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Global
Surgery
How toWork and Teach in Lowand Middle-Income Countries
MarkA.Hardy
BethR.Hochman
Editors
123
Global Surgery
Mark A. Hardy • Beth R. Hochman
Editors
Global Surgery
How toWork andTeach inLowandMiddle-Income Countries
Editors
Mark A. Hardy
General, Vascular & Abdominal
Transplant Surgery
Columbia University Medical Center
New York, NY, USA
Beth R. Hochman
General Surgery & Critical Care
Medicine
Columbia University Medical Center
New York, NY, USA
ISBN 978-3-031-28126-6 ISBN 978-3-031-28127-3 (eBook)
https://doi.org/10.1007/978-3-031-28127-3
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
I dedicate this book to my wife, Ruth, for her support, love, and
https://t.me/medicina_free
understanding, and to my children, Peter, Arthur, and Karen,
and their spouses, and to my grandchildren.
Mark A.Hardy
I dedicate this book to my parents, Marcia and Harry, for their
undying support and their unparalleled empathy and generosity
that inspired my interest in global health.
Beth R.Hochman
Acknowledgments
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We would like to thank:
Richard Lansing (Springer Editorial Director) and Richard Hurska (Springer
Executive Editor) for seeing the potential in our project and accepting this
undertaking on behalf of Springer, and Kristopher Spring (Springer Senior
Editor) for seeing it through.
Dhanapal Palanisamy (Project Coordinator) for so patiently working with
us as we navigated the process of generating and gathering content, and helping us stay organized despite our near constant attempts to embrace entropy.
Shalini Kameshwaran, Sendhilkumar Jayakumar, and Geetha Dhandapani
(Project Managers) for graciously and effectively ushering us to the nish
line.
MarkA.Hardy
BethR.Hochman
vii
Contents
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1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mark A. Hardy and Beth R. Hochman
Part I System Strengthening
2 How to Prepare for Short- or Long- Term Surgical Practice in
Low- and Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . 9
Mark A. Hardy, Brian A. Chang, Richard M. Smiley,
Richard K. Raker, and Beth R. Hochman
3 How to Maintain Ethical Standards of Global Surgery
Practice and Partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Barnabas T. Alayande, Robert R. Riviello, and Abebe Bekele
4 How to Develop Bidirectional Partnerships . . . . . . . . . . . . . . . . . 39
Rondi M. Kauffmann and Carl E. Haisch
5 How to Strengthen Surgical Systems in Low- and
Middle- Income Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Rennie X. Qin, Belain Eyob, Emmanuel Makasa,
and Kee B. Park
6 How to Do Surgical Needs Assessments: Where to Start,
How to Do It, and What to Keep in Mind . . . . . . . . . . . . . . . . . . . 57
Reinou S. Groen, K. Gianaris, and M. Lamine Gueye
7 How to Build Pediatric Neurosurgical Capacity Practice
in Low- and Middle-Income Countries and How to Focus on
Treatment of a Neurosurgical Disease . . . . . . . . . . . . . . . . . . . . . . 73
Marinus Koning, Jan Koning, and Patricia O’Neill
8 How to Train Surgical Subspecialists in Sub-Saharan Africa . . 87
Jeffrey Punch
9 How to Develop a Sustainable Program for Volunteer
Medical Care in Low- and Middle-Income Countries . . . . . . . . . 97
Sidney B. Eisig, Roberto Fajardo, and David Hoffman
10 How to Organize a Colon Cancer Screening Program
in a Low- and Middle-Income Country . . . . . . . . . . . . . . . . . . . . 103
Spencer E. Amory
ix
x
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11 How to Establish and Expand an Intensive Care Unit in a
Low- and Middle-Income Country . . . . . . . . . . . . . . . . . . . . . . . . 109
Emnet Tesfaye Shimber
12 How to Create a Post Anesthesia Care Unit for Recovery
After Surgery and Anesthesia in a Low- and Middle-Income
Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Tricia Brentjens and Rebecca Havlir Martinez
13 How to Establish and Maintain a Functional Operating
Room in a Low-Resource Environment . . . . . . . . . . . . . . . . . . . . 131
Robert Neighbour, Richard Raker, and Richard Smiley
14 How to Establish a Trauma and Disaster Response Service
in Low- and Middle-Income Countries, Including Staff,
Transportation, Testing, Triage, Resuscitation Training,
and Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Emnet Tesfaye Shimber
15 How To Select a Database Software for Surgical Data in
Low- and Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . 149
Henry M. Spotnitz and Matthew E. Spotnitz
Part II Education and Training
Contents
16 How to Establish Surgical Teaching, Guidance, and
Simulation Practices in Low- and Middle-Income Countries . . . 155
Shamir O. Cawich, Paul Shridath Ramphal, Marlon Mencia,
Chris Dodgion, and Alazar Behre
17 How to Teach Technical and Judgment Skills Effectively
from Outside the Operating Room (Including Virtually) . . . . . . 169
Elijah W. Riddle and Carl E. Haisch
18 How to Teach Teamwork and Leadership Skills Effectively
from Outside the Operating Room (Including Virtually) . . . . . . 185
Emad H. Asham, Korin E. Lefer, and Carl E. Haisch
19 How to Organize and Provide ICU Care in Low- and
Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Ananya Abate Shiferaw, Deborah A. Haisch,
Dawit Kebede Huluka, and David H. Chong
20 How to Use Surgical Ultrasound in Resource-Limited
Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Beth A. Schrope, Christopher Cassim, Shamir O. Cawich,
Ayemoethu Ma, Catherine McManus, Robbie A. Rampersad,
and Roshni Rao
21 How to Build an Academic Global Surgery Center:
The UCSF CHESA Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Ava Yap, Patti Orozco, Zayna Tommalieh, David Bayne,
Phyllis Kisa, Luggya Tonny Stone, Alex Emmanuel Elobu,
Naomi Kebba, and Marissa A. Boeck
Contents
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22 How to Build Research in Low- and Middle-Income
Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Theresa Chin and Nia Zalamea
Part III General Surgery: Organ-Focused Selected Interventions
23 How to Manage Urgent Neurosurgical Problems in
Low- and Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . 257
Ernest J. Barthélemy, Tsegazaeb Laeke, and Kee B. Park
24 How to Manage Urgent Problems in the Neck: Foreign
Bodies in the Trachea and in the Esophagus in Children
and Adults and Other Surgical Problems in Low- and
Middle-Income Countries
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Philip Vareed Alexander
25 How to Manage Thoracic Surgical Problems in Low- and
Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Warren D. Widmann
26 How to Manage Conditions of the Stomach in Low- and
Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Philip Vareed Alexander and Myla Jacob
xi
27 How to Diagnose and Manage Acute Abdomen and
Intra-Abdominal Infections in Low- and Middle-Income
Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Mark A. Hardy and Christine Yang
28 How to Diagnose and Manage Anorectal Disorders in
Low- and Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . 339
Connie Hong-Hung Keung
29 How to Manage Hernias in Limited-Resource Settings . . . . . . . 353
Imad Aljabban and Zachary Gleit
30 How to Diagnose and Treat Benign and Malignant Diseases
of the Breast in Low- and Middle-Income Countries . . . . . . . . . 361
Soji F. Oluwole and Olakunle O. Oluwole
31 How to Provide Acute Burn Care in Low- and
Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Cameron Gibson, Meghan Hoyle, and James Gallagher
32 How to Surgically Reconstruct Acute and Chronic Burn
Wounds in Low- and Middle-Income Countries . . . . . . . . . . . . . 395
Einar Eriksen
33 How to Manage Soft Tissue Infections and Injuries in
Low- and Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . 435
Shailvi Gupta and Jaclyn Clark
xii
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34 How to Approach NOMA and Facial Infections, Trauma,
and Tumours Through Charity Missions: The Origins
of Facing Africa and Lessons Learned . . . . . . . . . . . . . . . . . . . . . 441
Chris Lawrence and Terry Lawrence
35 How to Approach NOMA and Facial Infections,
Trauma and Tumours Through Charity Missions:
Facing Africa Non-operating Mission . . . . . . . . . . . . . . . . . . . . . . 449
Hiroshi Nishikawa
36 How to Approach Noma and Facial Infections,
Trauma and Tumours Through Charity Missions:
Ethics of Surgical Charity for Complex Patients . . . . . . . . . . . . . 455
Hiroshi Nishikawa
37 How to Approach Noma and Facial Infections,
Trauma and Tumours Through Charity Missions:
Noma – A Neglected Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Alexander J. Rickart and Graham Merrick
38 How to Approach Noma and Facial Infections, Trauma,
and Tumours Through Charity Missions: The Management
of Trismus and Ankylosis in Noma . . . . . . . . . . . . . . . . . . . . . . . . 465
Will Rodgers and David Dunaway
Contents
39 How to Approach Noma and Facial Infections,
Trauma, and Tumours Through Charity Missions:
Anaesthesia Considerations in Noma . . . . . . . . . . . . . . . . . . . . . . 471
Peter Lee and Patrick Seigne
40 How to Approach NOMA and Facial Infections,
Trauma and Tumours Through Charity Missions:
Wound Management and Nursing. . . . . . . . . . . . . . . . . . . . . . . . . 475
Pat McCluskey
41 How to Manage Vascular Trauma and Emergencies
in Low- and Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . 481
Adam Lee Goldstein, Jacob R. Krimbill, Alberto Saltiel,
and Mark A. Hardy
42 How to Manage Common Pediatric Surgical Conditions:
Infant Emergencies, Hernias, Congenital Malformations in
Low- and Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . 503
Rie Seu and Vincent Duron
43 How to Manage Common Orthopedic Injuries in
Low- and Middle-Income Countries . . . . . . . . . . . . . . . . . . . . . . . 525
Katherine A. Rosenwasser, Nicholas C. Danford,
and Joshua E. Hyman
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