Guest blog by Consultant Hand & Plastic Surgeon, James Bedford
“Innovation” has become one of the buzzwords of twenty-first century surgical practice, as we seek to improve our practice by deploying emerging technologies, finding creative uses for existing tools, and redesigning familiar pathways and processes. We look forward to using artificial intelligence and big data to improve western surgical practice, but an understanding of the opportunities for innovating in low and middle income countries (LMICs) is also crucial as we strive to deliver safe and effective global surgical missions.
Cheap smartphones and mobile internet access have opened up the web to LMICs. Phenomena such as “free, open-access meducation” encourage peer-to-peer learning, becoming increasingly popular among residents. App developers such as Touch Surgery are investing in content for those with limited access to training facilities, including elements such as virtual residency programmes. Open access titles from the major plastics journals permit sharing of research and knowledge more than ever before through free access and reduced authorship fees to authors in LMICs.
SMS remains a dependable method of communication in sub-Saharan Africa, especially where internet access is limited. The BFIRST Zimbabwe team have been impressed at the utility of SMS in facilitating organisation of a complex surgical camp. However, where internet infrastructure is stronger, WhatsApp provides secure, reliable messaging for groups. New apps specifically designed for clinical messaging such as Forward allow secure sharing of patient information including multimedia. And at the top of the tech tree are new augmented reality apps such as Proximie, where surgeons in austere environments can use tablets or smartphones for support with operative decision making or make plans in clinic for later procedures.
The logistics of surgical camps tend to be more stressful than the surgery, but there is scope for innovation in the operating theatre. Disposable instruments may be attractive, but there are cost, logistic and environmental issues. 3D printing, whilst still in its infancy, could produce durable, effective, lightweight and cheap instruments in the field.
Our surgical teams are as essential as surgical instruments, and the introduction of human factors training to established teams, such as NonTechnical Skills for Surgeons, could increase safety for patients in austere environments. Deliberate practice using simple, affordable simulation models provides experiential learning to LMIC trainees while reducing risk to patients.
While there is great potential for innovation, our host countries generally have smaller health budgets than the UK, and consequently resources are limited. Cutting-edge technology may have a role, but it is incumbent on us to foster innovation compatible with the resources available, and avoid seeing technology as a way to solve all problems. Due diligence about what infrastructure exists is an essential part of pre-visit preparations. Some hosts with well developed, consistent setups may welcome the addition of advanced tools for longer term mentorship, such as Proximie augmented reality, collaborative messaging and 3D printing. Others may benefit from less technologically advanced but equally impactful interventions, such as non-technical skills, or simple simulation models.