Originally published in BMC Research Notes on: 21 February 2018
David E. Rapp 1,4*, Andrew Colhoun 2,3, Jacqueline Morin2 and Timothy J. Bradford3,4
Surgical disease represents a significant problem in low- and middle-income countries (LMIC). Estimates suggest that 11% of disease worldwide is surgically treatable . However, the poorest third of the global population receives only 3.5% of its surgical care . International health initiatives have more recently been developed to address this need, including the World Health Organization (WHO) Global Initiative for Emergency and Essential Surgical Care .
Numerous international organizations have been created in an attempt to improve and deliver surgical care to the developing world and commonly deliver care through periodic surgical trips to countries in need. A notable challenge associated with this model is achieving longitudinal follow-up of patients after surgery. Following cleft lip and palate surgical trips, Foong et al. reported a 1-week follow-up rate of 60%, which decreased to 28% by 1-year follow-up . Similar difficulties related to poor follow-up compliance after surgical trips are reported by other authors [5, 6].
Much of this difficulty centers around the nature of visiting surgical mission, whereby surgical teams perform a high volume of surgical cases over a short period of time. The problems associated with this fragmented model are well documented and include lack of involvement of local physicians and limited access to local health care practitioners with appropriate expertise, which often results in deficient long-term follow-up . Given inadequate follow-up, visiting teams are prone to overestimate positive impact and underestimate adverse events associated with their surgeries .
Accordingly, research has focused on initiatives to improve follow-up using incentives as well as communication techniques. Travel subsidies, block appointments, and telephone reminders have all been shown to improve rates of follow-up after surgery [9–11]. More recently, mobile phone initiatives have been used to improve follow-up after surgery in developing countries .
Giving to Extremes Medical Missions (GTEMM) is a non-proft, tax-exempt charitable organization that sends surgical teams to countries lacking sufficient access to surgical care. The present report focuses on GTEMM efforts in Belize. Prior to the present study period, follow-up after surgical trips was conducted exclusively by local physicians in Belize City. However, given the common presentation of patients from distant locations through-out the country, post-operative follow-up was often poor.
In an attempt to better understand methods of communication and optimize post-operative follow-up, we conducted a 2-part prospective investigation as part of visiting surgical trips to Belize. First, we aim to identify communication modalities available to patients in Belize to optimize post-operative follow-up. The second portion of our investigation used this data to test a pilot program for post-operative surgical follow-up using telephone interviews. (continues)