The Center for Surgical Health: A Compassion-Driven Urban Surgical Mission

We are the Center for Surgical Health (CSH), an academic community partnership that supports, educates, and advocates for vulnerable Philadelphians with surgical diseases, founded in 2016 by Dr. Jon B. Morris, a leader in surgical education and a general surgeon at the University of Pennsylvania, and Dr. Alan Herbst, a current third-year Penn general surgery resident. At the time, Dr. Morris, raised in a Reform Jewish household, had been participating in an RCIA Program to convert to Catholicism. The mission of providing surgery to uninsured patients, primarily undocumented individuals, by helping them obtain insurance and see Penn providers was seen by Dr. Morris as a form of Catholic charity, which he has continued to remain dedicated to as his faith in Jesus Christ has deepened. Dr. Herbst, now Associate Director of Clinics for the CSH, recalls working with Dr. Morris as a sub-intern during his conversion, beginning with passion and a neon poster board inviting people to “See the Surgeon.” Since that time, the CSH has grown from an organization with 10 volunteers, called “personal patient navigators,” who provide insurance support and advocacy at every step of the perioperative continuum, to one with over 50, who have now seen 156 patients and assisted in providing 49 needed procedures. Much of this growth has been brought about through the dedication and vision of Dr. Matthew Goldshore, the Deputy Director of the CSH and a fifth-year Penn general surgery resident, as well as Dr. Carrie Z. Morales, Associate Deputy Director of the CSH and a recent Perelman School of Medicine graduate. Through their leadership, and the talent and commitment of other members of the CSH board, overseen by Director Dr. Morris, the CSH now has policy and research divisions, a surgical equity curriculum, and continues to develop new ways of providing better care.

Ethical Considerations for Surgical Planners from the Lessons Learned on USNS COMFORT (T-AH 20) Deployment 2019

Ethical issues can arise when planning for direct patient care surgical missions. Based on the lessons learned from the USNS COMFORT Deployment 2019, the authors present concise considerations and recommendations for future hospital ship surgical mission planning.

The Tale of the Unrepaired Cleft—Retrospective Evaluation of Cases Encountered by an Indigenous Mission in a Northern Nigerian Community

Objective: This study aims to document the experience of an indigenous surgical mission on the occurrence of unrepaired cleft in 2 visits to Minna, North-Central Nigeria. Design: This retrospective study involved participants with orofacial cleft anomaly at 2 surgical outreaches held in Minna in 2011 and 2017. Baseline data were initially obtained from case files of patients at both programs. Data collected were analyzed employing appropriate statistical tests for continuous and categorical variables. Setting: Two outreach programs in Minna, North-Central Nigeria by Cleft and Facial Deformity Foundation in 2011 and 2017. Results: A total of 117 participants with cleft anomaly were encountered at both surgical outreach programs. The sample prevalence of unrepaired cleft was 61.5% with an overall mean age (standard deviation) of 10 (13.2) years. Most participants presented with unilateral complete cleft lip (70.8%) which was more common on the left side and had no family history of orofacial cleft (54.2%). Information on the surgical program was mostly obtained via friends and relatives in 32.6% and lack of wherewithal to offset the expense of cleft surgery and supportive treatment represented the most common reason for the delay of surgical repair (50%). Conclusion: We found a high proportion of patients with unrepaired cleft in our sample which may mirror happenings in other developing world centers. We advocate continued collaborations between indigenous missions and international funding agencies to further encourage continued repair of unrepaired cleft in developing centers.

The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya

Category: Other Introduction/Purpose: Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips. Methods: A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology. Results: When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75. Conclusion: The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.

Short-Term Surgical Missions: Role of Pharmacist Volunteers

Health care professionals often participate in short-term surgical missions in underserved areas of the world. Surgical missions often rely on the use of medications to provide health care to these underserved areas in patients with multiple comorbid conditions. The direct role a pharmacist may have in surgical missions is not well described in the literature; however, numerous opportunities exist for pharmacist involvement to improve patient care and operational processes throughout medication planning and delivery of surgical missions. Pharmacists have specialized knowledge in medication acquisition, preparation, and distribution that result in a unique position to contribute positively to the mission’s clinical and operational dynamics. Pharmacists may assist in various activities such as medication ordering, accrual, purchasing and preparing during the surgical mission. Pharmacists may also provide clinical support and offer alternative medications in the setting of drug intolerance or allergies. In 2008, Operation Walk Boston, a short-term surgical mission was established to provide hip and knee joint replacements to patients in the Dominican Republic. Pharmacists and pharmacy residents play a crucial role as members of this surgical mission. Based on our experience, this article aims to describe the evolving role of pharmacists as a member of a surgical mission.