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Hand Surgery Outreach—From Short-Term “Missions” to Capacity Building

  • Lauren M. Shapiro
    Correspondence
    Corresponding author: Lauren M. Shapiro, MD, MS, Department of Orthopaedic Surgery, University of California San Francisco, 1500 Owens St., San Francisco, CA 94158.
    Affiliations
    Department of Orthopaedic Surgery, University of California — San Francisco, San Francisco, CA
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  • Luis Miguel Castro Appiani
    Affiliations
    Department of Orthopaedic Surgery, Hospital Clínica Bíblica, San José, Costa Rica
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  • GrUpo de estudio por extremidad Superior Traumatología y Orthopedico (GUSTO)
    Author Footnotes
    ‡ Gusto Group (Rolando Soto, MD, Department of Orthopaedic Surgery, Hospital del Trauma, Cristhian Castro Artavia, MD, Department of Orthopaedic Surgery, Centro National de Rehabilitatción, Gustavo Chavarria, MD, Department of Plastic Surgery, Centro National de Rehabilitatción, Paula Vindas, MD, Department of Orthopaedic Surgery, Hospital del Trauma, Brenda Romero, MD, Department of Orthopaedic Surgery, Hospital Metropolitano, San Jose, Costa Rica; Robin N. Kamal, MD, MBA, VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA; Juan Diego Díaz Salas, Department of Orthopaedic Surgery, Hospital La Católica, San José, Costa Rica)
  • Author Footnotes
    ‡ Gusto Group (Rolando Soto, MD, Department of Orthopaedic Surgery, Hospital del Trauma, Cristhian Castro Artavia, MD, Department of Orthopaedic Surgery, Centro National de Rehabilitatción, Gustavo Chavarria, MD, Department of Plastic Surgery, Centro National de Rehabilitatción, Paula Vindas, MD, Department of Orthopaedic Surgery, Hospital del Trauma, Brenda Romero, MD, Department of Orthopaedic Surgery, Hospital Metropolitano, San Jose, Costa Rica; Robin N. Kamal, MD, MBA, VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA; Juan Diego Díaz Salas, Department of Orthopaedic Surgery, Hospital La Católica, San José, Costa Rica)
Published:August 29, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.06.024
      Although great advancements have been made in global health over the past decades, progress has not been equivalent across the world. For example, the surgical burden (number of surgical cases per capita) remains highest in low- and middle-income countries (LMICs—a term used by The World Bank to classify countries on the basis of their gross national income), where there are frequently fewer surgeons per capita. Surgical outreach is on the rise, with the United States sponsoring more than 2,000 trips annually to LMICs to help address the mismatch in per capita surgical cases to per capita surgeons. These trips, however, are typically short-term in nature and effect and can have unintended consequences. In contrast, capacity building focuses on bidirectional partnerships to educate and empower individuals and organizations such that their care for the local community is enhanced. Capacity building is a priority of leading organizations (including the World Health Organization) but has often been absent in orthopedic and hand surgery outreach. We detail the evidence supporting the transition from short-term mission-based trips to that of capacity building, what we can learn from other specialties about capacity building, and how we can measure and build capacity to improve health in LMICs using our partnership with Costa Rican hand and upper-extremity surgeons as an example.

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