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The two pillars of a BFIRST project are that the direction is led by a local partner, usually a surgeon, and that the aim of the project is to empower and train the local multidisciplinary team.

 

As an organisation we suggest the following standards in order to implement the work in keeping with the above ethos:

 

  • Everything should be done in such a way that it empowers the local surgeons to develop a well respected service. In the past visiting teams have been revered to an extent that hampers the development of the local service and patients then choose to be operated on by visitors. Every effort should be made to work in such a way as to overturn this unhelpful perspective. This will only be achieved when visiting surgeons adhere to the following principals:

 

  • The visiting team may donate equipment, but they should not take equipment for their own sole use that is then not left for the National Surgeons to use. This creates a differential in what is possible for the visiting team compared to the local team, putting the local team at a disadvantage when they attempt to implement what they have been taught.

 

  • Where possible the visiting team should integrate with the local team rather than being a separate entity so that their presence augments the local team rather than replacing it

 

  • The main objective of the visit is to teach local surgeons and therefore the local surgeons should receive an element of training from the decision making pre-operatively and during every operation that is carried out.

 

  • No visiting trainees should take on roles that would displace local surgeons from having the opportunity to train

 

  • There should be no additional benefit to the patient of having their surgery done by the visiting surgeon. For example, any fees should be the same when the visiting team is present as when they are not. No action should be taken that gives the patient a different form of documentation that might become a trophy showing that they were done by the visiting team as this sets up the visiting team as superior to the local team.

 

  • Economy of visits: The economic impact of a visiting team should be assessed. If the visits place a financial burden on the hospital, i.e., cancellation of lists for other specialties, additional overtime for staff with lunches, refreshments etc, then these must be considered and discussed. Additional funding may be needed to support the projects. As far as possible, these issues need to be identified in advance by the scoping team.

 

  • The visiting team should not undertake work that is outside of their standard practice in the UK unless they have undertaken specific training for it and remain up to date with it by doing sufficient cases and participating in CPD.

 

  • All work carried out as part of BFIRST should be included in the scope of work that the surgeon declares in their annual appraisal.

 

  • The Project should be in partnership with a local provider
    • The direction of the project should be guided by the local partner

 

  • The visiting team should make reasonable efforts to ensure cultural understanding, e.g. as a minimum they should read the cultural introduction for that country in a well reputed travel guide

 

  • The project needs to consider the impact on local productivity and engage in local procurement before turning to foreign donors to supply their needs. The supplies used and any supply chains set up by the visiting team should facilitate the development of a sustainable local infrastructure wherever possible. For example;

 

  • If there are appropriate local resources these should be used in preference to foreign donated resources, e.g. filtered water for washing wounds, organic local honey, locally made theatre scrubs

 

  • Where there are acceptable local re-usable options are available these should be used in preference to disposables, e.g. surgical hats

 

  • The visiting team should act within the law of the country they are visiting.
    • The local regulatory framework for working as a surgeon should be checked and complied with. No surgeon representing BFIRST or partnered with BFIRST should operate without complying with these regulations even if it restricts the role that they are able to take on a visit.

 

  • The wider framework for healthcare and training in the host country should be taken into account
    • Where possible, local or national governmental support should be sought. Governmental support, if engaged at an early stage, provides recognition for the work done by the local surgeons, an awareness of their needs and may also facilitate future financial support for equipment and staffing. All of these are important for building sustainability and capacity.

 

  • BFIRST endorses the standards set out by ICOPLAST, in particular where informed consent is concerned;
    • This should be in accordance with the standards set by ICOPLAST. In addition, the forms must be clear if photographic consent is needed and what the images would be used for.