While Christian medical missionaries and mission hospitals in Africa have proven very effective, support from their traditional sources has been waning. These Christian missionary physicians commit their entire careers towards treating patients, training African colleagues, creating systems and building institutions in very difficult conditions throughout sub-Saharan Africa. They routinely do what their colleagues in the United States regard as impossible when they learn about it. We believe that they provide an excellent foundation to build upon and warrant more support and investment. AMH provides them with much-needed resources, enabling these missionary physicians, their African colleagues, and the mission hospitals they serve, to provide quality and compassionate care for the African poor.
Preoperative evaluation of surgical mission patients is a complex, time-consuming, and often chaotic process. Typically, these evaluations require intense work by the operating team on the day of arrival at the mission site. On-site screening, unfortunately, precludes many patients from receiving surgical treatment due to the identification of last-minute medical issues, such as comorbidities or the lack of necessary test results. Many of these patients wait for years to obtain surgical care only to be told they are inappropriate candidates for the surgical care that will be provided through the mission. It is unclear how many patients are disqualified from participation during on-site screening worldwide for any of the aforementioned reasons, but it is likely that the number is considerable.
For the last seven years, the Association of Filipino Physicians of Southern Illinois has organized a team of surgeons, anesthesiologists, nurses, and other health care professionals to deliver surgical care in Tagbilaran, the capital city of the island province of Bohol in the Philippines. Since 2012, this mission has been called Bohol Operation Giving Back. From year to year, with some exceptions, the all-volunteer surgical team comprises general surgeons with different subspecialty interests, otolaryngology surgeons, plastic surgeons, obstetrics-gynecology surgeons, anesthesiologists, certified registered nurse anesthetists, and/or other health care practitioners. During these annual one-week surgical missions, the team has performed an array of general surgery operations, including thyroidectomies for advanced goiters and thyroid cancer, hernia repairs, hysterectomies, oophorectomies, and other operations.
To assess the applicability of telemedicine in advance of short-term surgical missions, our team conducted a study comparing the use of store-and-forward telemedicine (SAFT) with in-person, on-site preoperative evaluations of surgical mission patients. The institutional review board (IRB) at the University of Arizona, Tucson, approved this study.
One of the mission surgeons, Rifat Latifi, MD, FACS, a co-author of this article, reviewed all of the data and images from a remote location and made the decision whether to operate and what type of operation was required. On the day the surgical team arrived at the site, the operating surgeon examined each patient in person preoperatively and made the final decision regarding whether to proceed with the operation. Any changes in the originally uploaded plans were recorded.
The correlation rate between SAFT and in-person preoperative evaluations was 98 percent. Only two operations preliminarily arranged based on the SAFT evaluations were canceled after an in-person on-site consult, both due to a lack of indication for surgery. Overall, preoperative telemedicine evaluation decreased the on-site screening time significantly over what it would have been, as compared with previous missions.
Several studies have shown that telemedicine is a safe and reliable method for evaluating surgical patients preoperatively and postoperatively.5-11 However, the infrastructure for using low-cost telemedicine technologies has yet to become ubiquitous worldwide.12 Most studies have used one of the two main techniques: SAFT or live teleconsultation. For the most part, live telemedicine consultation requires advanced infrastructure and technology, but low bandwidth telemedicine for intraoperative consultations in the jungles of Ecuador has been reported.9,12 Subsequently, Merrell and colleagues in Richmond, VA, used remote screening to evaluate 51 patients in Kenya using e-mails and attachments containing patient data and images. In this study, 33 patients (65 percent) were deemed poor candidates for operative care for various reasons. The rest of the patients underwent successful surgical procedures.10 Although a large number of patients were considered non-candidates for surgical services, the real number of patients that typically are disqualified from receiving care on surgical missions has never been reported.
Like many other reports, this study demonstrated that the use of SAFT immediately before such missions is safe and reliable. We were unable to render an opinion in advance of our surgical mission via SAFT only for a small number of patients. Additional information that was unobtainable remotely (for example, from maneuvers during in-person physical examinations) was required. The development of standardized SAFT techniques for surgical mission and additional live telemedicine consultation protocols may be a solution to this problem. Some studies have established guidelines for capturing radiologic images for telemedicine patients.13,14
Low-cost telemedicine is a viable and secure tool for preoperative evaluation of surgical mission patients. It increases efficiency and optimizes the use of existing resources. More specifically, it helps ensure an accurate assessment of patients before the surgical team arrives, reduces on-site prescreening time, and decreases the number of surgical candidates on the waiting list. Routine use of telemedicine in surgical missions most likely would reduce preoperative times and the number of operations canceled at the last minute. Moreover, it may be effectively used for long-term follow-up care, including the management of any postoperative complications.
In the OR corridor sit our large white plastic crates with all the contents of a modern OR inside. What happens next is part magic and part military mission as the OR nurses, anesthesiologists, and biotechnician take charge of transforming these tile and concrete enclosures into modern ORs. What is immediately evident is the expertise, skill, and dedication demonstrated by a group of true professionals, most of whom who have never met before.
Day 5, Monday, I am up before 6, as the sunrise wakes the avian chorus. I quickly wash, dress, and make a final check of my cheat sheet for bilateral cleft lip markings. I was confident of my cleft experience when I applied for the mission, but suddenly I am now not so sure it is enough. The clefts seemed so wide during screening.
The ward nurses have the most difficult job of the mission. For 15 hours a day they scurry between the tightly packed beds in the heat of the ward, caring for the postoperative patients who are rolled in from the OR in a constant stream.
That evening there is a party with our team and all those who participated in the mission, as well as the local sponsors, the Kenyan medical professionals, the mayor, and the district health officer, the translators, and the students. The mayor thanks the city utilities manager for the outstanding job he has done in keeping the electricity and water flowing (most of the time) to the hospital.
''This is not the first challenge the United States has ever faced. This is not the first war we've ever been in...We will get through this through solid leadership, caring for our troops and keeping focus on the mission.\"
\"We are committed to the health and safety of you and our families...We are the world's finest fighting force and it's because of you. Keep your eye on the mission and take care of yourselves and each other.\"
Our successes are driven by the talent, creativity, and hard work of the people who work for us. We strive to support and protect our staff to grow and thrive within the organization and to enable them to have a major impact in fulfilling our mission.
We do not seek credit for our work and will only take it if it is necessary to fulfill our mission. We do not seek to publicize our work independent of publicity that our government partners or donors want.
We want people to work with us who believe in the mission and whose fulfillment comes from the fact that collectively we succeed in advancing the mission. This ensures our unity of purpose, with all leaders and managers and their staff at all levels working to a common cause.
Two of our previous articles focused on mission and vision statements individually. The mission is focused on the purpose of your organization and your competitive advantage. The vision is focused on how you want your organization to develop in the future. To recap further:
This is one of the more interesting mission versus vision statement examples because it originates from a city department and is more specific than the overarching vision and mission of the city itself. This is not uncommon as it allows larger cities to narrow the focus of mission and visions within specific arenas.
The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA. 153554b96e