Letters COMMENT & RESPONSE
Surgical Missions: A View From Yet Another Side To the Editor We commend Ginwalla and Rickard on their recent publication “Surgical Missions: The View From the Other Side”1 in JAMA Surgery. At Operation Smile, we wholeheartedly support and agree with the comments put forward by the authors regarding the duty of mission-based organizations to implement programs that are not only effective but also conducted responsibly. The 2 vital components of implementing the mission model responsibly are integrating practices within the local health system, as highlighted by Ginwalla and Rickard,1 and emphasizing quality. Although elements of safety and effectiveness have been addressed extensively in the literature, patient centeredness has been notably absent in the global surgery discourse.2,3 Since its conception in the early 1980s, Operation Smile has grown into a truly global organization. Over this time, we have learned to listen to our patients and acknowledge the complex environments in which they live. From this, we have come to understand that increasing local capacity and access to health care only truly matters if it is congruent with and responsive to the needs of patients and, furthermore, delivered in a manner consistent with their needs, culture, and individual constraints.3 A commitment to providing patient-centered care ensures that service delivery is acceptable and equitable, and addresses barriers that so often leave those with facial deformities marginalized and without recourse.4 Value systems differ substantially across the settings in which we work, and further research is necessary to evaluate the demand side of the care delivery equation in order to refine and hone approaches to surgical care delivery in these areas. While it is imperative that mission-based activities are integrated into the loc al health system and that we
collaborate effectively with our local surgery, anesthesia, and nursing colleagues, it is also important to listen to the patient perspective. Our patients come from a wide range of cultures, socioeconomic backgrounds, and formative experiences, and one, whether from the same country or abroad, cannot presume to comprehend the complexities of their lives. Instead, we must cultivate opportunities to listen to patients and to more effectively incorporate their perspectives into approaches to surgical care delivery. Although further action is certainly necessary to build local infrastructure and strengthen surgical systems, to foster care that is truly local, we must not forget that the patient’s voice is vital to the conversation. Richard Vander Burg, RN, BSN Charles Kabetu, MD Ruben Ayala, MD Author Affiliations: Operation Smile, Virginia Beach, Virginia (Vander Burg, Ayala); Department of Anesthesiology, Kenyatta National Hospital, Kenya (Kabetu). Corresponding Author: Ruben Ayala, MD, Operation Smile, 3641 Faculty Blvd, Virginia Beach, VA 23453 ([email protected]). Published Online: May 20, 2015. doi:10.1001/jamasurg.2015.0744. Conflict of Interest Disclosures: None reported. 1. Ginwalla R, Rickard J. Surgical missions: the view from the other side. JAMA Surg. 2015;150(4):289-290. 2. Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AA; Safe Surgery Saves Lives Investigators and Study Group. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg. 2010;251(5):976-980. 3. Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT; DCP3 Essential Surgery Author Group. Essential surgery: key messages from Disease Control Priorities, 3rd edition [published online February 4, 2015]. Lancet. doi:10.1016/S0140-6736(15)60091-5. 4. Sharp HM, Canady JW, Ligot FAC, Hague RA, Gutierrez J, Gutierrez J. Caregiver and patient reported outcomes after repair of cleft lip and/or palate in the Philippines. Cleft Palate Craniofac J. 2008;45(2):163-171.
jamasurgery.com
(Reprinted) JAMA Surgery Published online May 20, 2015
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a University of Georgia User on 06/04/2015
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Surgical Missions: A View From Yet Another Side To the Editor We commend Ginwalla and Rickard on their recent publication “Surgical Missions: The View From the Other Side”1 in JAMA Surgery. At Operation Smile, we wholeheartedly support and agree with the comments put forward by the authors regarding the duty of mission-based organizations to implement programs that are not only effective but also conducted responsibly. The 2 vital components of implementing the mission model responsibly are integrating practices within the local health system, as highlighted by Ginwalla and Rickard,1 and emphasizing quality. Although elements of safety and effectiveness have been addressed extensively in the literature, patient centeredness has been notably absent in the global surgery discourse.2,3 Since its conception in the early 1980s, Operation Smile has grown into a truly global organization. Over this time, we have learned to listen to our patients and acknowledge the complex environments in which they live. From this, we have come to understand that increasing local capacity and access to health care only truly matters if it is congruent with and responsive to the needs of patients and, furthermore, delivered in a manner consistent with their needs, culture, and individual constraints.3 A commitment to providing patient-centered care ensures that service delivery is acceptable and equitable, and addresses barriers that so often leave those with facial deformities marginalized and without recourse.4 Value systems differ substantially across the settings in which we work, and further research is necessary to evaluate the demand side of the care delivery equation in order to refine and hone approaches to surgical care delivery in these areas. While it is imperative that mission-based activities are integrated into the loc al health system and that we
collaborate effectively with our local surgery, anesthesia, and nursing colleagues, it is also important to listen to the patient perspective. Our patients come from a wide range of cultures, socioeconomic backgrounds, and formative experiences, and one, whether from the same country or abroad, cannot presume to comprehend the complexities of their lives. Instead, we must cultivate opportunities to listen to patients and to more effectively incorporate their perspectives into approaches to surgical care delivery. Although further action is certainly necessary to build local infrastructure and strengthen surgical systems, to foster care that is truly local, we must not forget that the patient’s voice is vital to the conversation. Richard Vander Burg, RN, BSN Charles Kabetu, MD Ruben Ayala, MD Author Affiliations: Operation Smile, Virginia Beach, Virginia (Vander Burg, Ayala); Department of Anesthesiology, Kenyatta National Hospital, Kenya (Kabetu). Corresponding Author: Ruben Ayala, MD, Operation Smile, 3641 Faculty Blvd, Virginia Beach, VA 23453 ([email protected]). Published Online: May 20, 2015. doi:10.1001/jamasurg.2015.0744. Conflict of Interest Disclosures: None reported. 1. Ginwalla R, Rickard J. Surgical missions: the view from the other side. JAMA Surg. 2015;150(4):289-290. 2. Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AA; Safe Surgery Saves Lives Investigators and Study Group. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg. 2010;251(5):976-980. 3. Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT; DCP3 Essential Surgery Author Group. Essential surgery: key messages from Disease Control Priorities, 3rd edition [published online February 4, 2015]. Lancet. doi:10.1016/S0140-6736(15)60091-5. 4. Sharp HM, Canady JW, Ligot FAC, Hague RA, Gutierrez J, Gutierrez J. Caregiver and patient reported outcomes after repair of cleft lip and/or palate in the Philippines. Cleft Palate Craniofac J. 2008;45(2):163-171.
jamasurgery.com
(Reprinted) JAMA Surgery Published online May 20, 2015
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a University of Georgia User on 06/04/2015
E1
