume of 5000 procedures per 100 000 population, with six performing less than 1600. Four of 14 (29%) countries had at least 20 surgical, anaesthesia and obstetric providers in their workforce per 100 000 population, with a range of 0.9 (Timor Leste) to 18.5 (Tuvalu). Perioperative mortality rate was reported by 13 of 14 countries, and ranged from 0.11% to 1.0%. We believe it is feasible to collect global surgery indicators across the South Pacific, a diverse geographical region encompassing high-income and low-income countries. Such metrics will allow direct comparison between similar nations, but more importantly provide baseline data that providers and politicians can use in advocacy national health planning.

Wound management in disaster settings.

BACKGROUND: Few guidelines exist for the initial management of wounds in disaster settings. As wounds sustained are often contaminated, there is a high risk of further complications from infection, both local and systemic. Healthcare workers with little to no surgical training often provide early wound care, and where resources and facilities are also often limited, and clear appropriate guidance is needed for early wound management. METHODS: We undertook a systematic review focusing on the nature of wounds in disaster situations, and the outcomes of wound management in recent disasters. We then presented the findings to an international consensus panel with a view to formulating a guideline for the initial management of wounds by first responders and subsequent healthcare personnel as they deploy. RESULTS: We included 62 studies in the review that described wound care challenges in a diverse range of disasters, and reported high rates of wound infection with multiple causative organisms. The panel defined a guideline in which the emphasis is on not closing wounds primarily but rather directing efforts toward cleaning, debridement, and dressing wounds in preparation for delayed primary closure, or further exploration and management by skilled surgeons. CONCLUSION: Good wound care in disaster settings, as outlined in this article, can be achieved with relatively simple measures, and have important mortality and morbidity benefits.

Evaluation of the medium-term outcomes and impact of the Rowan Nicks Scholarship Programme.

BACKGROUND: Rowan Nicks was a cardiothoracic surgeon in Sydney. He endowed the Rowan Nicks Scholarship Programme of the Royal Australasian College of Surgeons, which was initiated in 1991 to provide opportunities for clinicians from developing countries so that they return to their countries as leaders and teachers. This paper's objective was to evaluate the outcomes and impact of the scholarship on individuals and their communities. METHODS: A survey was undertaken of 34 eligible scholars of whom 29 participated. It was directed at whether objectives were achieved in technical skills, patient management and in competency in research and leadership. RESULTS: Ninety-eight per cent of scholars returned to work in their home country. Twenty-eight of 29 were working in their chosen specialty and had returned to their former positions. The clinical/operative skills obtained were regarded as useful by 86%, and 22/29 (76%) scholars reported they had gained worthwhile leadership and administrative skills. Improved clinical outcomes for patients were achieved as evidenced by reduced mortality and less disability. There was also a positive impact on health systems. The best documented of these were improved trauma management, development of paediatric surgery in rural Bangladesh, a new cardiac unit in Myanmar, organ transplantation and better injury outcomes in Papua New Guinea. CONCLUSION: The programme has resulted in potential and actual leaders returning to their home countries where they positively impacted on health and surgical services. This has resulted in a reduced burden of surgical disease in the scholars' countries as measured by less death, disability and deformity.