Ten out of every 11 children in the world live in low- and middle-income countries, and yet there are very few dedicated paediatric facilities in these countries where children can access the surgical care they need.
There are not nearly enough local surgeons or anaesthetists trained to care for children and sending doctors from overseas to provide short-term care rarely does anything to change that. There are also very few bio-medical engineers that can fix broken equipment or stop it breaking in the first place through a proper maintenance schedule. And yet too many NGOs perpetuate the ‘mission’ model of care or refuse to invest in infrastructure that the local doctors tell us they need. This breeds dependency and hospitals across low- and middle-income countries become too reliant on surgical teams flying in from high-income countries. At the heart of the KidsOR strategy is a steadfast belief that local surgical teams should care for their own nation’s children. That is surely the only sustainable solution. The days of delivering care entirely separate from the local system is disrespectful. It fails to build any local capacity and it drives up dependency. At KidsOR, how we decide our policy and how we proportion future investment is all focused on achieving sustainability. We want to be told we are no longer needed. Our Africa 2030 Action Plan was developed in consultation with ministries of health, surgical colleges and doctors on the front line across our partner countries. We have looked to invest in areas where we can maximise the impact and improve and save as many children’s lives as possible. By 2030 we aim to install 120 dedicated paediatric operating rooms across 37 African countries, and this is expected to allow an estimated 750,000 children to access life-saving or life-changing care that would otherwise not have been available to them. When we have identified a suitable space for children’s surgery and recovery in an area where there currently is none, our installations provide all the machinery and equipment required specifically for children’s surgery. We also design colourful child-friendly wall vinyls specifically for each install to help reassure and distract children during their treatment. These beautiful animals are really popular with children, families and staff and have become our trademark. But the KidsOR model is not just about providing equipment and friendly surroundings. We want to invest in infrastructure and training. Through our scholarship grant system, we are supporting local doctors to become paediatric surgeons. Without financial support, many of the trainees have to take on extra hours to fund their studies – on top of what is already an exhausting working schedule. We want them to be able to concentrate on becoming the best surgeons they can be, and these grants help them to do that. We have also invested in the first pan-African collaborative e-learning programme. Working with COSECSA and WACS – two of Africa’s surgical colleges – and the Royal College of Surgeons in Ireland, we are providing an online training programme that provides paediatric surgical trainees with a range of learning possibilities to complement the clinical training they receive on the wards and in the operating theatres of their own hospitals. I believe the best way to stop children dying from simple surgically preventable conditions is to invest in infrastructure and training. Give the existing, local teams the kit they need to care for their own nation’s children. If there is no local team, then fund the training of one and then give them the tools to do the job. Of course, the local Ministry of Health needs to be involved – they will need to employ these people and provide consumables. But together we can build a new level of care, a new confidence and a new future for countless children. Look around the world right now. During the pandemic, what have developed countries been desperate to get? Critical care infrastructure and every possible person they can to work it. Medical and nursing students graduating early and moved straight into the front line in hospitals across the UK and beyond. Prime Ministers and Presidents appealing to companies to build infrastructure for these people to use. When our health is threatened in the West it seems people and equipment are not a problem. Children die every day in Africa, Latin America and South East Asia because we don’t think their health emergencies deserve the same response. It’s time to end this. Access to surgery should be a basic human right, and we believe in a world where every child has equal access to safe surgery.
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AuthorsArticles are written by Edinburgh-based students and doctors, for the benefit of those interested in surgery. Archives
March 2024
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