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Sustainability of a Successful Surgical Outreach Program: A Reflection on Good Fiscal Planning and the Global Goals

  • April 15, 2016
  • Medical Outreach Exchange, Orthopaedic, Nonprofit Organization or Foundation, Sustainability

Jeff Gelfand, MD

Jeff Gelfand, MD is an orthopaedic trained hand surgeon practicing in Annapolis, Md. He is the founder and president of The Helping Hands Foundation.

As capable as any visiting surgical team might be, the long term success and sustainability of any outreach program is dependent on the fiscal health of the partnering hospital. The future is looking good for collaboration through partnerships.

Good fiscal planning is one aspect of ensuring medical outreach trips are sustainable. A greater movement to support this effort and improve the health of those around the world includes three main commitments by world leaders for the next 15 years.  People all over the world are spreading the word about the 17 goals that could help accomplish these plans: the global goals for sustainable development. Each goal highlights an aspect of human life worldwide that needs improvement to ensure poverty and inequality are ended while also fixing climate change. In addition to showing their support for a specific goal through words and photos, many people have been trying to act on their goal as well.

The Touching Hands Project (THP) is proud to be among those who act on the supported goal: Good Health and Well-being. One of the targets for this goal is to substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and Small Island Developing States.  Volunteers on THP missions share their expertise with those in underserved areas who need hand and upper extremity care.

Teaching opportunities to local hospital staff allow the team to be able to influence lives even when they’re not there. These evaluations, treatments and surgeries as a collaboration from both THP and the local physicians help improve the quality of life for the patients and their families. More than 250 patients have already been evaluated through THP, and the team looks forward to continuing to serve the worldwide community and supporting the third global goal through ongoing volunteer medical trips.

The above stated goals are noble, ambitious and, I would imagine, sound very familiar to the goals of most NGOs involved with medical outreach in the developing world. Unfortunately, a lot of outreach efforts struggle with making an impact beyond the short period of time that the visiting team is present in the developing country. While, this certainly touches and improves individual lives, I am sure those involved with this sort of work look to have a far greater impact that reaches beyond the short time most medical missions are actually “on the ground”. Greater impact is achievable through effective partnerships between the “visiting teams” and the local medical personnel who carry the torch the remainder of the time. These partnerships must involve commitment, engagement and economic resources to support the efforts on both sides.

This past October I traveled with a team to The Hospital d’ Adventiste in Carrefour, Haiti just outside of Port Au Prince.  The trip represented a collaboration between The American Society for Surgery of the Hand’s  Touching Hands Project, The Helping Hands Foundation, and The Hospital  d’ Adventiste. The visiting team was comprised of two practicing hand surgeons, one hand surgery fellow, two anesthesiologists, a certified hand therapist, three nurses and an industry sponsored support person. We were a highly subspecialized team ready to handle just about any condition related to the upper extremity.

Our Haitian partners included an American trained surgeon who had just completed his general surgery residency and moved to Haiti with his wife and small child. He arrived five weeks before us to begin a five year volunteer commitment as the Medical Director of Hospital d’ Adventiste. There was a full time native Haitian orthopaedic surgeon who we worked directly with during our trip.  The hospital had just completed an OR renovation project which resulted in three well equipped, very functional, comfortable ORs. They also had recently upgraded an entire floor of patient rooms to be private rooms with air conditioning and showers, clearly a significant departure from the crowded “open wards” typically encountered in the developing world.

The Hospital d’ Adventiste has the good fortune to be affiliated with Loma Linda University which enabled the funding for these infrastructure improvements and provides salary support for some key administrative people. With these improvements, the Hospital plans to offer up the hospital ORs, as well as these private “luxury” rooms at a fee. The fee is determined by using a sliding scale based on what a private, paying patient can afford. The hospital continues to care for those without significant financial resources but this planned, “two tiered system” has the potential to generate revenue that will subsidize their other charitable work.

Today’s rapidly changing global health care environment is rife with opportunities for innovative care delivery models and the developing world is no different.