Scaling Surgical Resources: A Capacity Analysis of C-arm Machines in Haiti Following the 2021 Earthquake.

BACKGROUND: In 2021, a 7.2 magnitude earthquake struck Haiti resulting in a surge of orthopaedic trauma requiring immediate surgical treatment. Safe and efficient operative management of orthopaedic trauma injuries requires intraoperative fluoroscopy through C-arm machines. The Haitian Health Network (HHN) received a philanthropic donation of three C-arm machines and considered an analytical tool may guide efficacious placement of those machines. The study objective was to develop and apply a clinical needs and hospital readiness measuring tool relevant to C-arm machines, which may guide decision-makers, such as HHN, in response to an emergency situation with a surge in need for orthopaedic treatment. METHODS: An online survey to assess surgical volume and capacity was created and then completed by a senior surgeon or hospital administrator based at hospitals within the HHN. Multiple-choice and free-text answer data were collected and classified into five categories: staff, space, stuff, systems, and surgical capacity. Each hospital received a final score out of 100, calculated by equal weighting of each category. RESULTS: Ten out of twelve hospitals completed the survey. The average weighted score for the staff category was 10.2 (SD 5.12), the space category was 13.1 (SD 4.09), the stuff category was 15.6 (SD 2.56), the systems category was 12.25 (SD 6.50), and the surgical capacity category was 9.5 (SD 6.47). The average final hospital scores ranged from 29.5 to 83.0. CONCLUSION: This analysis tool provided data as to the clinical demand and capabilities of hospitals within the HHN to receive a C-arm machine and reaffirmed the critical need for more C-arms in Haiti. This methodology may be utilised by other health systems to provide data to distribute orthopaedic trauma equipment, which would benefit communities during periods of surge capacity, such as natural disasters.

Medical disaster response: A critical analysis of the 2010 Haiti earthquake.

Introduction: On January 12, 2010, a 7.0 magnitude earthquake struck the Republic of Haiti. The human cost was enormous-an estimated 316,000 people were killed, and a further 300,000 were injured. The scope of the disaster was matched by the scope of the response, which remains the largest multinational humanitarian response to date. An extensive scoping review of the relevant literature was undertaken, to identify studies that discussed the civilian and military disaster relief efforts. The aim was to highlight the key-lessons learned, that can be applied to future disaster response practise. Methods: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidance was followed. Seven scientific databases were searched, using consistent search terms-followed by an analysis of the existent Haitian literature. This process was supplemented by reviewing available grey literature. A total of 2,671 articles were reviewed, 106 of which were included in the study. In-depth analysis was structured, by aligning data to 12 key-domains, whilst also considering cross-sector interaction (Civilian-Civilian, Military-Military, and Civilian-Military). Dominant themes and lessons learned were identified and recorded in an online spreadsheet by an international research team. This study focuses on explicitly analysing the medical aspects of the humanitarian response. Results: An unpreceded collaborative effort between non-governmental organisations, international militaries, and local stakeholders, led to a substantial number of disaster victims receiving life and limb-saving care. However, the response was not faultless. Relief efforts were complicated by large influxes of inexperienced actors, inadequate preliminary needs assessments, a lack of pre-existing policy regarding conduct and inter-agency collaboration, and limited consideration of post-disaster redevelopment during initial planning. Furthermore, one critical theme that bridged all aspects of the disaster response, was the failure of the international community to ensure Haitian involvement. Conclusions: No modern disaster has yet been as devastating as the 2010 Haiti earthquake. Given the ongoing climate crisis, as well as the risks posed by armed conflict-this will not remain the case indefinitely. This systematic analysis of the combined civilian and military disaster response, offers vital evidence for informing future medical relief efforts-and provides considerable opportunity to advance knowledge pertaining to disaster response.

Conference equity in global health: a systematic review of factors impacting LMIC representation at global health conferences.

INTRODUCTION: Global health conferences are important platforms for knowledge exchange, decision-making and personal and professional growth for attendees. Neocolonial patterns in global health at large and recent opinion reports indicate that stakeholders from low- and middle-income countries (LMICs) may be under-represented at such conferences. This study aims to describe the factors that impact LMIC representation at global health conferences. METHODS: A systematic review of articles reporting factors determining global health conference attendance was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles presenting conference demographics and data on the barriers and/or facilitators to attendance were included. Articles were screened at title and abstract level by four independent reviewers. Eligible articles were read in full text, analysed and evaluated with a risk of bias assessment. RESULTS: Among 8765 articles screened, 46 articles met inclusion criteria. Thematic analysis yielded two themes: 'barriers to conference attendance' and 'facilitators to conference attendance'. In total, 112 conferences with 254 601 attendees were described, of which 4% of the conferences were hosted in low-income countries. Of the 98 302 conference attendees, for whom affiliation was disclosed, 38 167 (39%) were from LMICs. CONCLUSION: 'Conference inequity' is common in global health, with LMIC attendees under-represented at global health conferences. LMIC attendance is limited by systemic barriers including high travel costs, visa restrictions and lower acceptance rates for research presentations. This may be mitigated by relocating conferences to visa-friendly countries, providing travel scholarships and developing mentorship programmes to enable LMIC researchers to participate in global conferences.