A model for delivering subspecialty pediatric surgical care in low- and middle-income countries: one organization's early experience

Delivery of humanitarian global surgical aid to low-middle income countries (LMICs) often occurs as a "fly-in, fly-out" marathon of operations. Unfortunately, the sustainability and efficacy of these missions remain questionable because they are difficult to reproduce and they have limited ability to provide peri-operative care. The goal of this project was to describe the Moore Pediatric Surgery Center (MPSC) in Guatemala City as an alternative model that provides a centralized structure to the interaction between surgical providers and patients in the operative and peri-operative periods. We also describe the Center's patient population and present feedback from surgical teams visiting the MPSC. A retrospective chart review was performed to quantify the number of patients, procedures, and post-operative complications at the MPSC between January 2011 and December 2014. We also performed a cross-sectional sociodemographic survey of MPSC patients and conducted a satisfaction survey of patients and surgical team members visiting the Center. Since 2011, the MPSC has hosted 42 surgical teams representing 7 different specialties. During its first four years, the surgery center hospital performed 2260 operations with a 1.07 % peri-operative complication rate and 0 % peri-operative mortality rate. All surgeries were performed free-of-charge to children from low-income households. Furthermore, the MPSC was rated highly among visiting team members (range 4.5-6 on a 7-point Likert scale) for quality metrics including organization, physical space, and collaboration with local staff. The MPSC represents a model for delivering multi-specialty surgical aid in low-and middle-income countries by providing modern surgical facilities with quality-assured post-operative care for the treatment of childhood surgical diseases.