RESUMO
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.
Assuntos
Hospitais , Região de Recursos Limitados , Centros Cirúrgicos , Humanos , Haiti , Centros Cirúrgicos/organização & administraçãoRESUMO
Outcomes of landscape scale restoration and conservation can be maximized when planning is based upon quantitative and decision-relevant information. Existing tools to support data-driven planning are hindered by regionally inconsistent information and a need for advanced methods to analyze data of varying spatial resolution and coverage. We present a synthesis methodology for region-wide derived metrics to characterize natural resource value, ecosystem stress, and social vulnerability to inform implementation of conservation and restoration projects. Our three-part methodology was developed and tested for the Gulf of Mexico in support of the Southeast Conservation Blueprint that was created to advance the Southeast Conservation and Adaptation Strategy. The first step included integration of prioritized natural resource metrics alongside socio-ecological metrics to create a data layer of synthesized natural resource priority across the northern Gulf of Mexico. The second component was calculation of ecosystem stress indices based on ecologically relevant thresholds and a cumulative ecosystem stress layer, in addition to analyzing correlations between individual stressors and their relative importance. The final component was development of a social vulnerability (SoVI) index. Analysis of these metrics illustrate their ability to effectively capture variability at multiple scales in the Gulf of Mexico, including expected spatial correlation of stressors such as road density and non-point source pollution in populated areas and the dominance of sea-level rise as a future stressor along the coast. Significant composite components of social vulnerability for the northern Gulf of Mexico region were identified and include economic status, professional workforce, elderly population, population stability, migrant workforce, and rural population. To demonstrate the utility of the data synthesis approach, we used the developed data layers to evaluate proposed marsh creation projects in southern Louisiana. The synthesized data layers were capable of distinguishing differences at the scale of individual habitat restoration projects, and high-value projects could be aligned with the goals of key funding streams. This pilot application illustrates how restoration programs could use the methodology developed here to maximize benefits from conservation and restoration actions along the northern Gulf of Mexico or other regions globally.