Community for Global Health Equity Seed Funding Awardee

Improving Population Health through Pediatric Surgery Capacity-Building in the Eastern Democratic Republic of Congo

Comforting the injured in Haiti Earthquake_Adriana Zehbrauskas-Polaris_2010_photos-savethechildrenusa-4321944919_Unmodified

Comforting the injured in Haiti Earthquake, Adriana Zehbrauskas-Polaris, 2010, Unmodified

The 2015 Lancet Commission on Global Surgery’s seminal work on surgical care in resource-poor settings identified several key themes related to surgical care in low- and middle-income countries. However, this report did not directly address deficits in pediatric surgical care. In many low- and middle-income countries, patients less than 15 years old comprise nearly 50% of the population, therefore, addressing the pediatric population is essential (Ozgediz et alToobaie et alBickler et al).

Among the themes related to surgical care in low- and middle-income countries, the Lancet Commission on Global Surgery found that: a) nearly three-quarters of the earth’s population (or 5 billion persons) has no easy access to basic surgical care; b) major obstacles to obtaining surgical care lie not only in a lack of surgical providers and healthcare systems, but also the crippling out-of-pocket costs of seeking care (travel and lost wages) and paying for medical services (direct healthcare costs); and c) investment in safe delivery of surgical and anesthesia services as a cost-effective means toward improving health and reducing healthcare inequalities worldwide.

Because many low- and middle-income countries have high proportion of the population less than 15 years old, our project seeks to address pediatric surgical needs that are not currently being met. Improving pediatric surgical health care delivery and reducing inequalities in low- and middle-income country settings necessitates a multifaceted approach. This project focuses on leveraging the expertise of a wide range of UB faculty to provide both theoretical and hands-on assistance in improving health care in the eastern Democratic Republic of Congo, one of the world’s least-developed and poorest countries, and one with a large pediatric population with unmet surgical needs.

This project will address the gross disparity in access to pediatric surgical services through a traditional Plan, Do, Study, Act (PDSA) approach. The first part of the project will involve a global needs assessment to enhance the teams’ knowledge of available medical resources as well as geographic or other barriers in accessing care.  The second part of the project will work towards centralization of care such that the highest quality care and resources are made accessible to the largest number of people.  The third part of the study will focus on building local, sustainable capacity to address the pediatric surgical needs in the DRC through education and collaboration.

Some additional research questions this team is considering

  • Can comprehensive educational campaigns and strengthened centralized referral patterns reduce infant mortality due to congenital anomalies in the low-income country setting?
  • How do task-shifting and task-sharing models of improving care of newborns with surgically correctable congenital anomalies compare to surgical camp models with respect to local acceptance, cost-effectiveness and long-term functional outcomes?
  • Can external, United States-based team- based mentorship, including remote and on-site coaching and guided practice, with a low-income country surgical system lead to increased autonomy, workforce development, and improved patient outcomes?

Publications

Kalisya LM, Bake JF, Bigabwa R, Rothstein DH, Cairo SB. Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo. World J Surg. 2017 Dec 31. doi:10.1007/s00268-017-4452-2. [Epub ahead of print] PubMed PMID: 29290072.

Cairo SB, Agyei J, Nyavandu K, Rothstein DH, Kalisya LM. Neurosurgical management of hydrocephalus by a general surgeon in an extremely low resource setting: initial experience in North Kivu province of Eastern Democratic Republic of Congo. Pediatr Surg Int. 2018 Feb 16. doi: 10.1007/s00383-018-4238-0. [Epub ahead of print] PubMed PMID: 29453580.

Cairo SB, Kalisya LM, Bigabwa R, Rothstein DH. Characterizing pediatric surgical capacity in the Eastern Democratic Republic of Congo: results of a pilot study. Pediatr Surg Int. 2017 Nov 20. doi: 10.1007/s00383-017-4215-z. [Epub ahead of print] PubMed PMID: 29159423.

Our Team

The team includes a wide variety of individuals with experience both in surgical outcomes research methodology, the practice of global medicine, and knowledge in Congo-specific medical and surgical infrastructure. The particular strengths of the assembled team lie in its ability to integrate the problems of access to pediatric surgical care on the global scale and the minute scale, both in an academic and practical sense. In addition, it is well poised to strengthen affiliations at the local level (engaging with Buffalo’s Congolese Diaspora and working in a provincial eastern Congolese hospital) and at the national level (through SUNY Buffalo contacts and with the Congolese Ministry of Health).

David H. Rothstein

David H. Rothstein

Associate Professor

Department of Surgery

219 Bryant St

Phone: 718-878-7301

Email: davidrot@buffalo.edu

Noyes

Ekaterina (Katia) Noyes

Director, MPH Concentration in Health Services Administration; Professor and Director, Division of Health Services Policy and Practice

Epidemiology and Environmental Health

270C Farber Hall

Phone: 716-829-5386

Email: enoyes@buffalo.edu

Myron Glick

Myron Glick

Founder and Chief Medical Officer

Jericho Road Community Health Center

Enki Yoo

Enki Yoo

Associate Professor

Department of Geography

121 Wilkeson Quad

Phone: 716-645-0476

Email: eunhye@buffalo.edu

Sara Berkelhamer

Sara Berkelhamer

Clinical Associate Professor

Department of Pediatrics

219 Bryant Street

Phone: 716-878-7673

Email: saraberk@buffalo.edu

Sarah Cairo

Sarah B Cairo, MD, MPH

Research Fellow

Pediatric Surgery

Elizabeth Borngraber

Elizabeth Borngraber

Clinical Research Coordinator

Surgery

HEAL Africa

This organization is the best-resourced medical non-governmental organization in Goma (provincial capital of North Kivu), and most likely in all of North and South Kivu. They have an active operating theater with frequent expatriate visitors as well as a comprehensive operating team that performs some pediatric surgery. One of their medical staff is engaged in community-based research and would be our contact person for performing infrastructure surveys in the field, including neighboring eastern Congolese provinces.

Provincial Hospital of North Kivu

Equivalent of a U.S. county hospital, and serves as the referral center for patients from the rest of the province (estimated population, 5.8 million, 2010).

Provincial Hospital of South Kivu

Equivalent of a U.S. county hospital, and serves as the referral center for patients from the rest of the province (estimated population, 5.7 million, 2015).