Health Systems Evaluation
A cross-sectional analysis of the surgical capacity at different levels of health care facilities in Cameroon was performed. These results were used to define areas of strength and challenge in the current capacity to deliver surgical care.
Since 2008, Dr. Catherine Juillard has worked in collaboration with the Ministry of Public Health in Yaounde, Cameroon on injury surveillance and health system evaluation. A pilot study in 2008-2009 performed in collaboration with the Ministry under the leadership of Dr. Georges Alain Etoundi Mballa, Dr. Martin Ekeke Monono, and Dr. Marquise Kouo Ngamby helped demonstrate the potential burden of trauma on the health system in Yaounde, Cameroon’s capital city. Currently, a multi-site trauma registry is being developed to build on this groundwork and create the foundation for a National Trauma Registry in Cameroon, which will aim to provide ongoing injury surveillance to inform injury prevention policy at the national and local levels, as well as data for individual hospital trauma quality improvement programs.
Data Analyses Investigating Patterns of Injury in Mumbai
The Center for Global Surgical Sciences has an ongoing collaboration with Lokmanya Tilak Municipal Hospital under the leadership of Nobhojit Roy, MBSS, MS, MPH (bio below). Data collection on seriously injured trauma patients has been ongoing since 2010. Dr. Roy’s team has collaborated with the Center for Global Surgical Sciences to develop data analyses investigating patterns of injury in Mumbai using this data, as well as evaluating the appropriateness of different trauma scoring systems in this context. Future projects aim to include multiple site trauma registry data analysis to further understand the characteristics of injury and trauma treatment patterns in different areas of India. Ultimately, we hope to identify opportunities for injury prevention and improvement in the care of trauma patients using this system.
With our colleagues from Ghana and Tanzania, we created and updated a method to estimate inguinal hernia epidemiology, including prevalence and incidence, in low-resource settings. At current hernia repair rates in Tanzania, a backlog of nearly 1 million hernias for repaired will develop in the next ten years. This work has sparked Jessica’s participation in the Essential Surgery volume of the Disease Control Priorities in Developing Countries, 3rd Edition, for which she was the lead author on the chapter, “Hernia and hydrocele.” Jessica also has collaborated with Dr. Michael Ohene-Yeboah of Kwame Nkrumah University in Kumasi, Ghana on a community based survey of inguinal hernia prevalence in rural Ghana.
Low Cost Laparoscopic Box Project
The surgery department at MUHAS has usable laparoscopic equipment but few surgeons have been trained in laparoscopy. The MUHAS surgeons asked UCSF to collaborate in a laparoscopic skills course. The course was a 3-month guided practice experience for residents and surgeons at Muhimbili using a low cost, locally made laparoscopic trainer box developed at UCSF. All participants who completed the training scored highly on the post-test and were satisfied with the course.
Surgical Task-shifting in Tanzania
This study was a retrospective records review of major surgical procedures (MSPs) performed in 2012 conducted at seven hospitals in Pwani Region, Tanzania. We found that about a third of all MSPs were non-obstetric. Non-physician clinicians (NPCs) performed the majority of MSPs, and there were no significant differences between outcomes after MSPs performed by NPCs and physicians. This study was done in conjunction with our partners at MUHAS in Dar es Salaam, Tanzania. We interviewed practitioners of surgical care in all the hospitals on their training and educational needs and are analyzing this data currently.
Surgical Burden at a Regional Referral Hospital in Northern Uganda
Significant attention has been focused on district hospitals in low-income countries, however, little is known of the volume of surgical disease and the capacity of the regional referral hospitals that serve these districts. We are currently evaluating surveillance records from a regional referral hospital in northern Uganda to characterize the burden of surgical disease and evaluate the system of surveillance currently in place.
A Study of Patterns of Injury at Three District Hospitals in Central Uganda
Musculoskeletal injuries represent a significant proportion of injuries seen in low and middle-income countries. The true incidence and characteristics of these injuries, however, is unknown. In an effort to understand more about patterns of injury, demographics, and management, an observational study was conducted in three district hospitals in central Uganda. The primary investigator of this study is Dr. Dan Kisitu, an Orthopedic House Officer at the time. Dr. Rochelle Dicker was Dr. Kisitu’s external advisor for this thesis project.
Kampala Advanced Trauma Course Development & Assessment
Standard trauma training successfully taught and implemented in high income countries, often has limited utility in LMICs due to resource limitations. We have partnered with colleagues at Global Partners in Anesthesia and Surgery (GPAS), to design context specific courses in trauma training with partners on the ground in Uganda. Working together, we are creating courses that are both content rich and context appropriate in order to train providers to deliver essential care to the injured person. We are designing methods to test utility, feasibility, and impact of our courses.