Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project

ABSTRACT

In response to the 2010 earthquake and subsequent cholera epidemic, St Luke’s Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke’s become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the ‘delay framework’ to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.

KEYWORDS:

• Surgical procedures
• Haiti
• medical missions
• general anesthesia
• global surgical training

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

This work would not have been possible without the efforts in practice, staffing, training, implementation and editing from the SSRI-Haiti Project Group Contributors*: Fr. Enzo Del Brocco CP, Fr Hugo Esparza-Perez CP, Ogedad Pierre MD-HSL, Ersnt-Max Julmiste MD-HSL, Julie Colquist, Rosaline Paul, Wynn Walent, James Corcoran, Margaret Blaise, Patricia Rowland, Richard T McGlaughlin, Joseph Lake, Ali Sualeh, Jack Langford, Mahmoud Al-Fadhl, Anthony Thomas, Michael Aboukhaled, Nuha Zackariya, Hamid Al-Fadhl, Samuel Thomas, Shivani Patel, Eric Chang, Sufyan Zackariya, Rich Preuss, Maximilian McCoy, Madhura Sundararajan, Chloe Sherry, Sarah Philbin, Luke Nelligan, Michael Son, Daniel Hake, Timothy Noveroske, William Stonehill, Madelyn Lee, Douglas Gibson, Jacob Downs, Hillary Barrett, Erin Hurd, Sarah Greve, Cheney McWilliams, Richard Ward, Benoit Herbert, Kristin Huynh, Monica Niemec, Louis Cavadini, William Hurd, Faisal Salim Shariff, Phillip Marsh, Arthur Toth, Mark Thompson, Lyle Bontrager, Alan Barton, Lawrence Thompson, Richard Whitman, Joseph Marino, James Norman, John Mulligan, Sean Mulligan, Nico Mulligan, Anne Newbold, Philip Hurley, John Doherty, Jr., Nicole Schirilla, Michael Mazowiecki, Kim Beck, Donald Troyer, David Zimmer, Conan Conaboy, Elizabeth Kohler, Ryan Day, Damon Simpson, Scott Cheney, Kile Rose, Tracy Landreth, Janete Wulsin, Hollie Thornton, Nichole Herr, Shannon Olwine, Hannelisa Callisen, Zena Lind, John Wilson, Shane Kappler, Lucio Cervantes, James Lantry, Tom Green, Lia Losonczy, Alfred Papli, Peter Daly, John Lovejoy, Robert Stanton, Beth Preuss, Emil T. Hofman (RIP), Russell Farrell, Patrick Davis, Thomas Strait, David Fairchild, Scott Thomas, Anna Boll, AnnMarie Phelan-Thomas, Connor Bunch, Mark Fox. The authors wish to thank the clinical administrative staff at St Luke’s Hospital, Port-au-Prince Haiti for their invaluable support of this project as well as the Research and Education consortium for Acute Care in Haiti (REACH) which is a Haitian-led group of physicians and nurses consisting of a multinational group of clinicians, educators and researchers from Haiti, Canada and the United States of America. We also thank Matthew R. Walsh PhD for editorial assistance.

Author contributions

MA, AC, NC, RF, MTM, BP, RS, QT, MW, DZ, conceptualised the program, participated throughout program design, supported field data planning, training, and management, data collection, and interpretation. MTM, BP, RS, MW, DZ, drafted the initial version of the manuscript. QA, MM, MTM, BP, QT, MW, DZ performed data collection and conducted final data analysis. All authors participated in revising and editing of iterations of the manuscript and contributed to the final manuscript review, revision and approval of the submitted manuscript. All authors have been provided the opportunity to revise and critically review the manuscript, and each accepts accountability for the accuracy or integrity of any part thereof.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Special attention was taken to deliver surgical care in accordance with the U.S. standards of care for all patients. This included established best practices, Health Insurance Portability and Accountability Act (HIPAA) protections for all patients and informed consent.

Paper context

Developing sustainable surgery centres in LMIC environments is crucial to the improvement of global health. Here we report the conception, staffing, training, procedures, data collection and follow-up for a sustainable surgery centre in Haiti and discuss the methods and results within the prevailing paradigm of global healthcare, the Delay Framework. We stress the relationship-based approach between local and foreign staff, noting the importance of prioritisation in resource allocation to ensure sustained local capability.

Additional information

Funding

The authors reported that there is no funding associated with the work featured in this article.